本文選題：Spectralis　切入點(diǎn)：OCT　出處：《西安醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:運(yùn)用頻域光學(xué)相干斷層掃描儀(Spectralis optical coherence tomography,Spectralis OCT)測(cè)量正常組及早期原發(fā)性閉角型青光眼組視乳頭周圍視網(wǎng)膜神經(jīng)纖維層(circumpapillary retinal never fiber layer,cp RNFL)厚度、黃斑區(qū)全視網(wǎng)膜厚度(MR)、黃斑區(qū)神經(jīng)節(jié)細(xì)胞復(fù)合體(macular ganglion cell complex,m GCC)厚度、黃斑區(qū)神經(jīng)纖維層(macular retinal nerve fiber layer,m RNFL)厚度、黃斑區(qū)神經(jīng)節(jié)細(xì)胞層(macular ganglion cell layer,m GCL)厚度、黃斑區(qū)內(nèi)叢狀層(macular inner plexiform layer,ml PL)厚度、黃斑區(qū)神經(jīng)節(jié)細(xì)胞層+內(nèi)叢狀層(即m GCL+IPL)厚度和神經(jīng)節(jié)細(xì)胞復(fù)合體的厚度與全視網(wǎng)膜厚度的比值(ganglion cell complex thickness to total retinal thickness ratio,G/T),對(duì)比兩組間cp RNFL、MR、m GCC、m RNFL、m GCL、ml PL、m GCL+IPL厚度及G/T比值差異,進(jìn)而分析cp RNFL厚度與黃斑區(qū)各個(gè)參數(shù)在早期原發(fā)性閉角型青光眼中所具有的診斷意義。方法:臨床橫斷面研究。經(jīng)過匯總2016年07月到2016年12月期間來我院眼科就診的患者、體檢人員和本院所屬職工相關(guān)病史資料,并嚴(yán)格按照篩選標(biāo)準(zhǔn),最終確定受試研究對(duì)象29例(50眼),將其分為2組:正常組20例(39眼),早期原發(fā)性閉角型青光眼組9例(11眼);所有受試研究對(duì)象統(tǒng)一接受全面的眼科檢查,具體包括視力或最佳矯正視力(best corrected visual acuity,BCVA)、電腦驗(yàn)光、眼壓測(cè)量、裂隙燈檢查、超聲生物顯微鏡檢查房角、眼前節(jié)三維分析測(cè)量角膜厚度、自動(dòng)視野檢查以及Spectralis OCT等檢查。Spectralis OCT檢查所有研究對(duì)象時(shí),選擇青光眼(Glaucoma)模式下的視乳頭周圍視網(wǎng)膜視神經(jīng)纖維(RNFL)掃描和黃斑部多層掃描。運(yùn)用統(tǒng)計(jì)學(xué)方法對(duì)比兩組間每項(xiàng)參數(shù)的差異;同時(shí)利用受試者工作特征曲線下面積(area under the receiver operating characteristic,AROC)分析以上每項(xiàng)參數(shù)在早期原發(fā)性閉角型青光眼中的診斷價(jià)值。結(jié)果:兩組間一般情況比較:正常組20例(39眼),其中男9例(18眼),女11例(21眼),年齡23~52(38.7±10.9)歲;早期原發(fā)性閉角型青光眼組9例(11眼),其中男3例(5眼),女6例(6眼),年齡41~76(55.8±10.2)歲;在性別和年齡構(gòu)成比上兩組間的差異并無統(tǒng)計(jì)學(xué)意義(P0.05);而MD對(duì)比差異則具有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)比兩組間的cp RNFL厚度變化,結(jié)果顯示:鼻下cp RNFL厚度差異具有統(tǒng)計(jì)學(xué)意義(P0.05);而顳側(cè)、顳上、顳下、鼻側(cè)、鼻上的cp RNFL厚度比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)比兩組間的MR厚度變化,結(jié)果顯示:外環(huán)顳側(cè)MR厚度在這兩組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),而其余各象限的MR厚度在這兩組間對(duì)比差異均無統(tǒng)計(jì)學(xué)意義(P:0.759、0.787、0.864、0.435、0.774、0.679、0.550均0.05);對(duì)比兩組間m RNFL厚度變化,結(jié)果顯示:內(nèi)環(huán)上方m RNFL厚度在兩組間的差異有統(tǒng)計(jì)學(xué)意義(P0.05);而其余各象限如:內(nèi)環(huán)顳側(cè)、顳下、鼻側(cè)及外環(huán)顳側(cè)、顳下、鼻側(cè)、鼻上的m RNFL厚度在兩組之間差異均無統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)比兩組間m GCL厚度變化,結(jié)果顯示:內(nèi)環(huán)鼻側(cè)、及外環(huán)顳側(cè)、鼻側(cè)的m GCL厚度在兩組間差異均有統(tǒng)計(jì)學(xué)意義(P0.05);而內(nèi)環(huán)顳側(cè)、下方及外環(huán)上方、下方m GCL厚度在兩組之間的差異均無統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)比兩組間m IPL厚度變化,結(jié)果顯示:內(nèi)環(huán)鼻側(cè)、上方及外環(huán)下方的m IPL厚度在兩組之間差異均有統(tǒng)計(jì)學(xué)意義(P0.05);而內(nèi)環(huán)顳側(cè)、下方及外環(huán)顳側(cè)上方、鼻部側(cè)面的m IPL厚度在兩組之間的差異無統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)比兩組間m GCC厚度變化,結(jié)果發(fā)現(xiàn):內(nèi)環(huán)鼻側(cè)、顳側(cè)m GCC厚度在兩組間的差異有統(tǒng)計(jì)學(xué)意義(P≤0.05);而其余各象限:內(nèi)環(huán)上方、下方及外環(huán)上方、顳側(cè)、下方、鼻側(cè)m GCC厚度在兩組之間差異均無統(tǒng)計(jì)學(xué)(P0.05);對(duì)比兩組間m GCL+IPL厚度變化,結(jié)果發(fā)現(xiàn):內(nèi)環(huán)上方、鼻側(cè)及外環(huán)下方m