摘要
目的观察手持式免散瞳视觉电生理诊断系统RETeval在筛查糖尿病视网膜病变(DR)中的初步临床应用价值。方法回顾性临床研究。2017年11月至2018年6月于解放军中部战区总医院眼科和内分泌科就诊的2型糖尿病患者58例和同期健康志愿者16名(对照组)纳入研究。患者既往均未接受任何眼局部治疗。采用RETeval设备的“DR评估方案”模式行闪光ERG检查。记录系统测量的“DR评估方案结果评分”。以FFA结果为金标准,依据2002年制定的国际DR分级标准对DR进行分级,将患者分为威胁视力的DR(VTDR)组[VTDR(+)]和VTDR(-)组,DR(+)和DR(-)组。不同分组受检眼之间隐含期、振幅、瞳孔面积比的比较行两独立样本t检验;“DR评估方案结果评分”与DR严重程度相关性采用Spearman相关性分析。受试者工作特征曲线下面积(AUC)评估RETeval检测DR及VTDR的灵敏度和特异性;以Youden指数最大为标准确定灵敏度和特异性的临界值。结果“DR评估方案结果评分”诊断DR的AUC为0.936,灵敏度和特异性分别为81%、92%;诊断VTDR的AUC为0.976,灵敏度和特异性分别为96%、70%。与DR(-)组比较,DR(+)组患眼隐含期延迟,振幅、瞳孔面积比降低,差异均有统计学意义(t=-13.43、5.49、6.09,P=0.000、0.000、0.000)。与VTDR(-)组比较,VTDR(+)组患眼隐含期延迟,振幅、瞳孔面积比降低,差异均有统计学意义(t=-11.05、7.46、5.73,P=0.000、0.000、0.000)。相关性分析结果显示,“DR评估方案”结果评分与DR严重程度呈正相关(r=0.89,P<0.05)。结论RETeval记录的“DR评估方案结果评分”诊断DR及VTDR有较高的灵敏度和特异性,且与DR严重程度呈正相关。
Objective To observe the preliminary clinical application value of the handheld nonmydriatic visual electrophysiological diagnostic system RETeval in screening for diabetic retinopathy(DR).Methods Retrospective clinical study.Fifty-eight patients with type 2 diabetes mellitus and 16 normal subjects who were admitted to Wuhan General Hospital of the PLA from November 2017 to May 2018 were enrolled in this study.All patients had not received any ophthalmologic treatment.All patients were examined by the default"DR assessment protocoF,model of the RETeval device,and the"DR score"were measured by the system.The FFA results were used as the gold standard,and the DR was graded according to the international DR grading standard established in 2002.Patients were divided into vision threatening DR(VTDR)positive group and VTDR(-)group,DR(+)group and DR(-)group.Two independent sample t tests was used to compare the implicit time,amplitude,and pupil area ratio between eyes of different groups.Spearman correlation analysis was used to analyze the relationship between"DR score"and DR severity.The receiver operating characteristic area under the curve(AUC)assesses the sensitivity and specificity of RETeval in detecting DR and VTDR.The threshold of sensitivity and specificity was determined by using the maximum Youden index as a standard.Results The AUC of DR was 0.936,the sensitivity was 81%,the specificity was 92%;the AUC of VTDR was 0.976,the sensitivity was 96%and the specificity was 70%.Compared with DR(-)group,the implicit time of DR(+)group was delayed and the amplitude and pupil area were decreased(t=-13.43,5.49,6.09;P=0.000,0.000,0.000).Compared with VTDR(-)group,the implicit time of VTDR(+)group was delayed and the amplitude and pupil area were decreased(t=-11.05,7.46,5.73;P=0.000,0.000,0.000).The "DR score" was significantly correlated with the severity of DR(r=0.89,PV0.05).Conclusions The "DR score" measured by the RETeval instrument has a high degree of specificity and sensitivity in the diagnosis of DR and VTDR.It
作者
李文清
宋艳萍
丁琴
Li Wenqing;Song Yanping;Ding Qin(Department of Ophthalmology,Wuhan General Hospital of the PLA,Clinical Research Center for Fundus Laser in Hubei Province,Wuhan 430070,China;Clinical Medical College of Southern Medical University,Wuhan 430070,China)
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2020年第2期94-98,共5页
Chinese Journal of Ocular Fundus Diseases
