联合检测GCC厚度和pRNFL厚度对原发性开角型青光眼的诊断价值-现代医学

联合检测GCC厚度和pRNFL厚度对原发性开角型青光眼的诊断价值

单位：绵阳市中心医院眼科, 四川绵阳 621000

分类号：R775

出版年·卷·期（页码）：2020·48·第十期（1288-1293）

摘要：

目的：探讨神经节细胞复合体（GCC）厚度和视乳头周围神经纤维层（pRNFL）厚度联合指标对原发性开角型青光眼（POAG）的诊断价值。方法：选取2016年2月至2017年12月于我院就诊的118例118眼作为研究对象，其中正常眼44眼（正常组）、早期原发性开角型青光眼（EPOAG）36眼（EPOAG组）、晚期原发性开角型青光眼（APOAG）38眼（APOAG组），应用频域光学相干层析成像（SD-OCT）的GCC模式和视乳头（ONH）模式对所有受试者扫描检测，比较所有受试者黄斑区GCC厚度与pRNFL厚度的曲线下面积（AUC）以评估其诊断能力。结果：正常组各区域GCC厚度、pRNFL厚度均高于EPOAG组和APOAG组，差异具有统计学意义（P<0.05）；EPOAG组各区域GCC厚度和pRNFL厚度均高于APOAG组，差异具有统计学意义（P<0.05）；所有受试者全周GCC厚度与pRNFL厚度呈正相关（P<0.05）；EPOAG组中全周、上方、下方GCC厚度与pRNFL厚度诊断效能比较差异均无统计学意义（P>0.05）；APOAG组中全周、上方、下方GCC厚度与pRNFL厚度诊断效能比较差异均无统计学意义（P>0.05）；以全周pRNFL厚度为参照，EPOAG组中全周GCC厚度及全周pRNFL厚度按回归联合、串联、并联3种不同方式联合后的诊断能力均未见明显提高（P>0.05）；APOAG组中全周GCC厚度及全周pRNFL厚度回归联合及串联后诊断能力未见明显提高（P>0.05）；APOAG组中全周GCC厚度及全周pRNFL厚度并联后灵敏度显著升高，差异有统计学意义（P<0.05）。结论：GCC厚度和pRNFL厚度在各期原发性开角型青光眼中具有较高的诊断价值，且在晚期原发性开角型青光眼中，全周GCC厚度和全周pRNFL厚度联合可能提高其诊断灵敏度。

Objective: To study the diagnostic value of ganglion cell complex(GCC) thickness and peripapillary retinal nerve fiber layer(pRNFL) thickness in primary open-angle glaucoma(POAG) by joint indicators. Methods: A total of 118 eyes of 118 patients who received treatment in our hospital from February 2016 to December 2017 were selected as the study subjects, among which there were 44 normal eyes(normal group), 36 early primary open-angle glaucoma(EPOAG) eyes(EPOAG group) and 38 advanced primary open-angle glaucoma(APOAG) eyes(APOAG group). GCC mode and optic nerve head(ONH) mode of spectral domain optical coherence tomography(SD-OCT) are applied to scan all the subjects. The area under the curve(AUC) of macular GCC thickness and pRNFL thickness were compared for all subjects to assess their diagnostic ability. Results: The thickness of GCC and pRNFL in all areas of the normal group was higher than that of the EPOAG group and APOAG group, and the difference was statistically significant(P<0.05). The thickness of GCC and pRNFL in all areas of EPOAG group were higher than that of APOAG group, and the difference was statistically significant(P<0.05). The complete cycle GCC thickness was positively correlated with pRNFL thickness in all subjects(P<0.05). In the EPOAG group, there was no statistically significant difference in diagnostic efficacy between the complete cycle, upper and lower thickness of GCC and pRNFL(P>0.05); In APOAG group, there was no statistically significant difference in diagnostic efficacy between the complete cycle, upper and lower thickness of GCC and pRNFL(P>0.05); Taking complete cycle pRNFL thickness as a reference, the diagnostic ability of complete cycle GCC thickness and complete cycle pRNFL thickness in the EPOAG group was not significantly improved after being combined in three different ways, namely joint regression, connection in series and in parallel(P>0.05); In APOAG group, the diagnostic ability of complete cycle GCC thickness and complete cycle pRNFL thickness showed no significant improvement after joint regression and connection in parallel(P>0.05); In the APOAG group, the sensitivity of complete cycle GCC thickness and complete cycle pRNFL thickness were significantly increased after parallel connection, and the difference was statistically significant(P<0.05). Conclusion: GCC thickness and pRNFL thickness have high diagnostic value in various stages of primary open-angle glaucoma, and the combination of complete cycle GCC thickness and complete cycle pRNFL thickness may improve the diagnostic sensitivity in advanced primary open-angle glaucoma.

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