GCL+IPL厚度在兩組之間的差異有統(tǒng)計(jì)學(xué)意義(P0.05);而內(nèi)環(huán)顳側(cè)、鼻側(cè)及外環(huán)上方、顳側(cè)、鼻側(cè)m GCL+IPL厚度在兩組之間的差異均無統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)比兩組間G/T比值的差異,結(jié)果顯示:正常人的G/T比值在內(nèi)環(huán)上方、顳側(cè)、下方、鼻側(cè)及外環(huán)上方、顳側(cè)、下方、鼻側(cè)分別為34.2±1.9%、32.6±1.2%、36.4±3.3%、34.0±1.5%、35.4±2.1%、31.6±1.2%、36.4±2.1%、38.4±1.9%;內(nèi)環(huán)上方、顳側(cè)、鼻側(cè)及外環(huán)顳側(cè)G/T比值在兩組間的差異有統(tǒng)計(jì)學(xué)意義(P0.05);內(nèi)環(huán)下方及外環(huán)上方、下方、鼻側(cè)在兩組間的差異均無統(tǒng)計(jì)學(xué)意義(P0.05);區(qū)別兩組間的AROC:除了顳側(cè)cp RNFL厚度的AROC值(0.815)差異有統(tǒng)計(jì)學(xué)意義外(P=0.0020.05),其余各象限cp RNFL的AROC值均無統(tǒng)計(jì)學(xué)意義(P0.05);除了內(nèi)環(huán)上方MR厚度的AROC值(0.731)差異有統(tǒng)計(jì)學(xué)意義外(P=0.0200.05),其余各象限MR的AROC值均無統(tǒng)計(jì)學(xué)意義(P0.05);內(nèi)環(huán)顳側(cè)、下方及鼻側(cè)m RNFL厚度的AROC值在區(qū)別正常組與早期閉角型青光眼組差異無統(tǒng)計(jì)學(xué)意義外(P0.05),其余各象限差異均有統(tǒng)計(jì)學(xué)意義(P0.05);除了內(nèi)環(huán)上方m GCL厚度的AROC值(0.803)差異有統(tǒng)計(jì)學(xué)意義外(P0.05),其余各象限均無統(tǒng)計(jì)學(xué)意義(P0.05);除了內(nèi)環(huán)上方m IPL厚度的AROC值(0.765)差異有統(tǒng)計(jì)學(xué)意義外(P=0.0080.05),其余各象限m IPL的AROC值均無統(tǒng)計(jì)學(xué)意義(P0.05);內(nèi)環(huán)上方m GCL+IPL厚度AROC值(0.797)差異有統(tǒng)計(jì)學(xué)意義(P=0.0030.05),其余各象限m GCL+IPL厚度AROC值均無統(tǒng)計(jì)學(xué)意義(P0.05);內(nèi)環(huán)上方以及外環(huán)鼻側(cè)m GCC厚度的AROC值分別為0.854、0.741,在區(qū)別正常組與早期閉角型青光眼組間差異有統(tǒng)計(jì)學(xué)意義(P0.05),其余各象限m GCC厚度AROC值均無統(tǒng)計(jì)學(xué)意義(P0.05);內(nèi)環(huán)上方、顳側(cè)及外環(huán)上方、下方、鼻側(cè)G/T值的AROC值分別為0.869、0.744、0.726、0.734、0.732,在區(qū)別正常組與早期閉角型青光眼組間差異有統(tǒng)計(jì)學(xué)意義(P0.05),其余各象限G/T值的AROC值均無統(tǒng)計(jì)學(xué)意義(P0.05);且內(nèi)環(huán)上方的G/T值的AROC值最高,為0.869,其次為內(nèi)環(huán)上方及外環(huán)上方、顳側(cè)的m RNFL厚度、內(nèi)環(huán)上方的m GCC厚度、顳側(cè)cp RNFL厚度,即就是內(nèi)環(huán)上方G/T值的AROC值內(nèi)環(huán)上方及外環(huán)上方、顳側(cè)的m RNFL厚度的AROC值內(nèi)環(huán)上方的m GCC厚度AROC值顳側(cè)cp RNFL厚度的AROC值。結(jié)論:1.cp RNFL、MR、m RNFL、m GCL、m IPL、m GCL+IPL、m GCC厚度在青光眼患者中均出現(xiàn)局部變薄,G/T比值局部變小;2.G/T值A(chǔ)ROC值明顯高于cp RNFL及m GCC厚度,尤其是內(nèi)環(huán)上方G/T值。
[Abstract]:Objective: using frequency domain optical coherence tomography (Spectralis optical coherence tomography, Spectralis OCT) measurement of the normal group and early primary angle closure glaucoma group of peripapillary retinal nerve fiber layer (circumpapillary retinal never fiber layer, CP RNFL) thickness, retinal macular thickness (MR), macular ganglion cell complex (macular ganglion cell complex, m GCC) thickness and macular retinal nerve fiber layer (macular retinal nerve fiber layer, m RNFL) thickness and macular ganglion cell layer (macular ganglion cell layer, m GCL) macular thickness, inner plexiform layer (macular inner plexiform layer, ML PL) thickness and macular ganglion cell layer and inner plexiform layer (m GCL+IPL) and the ratio of the thickness of the ganglion cell complex and the thickness of retinal thickness (ganglion cell complex thickness to total retinal thic Kness ratio, G/T, CP) were compared between two groups of RNFL, MR, m GCC, m RNFL, m GCL, ML PL, m GCL+IPL and G/T thickness ratio difference, and analysis of diagnostic value of CP RNFL thickness and macular