关于糖尿病视网膜病变患者脉络膜血管指数的初步研究

目的：探讨并发糖尿病视网膜病变(DR)的2型糖尿病患者与健康人群脉络膜血管指数(CVI)的差异及特点。

方法：选取2017-01/12于我院就诊的并发DR的2型糖尿病患者68例68眼作为DR组,同时纳入同期体检的无糖尿病病史健康人群34例34眼作为对照组。通过频域相干光层析深度增强成像术(EDI-OCT)获取受检者黄斑中心凹下脉络膜厚度(SFCT)、黄斑中心凹处视网膜厚度(CRT),并将黄斑区图像进行二值化处理,采用图像分析软件计算黄斑区脉络膜总面积(TCA)、血管区面积(LA)及间质区面积(SA),计算CVI。

结果：对照组和DR组受检者TCA(0.53±0.14mm² vs 0.49±0.15mm²)、LA(0.35±0.09mm² vs 0.32±0.10mm²)、SA(0.17±0.05mm² vs 0.17±0.06mm²)及SFCT(347.9±76.9μm vs 325.9±92.9μm)均无差异(P>0.05),但DR组患者CVI明显低于对照组(64.33%±3.25% vs 67.04%±2.46%,P<0.001),二者临界值为63.59%。

结论：CVI可以直观反映脉络膜内部结构的变化,较SFCT更加稳定可靠,合并DR的2型糖尿病患者其CVI较健康人群降低。     

99锝-亚甲基二膦酸盐联用甲泼尼龙治疗甲状腺相关眼病的Meta分析

目的：评价99锝-亚甲基二膦酸盐(⁹⁹Tc-MDP)联用甲泼尼龙治疗甲状腺相关眼病(TAO)的临床效果。

方法：检索Pubmed、The Cochrane Library、EMbase、ClinicalTrial.gov、Web of Science、中国知网、维普、中国生物医学文献数据库和万方数据库9个数据库,检索时间从建库至2019-03,收集⁹⁹Tc-MDP联用甲泼尼龙治疗TAO的随机对照试验(RCT)。2名研究人员根据纳入和排除标准,独立检索文献、提取数据及进行方法学质量评估。采用Review Manager 5.3进行Meta分析。

结果：最终纳入8篇RCT文献,共644例患者。Meta分析结果显示,⁹⁹Tc-MDP联用甲泼尼龙与单用甲泼尼龙的临床总有效率有差异(RR=1.14,95%CI：1.03～1.26,P=0.01)。两组眼球突出度治疗有效率有差异(RR=1.28,95%CI：1.16～1.41,P<0.00001)。⁹⁹Tc-MDP联用甲泼尼龙改善TAO复视症状优于单用甲泼尼龙(RR=1.64,95%CI：1.04～2.58,P=0.03)。两组治疗眼球运动障碍症状无差异(P=0.37)。⁹⁹Tc-MDP联用甲泼尼龙组不良反应发生率低于单用甲泼尼龙组。

结论：⁹⁹Tc-MDP联用甲泼尼龙治疗TAO优于单用甲泼尼龙,是TAO的有效治疗方法,且副作用小。     

OCTA观察BRVO患者黄斑区微血管的改变及其与预后的关系

目的：应用光学相干断层扫描血管造影(OCTA)观察视网膜分支静脉阻塞(BRVO)患者黄斑区微血管参数的变化及其与最佳矫正视力(BCVA)的相关性。

方法：采用OCTA对29例BRVO患者双眼后极部视网膜浅层毛细血管层进行扫描,获取基线、1、6mo复查时不同区域的血管线性密度(VD)、血流灌注密度(PD)、黄斑中心凹无血管区域(FAZ)面积和形态指数。

结果：BRVO组FAZ面积为0.32±0.08mm²,大于健侧眼组FAZ面积0.21±0.06mm²(t=-6.958,P<0.001); BRVO组与健侧眼组在3mm×3mm及6mm×6mm分析模式中比较全部区域的VD均有差异(P<0.05); BRVO组与健侧眼组在3mm×3mm分析模式中比较PD,中心环区和内环区均有差异(P<0.001),6mm×6mm分析模式中中心环区、外环区和完整区均有差异(P<0.05)。基线BCVA与6mo复查时BCVA比较有差异(t=2.43,P<0.05); BCVA(LogMAR)与3mm×3mm VD中心环区、PD中心环区及6mm×6mm PD中心环区、PD完整区呈正相关,与6mm×6mm PD外环区呈负相关。

