發(fā)布時(shí)間：2018-05-02 22:49

  本文選題：相干光斷層掃描儀 + 視網(wǎng)膜神經(jīng)纖維層厚度�。� 參考：《河北醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的:相關(guān)光斷層掃描儀(Optical Coherence Tomography,OCT)是一種高分辨率,非接觸性的生物組織成像技術(shù),依據(jù)光學(xué)相干原理設(shè)計(jì)而成,可以起到類似活體組織病理觀察的作用,并定量地測(cè)量各結(jié)構(gòu)參數(shù)和變化。自問世以來已獲得廣泛的臨床應(yīng)用,其中視網(wǎng)膜神經(jīng)纖維層(Retinal Nerve Fiber Layer,RNFL)厚度的檢測(cè)在青光眼早期診斷和隨訪中具有重要的作用。但是目前國內(nèi)尚未建立中國人RNFL正常值范圍,目前使用的OCT所提供的正常人RNFL厚度的參考值與國人是否有差異還存在爭(zhēng)議。此外,對(duì)眾多影響因素如年齡、性別、眼別、視盤大小等對(duì)RNFL厚度的影響還不明確。本研究旨在通過測(cè)量正常人RNFL厚度值并與國外相關(guān)參考值對(duì)照,建立中國人RNFL厚度正常值的參考范圍同時(shí)探討可能影響正常人RNFL厚度的因素及其變化規(guī)律,以期為青光眼早期診斷的臨床工作提供參考。 方法: 1研究對(duì)象:選擇2009年6月至2011年3月在河北醫(yī)科大學(xué)第二醫(yī)院眼科門診檢查為符合納入和排除標(biāo)準(zhǔn)的自愿受試者,共172例331眼,8~73歲(平均年齡41.81±1.21歲)正常中國人,其中女性84例(164只眼),男性88例(167只眼)。 2檢查方法:所有研究對(duì)象均接受病史詢問,視力、屈光度、裂隙燈、眼底、眼壓及視野檢查,符合納入標(biāo)準(zhǔn)者行OCT檢測(cè)。 2.1應(yīng)用海德堡Spectralis OCT,選擇RNFL厚度(3.4mm)掃描模式對(duì)受試者視網(wǎng)膜進(jìn)行以視盤為中心3.4mm為直徑的環(huán)形掃描,利用計(jì)算機(jī)自帶的分析軟件圖像分析系統(tǒng)分析RNFL厚度值并記錄結(jié)果,包括9個(gè)參數(shù):N,I,T,S,NI,TI,TS,NS,G分別指鼻側(cè),下方,顳側(cè),上方,鼻下,顳下,鼻上,顳上象限及全周平均厚度值。 2.2選擇光柵線性掃描模式橫向及縱向掃描視盤,對(duì)視盤橫徑及豎徑進(jìn)行測(cè)量,記錄結(jié)果包括:視盤橫徑,視盤豎徑。 3統(tǒng)計(jì)學(xué)方法:采用SPSS13.0統(tǒng)計(jì)軟件進(jìn)行分析,各項(xiàng)均數(shù)以x±s表示;與國外參考值、不同年齡組、不同性別和眼別間比較采用單樣本t檢驗(yàn)、方差分析、獨(dú)立樣本t檢驗(yàn)等比較方法;年齡、視盤橫徑和豎徑與RNFL厚度的相關(guān)性分析采用線性相關(guān)與回歸分析進(jìn)行統(tǒng)計(jì)學(xué)比較。以P0.05為差異具有統(tǒng)計(jì)學(xué)意義,P0.01為差異具有顯著統(tǒng)計(jì)學(xué)意義。 結(jié)果: 1正常人RNFL厚度值和視盤橫徑、豎徑分別為:鼻側(cè)75.46±15.20μm,下方139.33±19.02μm,鼻下121.74±24.90μm,顳下157.48±20.76μm,顳側(cè)80.54±12.81μm,顳上146.74±18.81μm,鼻上121.71±23.68μm,上方133.93±17.35μm,全周107.62±10.60μm;視盤橫徑為1.56±0.17mm,豎徑為1.74±0.17mm。 2與國外參考值間的比較:中國人各象限及全周RNFL厚度值均顯著高于國外參考值(P0.01)。 3不同年齡間的比較:各年齡組間除N、T、NS三個(gè)象限,其余象限I、NI、TI、TS、S五個(gè)象限及全周G平均RNFL厚度值均有差別(P0.05)。在這五個(gè)象限和全周平均RNFL厚度值中,6個(gè)年齡組的曲線圖除NI象限外,其余均呈以21~30歲組和41~50歲組為高點(diǎn)≤20歲組、31~40歲組和61~73歲組值為低點(diǎn)的“M”形,其中又以≤20歲組和61~73組值較低。 4不同性別間的比較:顳側(cè)T平均RNFL厚度值女性高于男性(P0.05),其余象限和全周平均RNFL厚度值均無差別(P0.05)。 5不同眼別間的比較:鼻上NS和上方S平均RNFL厚度值左眼高于右眼(P0.05),其余象限和全周平均RNFL厚度值均無差別(P0.05)。 