CAJ | 학술논문

目的探讨应用眼前节相干光断层扫描仪(AS-OCT)测量下方泪河高度(TMH)的可行性及其对干眼症的临床诊断价值.方法诊断试验的评价.选择2007年11月至2008年8月就诊于中山大学中山眼科中心的36例(36只眼)不同程度干眼症患者和38例(38只眼)正常志愿者,应用AS-OCT和测微月镜测量下方泪河高度,采用配对t检验、组内相关系数、单因素方差分析及Spearman秩相关分析等方法,比较正常人组与十眼症患者组、两研究者同一时间获取分析同一组人的TMH值、两研究者分析同一检查者获取的TMH值、同一研究者1周前后重复的测量值,以及比较AS-OCT与裂隙灯显微镜下测微目镜的TMH值.结果同一时间两研究者独立获取分析22只正常眼TMH值分别为(0.256±0.052)mm和(0.265±0.066)mm,同一研究者不同时间获取分析20只正常眼TMH值分别为(0.265±0.056)mm和(0.272±0.052)mm,两研究者分析20只正常眼TMH值分别为(0.266±0.059)mm和(0.259±0.062)mm,差异均无统计学意义(t=1.881,P=0.074;t=1.306,P=0.207;t=2.048,P=0.065);AS-OCT与测微目镜测量TMH结果呈正相关(r=0.713,P=0.000);正常人泪河高度明显高于干眼患者(t=9.368,P=0.000),正常眼和2、3、4级程度干眼组TMH值[(0.228±0.036)mm,(0.145±0.056)mm,(0.084±0.048)mm]的组间有明显差异(F=55.763.P=0.000).绘制受试者工作特征曲线(ROC曲线),将诊断界别值定为0.213 mm,其敏感性为77.8%,特异性为71.7%.结论应用眼前节相干光断层扫描测量泪河高度具有良好的可重复性和町靠性,有望作为临床上诊断水样液缺乏性干眼症的客观指标之一.(中华眼科杂志,2009,45:616-620)
목적 탐토응용안전절상간광단층소묘의(AS-OCT)측량하방루하고도(TMH)적가행성급기대간안증적림상진단개치.방법 진단시험적평개.선택2007년11월지2008년8월취진우중산대학중산안과중심적36례(36지안)불동정도간안증환자화38례(38지안)정상지원자,응용AS-OCT화측미월경측량하방루하고도,채용배대t검험、조내상관계수、단인소방차분석급Spearman질상관분석등방법,비교정상인조여십안증환자조、량연구자동일시간획취분석동일조인적TMH치、량연구자분석동일검사자획취적TMH치、동일연구자1주전후중복적측량치,이급비교AS-OCT여렬극등현미경하측미목경적TMH치.결과 동일시간량연구자독립획취분석22지정상안TMH치분별위(0.256±0.052)mm화(0.265±0.066)mm,동일연구자불동시간획취분석20지정상안TMH치분별위(0.265±0.056)mm화(0.272±0.052)mm,량연구자분석20지정상안TMH치분별위(0.266±0.059)mm화(0.259±0.062)mm,차이균무통계학의의(t=1.881,P=0.074;t=1.306,P=0.207;t=2.048,P=0.065);AS-OCT여측미목경측량TMH결과정정상관(r=0.713,P=0.000);정상인루하고도명현고우간안환자(t=9.368,P=0.000),정상안화2、3、4급정도간안조TMH치[(0.228±0.036)mm,(0.145±0.056)mm,(0.084±0.048)mm]적조간유명현차이(F=55.763.P=0.000).회제수시자공작특정곡선(ROC곡선),장진단계별치정위0.213 mm,기민감성위77.8%,특이성위71.7%.결론 응용안전절상간광단층소묘측량루하고도구유량호적가중복성화정고성,유망작위림상상진단수양액결핍성간안증적객관지표지일.(중화안과잡지,2009,45:616-620)
Objective To investigate the reproducibility and repeatability of anterior segment optical coherence tomography (AS-OCT) for measuring the tear meniscus height (TMH) and to evaluate its clinical application in the diagnosis of dry eye diseases. Methods Evaluation of diagnostic test. The inferior tear meniscus height of 36 eyes of 36 patients with dry eyes and 38 eyes of 38 normal volunteers were measured by AS-OCT and slit lamp marker lens in Zhongshan Ophthalmic Center, Sun Yat-sen University from November 2007 to August 2008. Then the paired t test, intra-class correlation coefficiency test, ANOVA and Spearman test were used for comparing TMH values between normal subjects and dry eye patients, two different examiners, two analysts, the repeated examines within a week, and AS-OCT group and slit lamp reticle lens group. Results There are no significant differences between different observers for the same 22 subjects [t = 1.881, P =0.074; TMH: (0.256 ± 0.052) mm and (0.265 ± 0.066) mm], the same observer in different check-points for 20 subjects [t = 1. 306, P =0. 207 ; TMH : (0. 265 ± 0. 056) mm and (0. 272 ± 0. 052) mm]as well as different analyzers for the same 20 AS-OCT pictures [t = 2. 048, P = 0.065; TMH: (0.266±0.059) mm and (0.259 ±0.062) mm]. There is a positive correlation between AS-OCT and reticule reading in measuring TMH (r =0. 713,P =0. 000) ; there are significant differences between normal subjects and patients with dry eye (t = 9. 368, P = 0. 000), and between groups of dry eye at different degree (F=55.763,P=0.000) [TMH: grade Ⅱ, (0.228 +0.036) ram; grade Ⅲ, (0. 145 ± 0. 056) mm; and grade Ⅳ, (0. 084 ± 0. 048) mm]. The sensitivity and specificity of TMH value with AS-OCT for dry eye diagnosis was 77.8% and 71.7%, when the diagnostic value was set to be 0. 213 mm under the instruction of receptor operating characteristics curve (ROC). Conclusion AS-OCT has excellent reproducibility and repeatability for measuring the inferior tear meniscus height, and can be taken as an objective clinical imaging method for the diagnosis of aqueous deficiency dry eye. (Chin J Ophthalmol,2009,45:616-620)