parameters are in the early stage of primary angle closure glaucoma. Methods: the study the clinical cross section. After 07 months to December 2016 2016 during the summary to our hospital for treatment of patients, the medical personnel and staff related history data in our hospital, and in strict accordance with the selection criteria, and ultimately determine the subjects of the study of 29 cases (50 eyes), which can be divided into 2 groups: normal group of 20 cases (39 eye), early primary angle closure glaucoma group 9 cases (11 eyes); all subjects studied the unified acceptance of a comprehensive eye examination including visual acuity and best corrected visual acuity (best corrected visual acuity, BCVA), computer optometry, intraocular pressure, slit lamp examination, examination of ultrasound biomicroscopy angle. Anterior segment Three dimensional analysis of corneal thickness measurement, automatic perimetry, Spectralis OCT.Spectralis OCT check to check all the research object, choice of glaucoma (Glaucoma) under the mode of peripapillary retinal nerve fiber (RNFL) scanning and macular multi scanning. Using the statistical methods of each parameter differences between the two groups; at the same time use the area under the receiver operating characteristic curve (area under the receiver operating characteristic, AROC) analysis of the value of each parameter in the early diagnosis of primary angle closure glaucoma. Results: general comparison between the two groups: the normal group of 20 cases (39 eyes), including male 9 cases (18 eyes). 11 female patients (21 eyes), aged 23~52 (38.7 + 10.9) years; early primary angle closure glaucoma group 9 cases (11 eyes), including male 3 cases (5 eyes), female 6 cases (6 eyes), aged 41~76 (55.8 + 10.2) years; in gender and age composition the difference between the two groups than on There was no statistically significant difference (P0.05); while the MD difference was statistically significant (P0.05). CP RNFL thickness changes, comparison between the two groups showed that there was significant difference of CP RNFL thickness under the nose (P0.05); and the temporal, superior, temporal, nasal, nasal CP RNFL thickness the difference was not statistically significant (P0.05); MR thickness changes, comparison between the two groups showed that the outer ring of temporal MR thickness in the comparison between the two groups was statistically significant (P0.05), while the MR thickness of each quadrant of the contrast in the rest of this difference between the two groups were not statistically significant (P:0.759,0.787,0.864,0.435,0.774,0.679,0.550; 0.05) between the two groups m RNFL thickness, the results indicated that there were statistically significant differences in the thickness of RNFL above the inner m between the two groups (P0.05); and the rest of the quadrant such as inner temporal, temporal, nasal and temporal side of outer ring, temporal, nasal, nasal m RNFL in thickness 涓ょ粍涔嬮棿宸紓鍧囨棤緇熻瀛︽剰涔，

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