6年齡與RNFL厚度的相關(guān)性分析:顳上TS和顳下TI象限平均RNFL厚度與年齡成負(fù)相關(guān)(r=0.137,P=0.012和r=0.145,P=0.008),其余象限和全周平均RNFL厚度值與年齡未發(fā)現(xiàn)線性相關(guān)。 7 RNFL厚度與視盤橫徑和豎徑的相關(guān)性分析:鼻側(cè)N、下方I、顳側(cè)T、上方S四個(gè)象限與視盤橫徑均呈正相關(guān)(P0.05),相關(guān)系數(shù)分別為0.215,0.158,0.252,0.189。除鼻側(cè)N象限外(P0.05),下方I、顳側(cè)T、上方S三個(gè)象限與視盤豎徑均呈正相關(guān)(P0.05),相關(guān)系數(shù)分別為0.214,0.117,0.240。 結(jié)論: 1正常人視網(wǎng)膜神經(jīng)纖維層掃描曲線呈雙峰形,以鼻側(cè)N和顳側(cè)T較薄,上方S和下方I較厚,其中以顳上TS和顳下TI最厚。正常國人各象限及全周RNFL平均厚度參考值見表1。 2正常人RNFL厚度主要受種族、年齡、及視盤橫徑和豎徑的影響,性別和眼別對(duì)RNFL厚度的影響很小。
[Abstract]:Objective: Optical Coherence Tomography (OCT) is a high resolution, non-contact biological tissue imaging technique designed according to the principle of optical coherence. It can play a role similar to the pathological observation of the living tissue and measure the parameters and changes of each structure. The detection of the thickness of the retinal nerve fiber layer (Retinal Nerve Fiber Layer (RNFL)) plays an important role in the early diagnosis and follow-up of glaucoma. However, the normal range of the normal value of the Chinese people's RNFL has not been established at home. There is a dispute between the reference value of the normal human RNFL thickness provided by the current OCT and whether there is a difference between the people of RNFL and the people. In addition, the influence of many factors such as age, sex, eye and disc size on the thickness of RNFL is not clear. This study aims to establish the reference range of the normal value of the Chinese people's RNFL thickness by measuring the RNFL thickness of normal people and comparing with the relevant reference values abroad. In order to provide reference for the early diagnosis of glaucoma.
Method:
1 subjects: selected volunteers in the ophthalmology outpatient department of the second hospital of Hebei Medical University from June 2009 to March 2011, 172 cases, 331 eyes, and 8~73 years (average age 41.81 + 1.21 years) were normal Chinese, including 84 women (164 eyes) and 88 men (167 eyes).
