本文選題：Vogt-小柳-原田綜合征 + 光學(xué)相干斷層成像　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:Vogt-小柳-原田綜合征(Vogt-Koyanagi-Harada syndrome,簡(jiǎn)稱 VKH)在臨床上常以造影檢查結(jié)果作為診斷的金標(biāo)準(zhǔn),一經(jīng)診斷則早期應(yīng)用激素治療,且應(yīng)足療程。目前臨床有部分患者因造影劑過敏或腎功能不全等全身狀態(tài)因素,無法完成造影檢查,故不能及時(shí)診斷、盡早開展激素治療。本研究應(yīng)用光學(xué)相干斷層成像法(optical coherence temography,OCT)定量測(cè)量黃斑區(qū)脈絡(luò)膜厚度,研究其在VKH診斷中的準(zhǔn)確度、敏感度及特異度,明確該方法用于臨床診斷VKH的準(zhǔn)確性,以期有助于臨床早期診斷及治療。方法:選取眼底熒光血管造影(fundus fluorescence angiography,FFA)及引哚菁綠血管造影(indocyanine green angiography,ICGA)結(jié)果為VKH診斷的金標(biāo)準(zhǔn),應(yīng)用OCT定量測(cè)量黃斑區(qū)脈絡(luò)膜厚度,根據(jù)預(yù)設(shè)臨床預(yù)期的敏感度及特異度,依樣本量計(jì)算公式計(jì)算出所需病例組及對(duì)照組的病例數(shù)。收集沈陽市第四人民醫(yī)院2015年1月1日至2016年12月31日就診的VKH患者及其他眼病患者的眼底熒光血管造影檢查結(jié)果、脈絡(luò)膜造影檢查結(jié)果、黃斑區(qū)脈絡(luò)膜厚度結(jié)果等,邀請(qǐng)3位副高級(jí)以上從事眼底病專業(yè)臨床醫(yī)師盲法判讀熒光血管造影結(jié)果、吲哚菁綠血管造影結(jié)果,診斷VKH或排除VKH,根據(jù)結(jié)果取平均數(shù)(按四舍五入法)作為最終計(jì)算病例數(shù)計(jì)入研究結(jié)果。OCT測(cè)量黃斑區(qū)中心凹處脈絡(luò)膜厚度,根據(jù)受試者工作特性曲線確定檢查結(jié)果臨界值,最終根據(jù)診斷實(shí)驗(yàn)研究的標(biāo)準(zhǔn)四格表法來計(jì)算敏感度及特異度等結(jié)果。結(jié)果:1、OCT測(cè)量脈絡(luò)膜厚度大于等于500 μm時(shí),診斷VKH的準(zhǔn)確度為88.10%。2、OCT測(cè)量脈絡(luò)膜厚度大于等于500 μ m時(shí),診斷VKH的敏感度為86.52%。3、OCT測(cè)量脈絡(luò)膜厚度小于300 μ m時(shí),排除VKH的特異度為89.23%。4、OCT測(cè)量脈絡(luò)膜厚度小于300 μ m的患者,有85.31%的把握該病人未患VKH。5、OCT測(cè)量脈絡(luò)膜厚度得到陰性結(jié)果的患者,有90.16%的把握病人未患VKH。結(jié)論:1、本診斷試驗(yàn)研究所確立的OCT測(cè)量脈絡(luò)膜厚度界限在臨床VKH的診斷中診斷準(zhǔn)確度較高,且具有較好的診斷效率。2、OCT測(cè)量脈絡(luò)膜厚度大于等于500 μ m臨床診斷VKH的敏感性較高。陽性似然比較大,臨床應(yīng)用指標(biāo)診斷VKH的把握度較大,不易漏診。3、OCT測(cè)量脈絡(luò)膜厚度小于300 μm時(shí)排除VKH的特異度較高,陰性似然比較小。臨床應(yīng)用此指標(biāo)排除VKH的把握度較大,不易誤診。4、OCT測(cè)量脈絡(luò)膜厚度介于300 μm-500μm之間時(shí),需結(jié)合病史、查體、其他輔助檢查結(jié)果做出準(zhǔn)確診斷。
[Abstract]:Objective: Vogt-Koyanagi-Harada syndromeVogt-Koyanagi-Harada syndrome (VKHH) is often used as the gold standard for diagnosis. At present, some patients can not complete the examination because of contrast agent allergy or renal insufficiency, so they can not diagnose in time and start hormone therapy as soon as possible. In this study, optical coherence tomography (Oct) was used to quantitatively measure the choroidal thickness in macular area, to study its accuracy, sensitivity and specificity in the diagnosis of VKH, and to determine the accuracy of this method in clinical diagnosis of VKH. In order to help clinical early diagnosis and treatment. Methods: fundus fluorescence angiographygraphy (FFAA) and indyanine green angiographyography (ICGA) were selected as the gold criteria for the diagnosis of VKH. The choroidal thickness of macular area was quantitatively measured by OCT, and the sensitivity and specificity of the preset clinical expectation were calculated according to the preset clinical expected sensitivity and specificity. The number of cases in the needed case group and control group was calculated according to the formula of sample size. The results of fundus fluorescein angiography, choroidal angiography and choroidal thickness of VKH patients and other ophthalmopathy patients in Shenyang fourth people's Hospital from January 1, 2015 to December 31, 2016 were collected. Invited three senior and senior clinical doctors engaged in fundus disease to interpret the results of fluorescein angiography and indocyanine green angiography by blind method. Diagnosis of VKH or exclusion of VKH, taking the average of the results (rounding method) as the final calculated case count. Oct measured the choroidal thickness at the fovea of the macular area, and determined the critical value of the examination results according to the operating characteristic curve of the subjects. Finally, the sensitivity and specificity are calculated according to the standard four-grid table method. Results when the thickness of choroid was greater than 500 渭 m by Oct, the diagnostic accuracy of VKH was 88.10 when the thickness of choroid was greater than 500 渭 m, and the sensitivity of diagnostic VKH was 86.52. 3 when the thickness of choroid was less than 300 渭 m, the diagnostic accuracy of Oct was 88.10 渭 m. The specificity of excluding VKH was 89.23.4Oct in the patients whose choroidal thickness was less than 300 渭 m. 85.31% of the patients were sure that the patients had no VKH.5OCT negative results, and 90.16% of the patients had no VKHs. ConclusionThe diagnostic accuracy of OCT for measuring choroidal thickness in clinical VKH is higher, and the sensitivity of VKH is higher than 500 渭 m by using Oct to measure choroidal thickness more than 500 渭 m. The positive likelihood was large, the certainty of clinical application index in the diagnosis of VKH was high, the specificity of excluding VKH was higher when the thickness of choroid was less than 300 渭 m, and the negative likelihood was small. Clinical application of this index to exclude VKH has a greater degree of certainty, and it is difficult to misdiagnose. 4. When measuring choroidal thickness between 300 渭 m and 500 渭 m, it is necessary to make an accurate diagnosis with the results of medical history, physical examination and other auxiliary examinations.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R773.9
，

本文編號(hào)：1835399