本文選題：法醫(yī)學 + 自動視野儀　； 參考：《中國政法大學》2017年碩士論文

【摘要】：目的:本研究圍繞著視野的客觀評估,結合司法鑒定標準,展開了對于自動視野儀、模式翻轉視覺誘發(fā)電位(PR-VEP)和視網(wǎng)膜神經(jīng)纖維層(RNFL)厚度三種技術的分別研究,以探索視野客觀評估的方法學路徑。對象與方法:本研究采集60眼別,配合良好的青年受試者,進行2次自動視野儀的正常及模擬缺損檢查,對2次測試結果進行配對T檢驗及ICC檢驗,并對判別為不可信的案例進行統(tǒng)計;PR-VEP采集常規(guī)位點的正常組、模擬1/4視野缺損組、模擬1/2視野缺損組的數(shù)據(jù),進行配對T檢驗,后采集左右旁開2cm位點的數(shù)據(jù),進行配對T檢驗,并對MD與振幅進行秩相關、回歸分析。采集52眼別某醫(yī)院明確診斷的外傷視神經(jīng)病變所致視野缺損病歷,進行RNFL與視野缺損指標的相關性及回歸分析研究。結果:(1)自動視野儀PSD的ICC為98.9%,MD的ICC為95.5%,其他指標的ICC都小于60%,重復測試后,僅假陰性率的多次檢測結果間的差異具有統(tǒng)計學意義,其自帶的可信性評估系統(tǒng),不能完全識別出偽裝。(2)PR-VEP進行檢測,正常人組的振幅1/4視野缺損組的振幅1/2視野缺損組的振幅,視野缺損達到1/4即可出現(xiàn)波形的異常,視野缺損達到1/2時,振幅明顯低平,波形可以呈現(xiàn)反向波、w型波等。同時采集左右旁開處VEP數(shù)據(jù):兩處波形明顯不同,差異具有統(tǒng)計學意義,左旁開的振幅右旁開的振幅,60’PR-VEP測得的N75-P100振幅與自動視野儀平均偏差的相關性為R=0.471(P=0.000)。(3)平均RNFL厚度(X)與視野有效值(Y)呈顯著正相關R=0.543(P=0.000),相關回歸方程為Y=-93.795+5.208X-0.037X2(R=0.691,P=0.000),與MD呈中度負相關R=-0.450(P=0.001),與LV呈中度負相關R=-0.440(P=0.001),與MS呈中度正相關R=0.400(P=0.003)。按照《人體損傷程度鑒定標準》規(guī)定,對平均RNFL厚度進行分組,通過方差分析,重傷組與輕傷組有極顯著差異性,重傷組與輕微傷組有極顯著差異性,輕傷組與輕微傷組有顯著差異。結論:自動視野儀可以作為主觀的功能性手段,結合視覺通路的特點,輔助鑒別偽裝,而視覺電生理作為客觀的定性手段,一定程度上也可以實現(xiàn)視野缺損的半定量和定位,RNFL厚度可以作為形態(tài)學手段,在司法鑒定中,定位并半定量地判別視野缺損的程度。多種手段聯(lián)合使用,具有客觀評估視野缺損程度的功能,可應用于《人體損傷程度鑒定標準》相關條款中。
[Abstract]:Objective: this study focused on the objective evaluation of visual field, combined with the standard of forensic identification, and carried out a study of the thickness of automatic visual field instrument, pattern reversal visual evoked potential (PR-VEP) and retinal nerve fiber layer (RNFL), respectively. In order to explore the perspective of objective assessment of the methodological path. Objects and methods: in this study, 60 eyes were collected and matched with good young subjects. The normal and simulated defects were examined twice by automatic visual field meter. The results of two tests were matched T test and ICC test. The normal group of normal loci were collected by PR-VEP, the data of 1 / 4 visual field defect group and 1 / 2 visual field defect group were simulated, then matched T test was performed, and the data of left and right 2cm sites were collected. Matched T test was performed, and rank correlation and regression analysis of MD and amplitude were carried out. Cases of visual field defect caused by traumatic optic neuropathy were collected in 52 eyes of a hospital. The correlation between RNFL and visual field defect index and regression analysis were studied. Results the ICC of PSD was 98.9 and the ICC of other indexes was 95.50.After repeated tests, the difference between the results of multiple tests with only false negative rate was statistically significant. The amplitude of the 1 / 4 visual field defect group in the normal group was 1 / 2 of the amplitude of the visual field defect group, and the abnormal waveform could be seen when the visual field defect reached 1 / 4. When the visual field defect reached 1 / 2, the amplitude was obviously low. The waveforms can be reversed waves and so on. At the same time, the VEP data were collected at the left and right side: the two waveforms were obviously different, and the difference was statistically significant. The correlation between the mean deviation of N75-P100 amplitude and the mean deviation of automatic visual field instrument is R = 0.471g / r 0.0000.000) the correlation between the mean RNFL thickness (X) and the effective value of visual field (Y) is significant positive correlation, and the correlation equation is: Y-93.795 5.20X-0.037X _ 2 ~ (0.691N) P _ (0.000), and the correlation equation is: Y-93.795 5.20X-0.037X _ 2 ~ (0.691N) P _ (0.000N), and the correlation equation is: r ~ (0.43) P ~ (0.000) (r _ 0. 795 ~ 5.20X-0.037X _ 2 ~ + _ 0. There was a negative correlation between RV and LV, a moderate negative correlation with LV, and a moderate positive correlation with MS, and a moderate positive correlation with MS. According to the Standard for the Identification of Human injury degree, the average thickness of RNFL was divided into two groups. By ANOVA, there were significant differences between severe injury group and mild injury group, and significant difference between severe injury group and mild injury group. There was significant difference between mild injury group and slight injury group. Conclusion: the automatic visual field instrument can be used as a subjective functional means, combined with the characteristics of the visual pathway to assist the identification of camouflage, and visual electrophysiology as an objective qualitative means. The thickness of RNFL can also be used as a morphological means to determine the degree of visual field defect in judicial identification. It has the function of objectively evaluating the degree of visual field defect and can be used in the relevant articles of the Standard for the Identification of Human injury degree.
【學位授予單位】：中國政法大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：D919

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