2 method of examination: all the subjects were examined by medical history, visual acuity, diopter, slit lamp, fundus, intraocular pressure and visual field examination. The patients met the inclusion criteria were tested by OCT.
2.1 Spectralis OCT in Heidelberg was used to select the RNFL thickness (3.4mm) scan mode for the retina of the subjects to scan the diameter of the retina with the center of the disc as the center, and to analyze the RNFL thickness value and record the results by the computer analysis software image analysis system, including the 9 parameters: N, I, T, S, NI, TI, temporal side, respectively. Above, under nasal, temporal, nasal, upper temporal quadrant and whole week mean thickness.
2.2 choose grating linear scanning mode to scan horizontally and vertically, and measure the transverse diameter and vertical diameter of the optic disc. The results include: the transverse diameter of the optic disc and the vertical diameter of the optic disc.
3 statistical method: using SPSS13.0 statistical software to analyze, each of them was represented by X + s; compared with foreign reference values, different age groups, different sex and eyes, comparison of single sample t test, variance analysis, independent sample t test and so on; age, the correlation analysis of the transverse diameter and vertical diameter of the optic disc and the thickness of RNFL is linear correlation and Regression analysis was used for statistical comparison. The difference between P0.05 and P0.01 was statistically significant.
Result:
1 the thickness of RNFL and the transverse diameter of the optic disc were 75.46 + 15.20 mu m in the nasal side, 139.33 + 19.02 m below the nose, 121.74 + 24.90 in the nose, 80.54 + and 12.81 m in the temporalateral, 146.74 + 19.02 m on the temporal side, 15.20 of the temporomandibular 15.20 mu m. 74 + 0.17mm.
2 comparison with foreign reference values: Chinese quadrant and full week RNFL thickness values are significantly higher than foreign reference values (P0.01).
3 the comparison between different age groups: except N, T, NS three quadrants, the rest quadrant I, NI, TI, TS, S, five quadrants and all week G average RNFL thickness values are different (P0.05). In these five quadrants and all Zhou Pingjun RNFL thickness values, the 6 age groups, except for the age group and the age group, are higher than 20 years old. The 31~40 year old group and the 61~73 year old group were low value "M" shape, and the values of the group aged less than 20 years and the 61~73 group were lower.
4 Comparison between different sexes: the mean RNFL thickness of the temporal T was higher in females than in males (P0.05), but there was no difference in the other quadrants and the mean RNFL thickness of the whole week (P0.05).
5 Comparison of different eyes: the average RNFL thickness of the upper nasal NS and the upper S was higher in the left eye than in the right eye (P0.05), and there was no difference in the other quadrants and the mean RNFL thickness of the whole week (P0.05).
The correlation analysis of 6 age and RNFL thickness: the average RNFL thickness of the temporal TS and the infratemporal TI quadrant was negatively correlated with age (r=0.137, P=0.012 and r=0.145, P=0.008), and the rest quadrant and the total weekly mean RNFL thickness was not linearly correlated with age.
The correlation between 7 RNFL thickness and the transverse diameter and vertical diameter of the optic disc: the nasal N, the lower I, the temporal T, the S four quadrants above the disc transverse diameter were positively correlated (P0.05), the correlation coefficient was 0.215,0.158,0.252,0.189. except the nasal N quadrant (P0.05), the lower I, the temporal T, and the three quadrants above the optic disc were positively correlated with the optic disc vertical diameter. For 0.214,0.117,0.240.
Conclusion:
The retinal nerve fiber layer scanning curve of 1 normal people was Shuangfeng shaped, with the thinner T in the N and the temporal side of the nasal side, the thicker S and lower I above, and the thickest of TS and infratemporal TI. The reference values of the normal people's quadrants and the whole week RNFL mean thickness were shown in table 1..
2 the thickness of RNFL in normal subjects was mainly affected by race, age, transverse diameter and vertical diameter of optic disc, and gender and eye had little effect on RNFL thickness.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R775

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