结论：作为非侵入性检查手段,OCTA能够某种程度上反映BRVO患者黄斑区血流改变情况,黄斑区微血管的改变可能与预后存在相关。     

三种波前像差仪测量成年近视患者角膜高阶像差的一致性

目的：评估Topcon KR-1W、i.Profiler、OPD-Scan Ⅲ三种波前像差仪测量成年近视患者角膜高阶像差的一致性。

方法：前瞻性临床研究。收集2022-06/08在广西壮族自治区人民医院视光中心就诊的成年近视患者92例92眼，分别采用Topcon KR-1W、i.Profiler、OPD-Scan Ⅲ测量4、6mm瞳孔直径下角膜三、四阶像差，评估三种波前像差仪的差异性和一致性。

结果：三种像差仪6mm瞳孔直径下测量值均高于4mm瞳孔直径下测量值。4mm瞳孔直径下三种像差仪Z^-4₄、Z^-2₄测量值均无差异(P>0.05)，其余测量值均有差异(P<0.05)； 6mm瞳孔直径下三种像差仪测量值均有差异(P<0.05)。4mm瞳孔直径下三阶像差测量值、6mm瞳孔直径下三、四阶像差(除Z^-2₄)测量值的95%LoA>0.1μm，一致性相关系数P_c<0.90，显示一致性较差。三种像差仪4、6mm瞳孔直径下角膜高阶像差测量值相关性差异较大(r_4mm=0.215～0.805，P_4mm<0.05； r_6mm=0.561～0.916，P_6mm<0.001)。

结论：Topcon KR-1W、i.Profiler与OPD-Scan Ⅲ测量4、6mm瞳孔直径下角膜三、四阶像差时测量结果存在差异性，一致性较差，临床应用中三种像差仪不可相互替代。     

正常人黄斑中央凹无血管区域面积分析

目的：运用光学相干断层扫描技术(optical coherence tomography,OCT)血流成像技术测量正常人黄斑中央凹无血管区域(foveal avascular zone,FAZ)面积并分析FAZ面积相关临床特征。

方法：采用横断面研究。用RTVue-100光学相干断层扫描血流成像技术测量健康研究对象的138眼FAZ面积。FAZ面积与相关因素的相关性用单因素和多因素线性回归分析。采用配对t检验比较右眼与左眼FAZ面积的差异。Pearson相关性分析双眼FAZ面积的相关性。

结果：所有研究对象的平均FAZ面积为0.30±0.11mm²。男性研究对象平均FAZ面积为0.29±0.13mm²,而女性为0.31±0.09mm²,男性FAZ面积小于女性FAZ面积,但差异无统计学意义(t=-1.346,P=0.180)。FAZ面积与年龄、性别等临床基本资料无相关性。右眼平均FAZ面积为0.30±0.11mm²,左眼平均FAZ面积为0.30±0.10mm²,双眼差异无统计学意义(P=0.943)。双眼FAZ面积存在很强的相关性。

结论：OCT血流成像技术可清晰观察并定量测量FAZ面积。FAZ面积与老龄、性别等因素无关,双眼FAZ面积呈对称性特征。     

糖尿病视网膜病变预测模型的构建与验证

目的：分析筛选糖尿病患者发生视网膜病变的影响因素,建立列线图预测模型并进行验证分析。

方法：选取2013-01/2021-01国家人口健康科学数据中心数据仓储PHDA的《糖尿病并发症预警数据集》中的1 252例患者为研究对象,通过随机化将研究对象划分为建模组(n=941)和验证组(n=311)。采用单因素分析、LASSO回归和Logistic回归分析筛选影响糖尿病患者并发视网膜病变的影响因素,构建列线图预测模型,采用ROC曲线、校正曲线和Hosmer-Lemeshow检验对模型进行验证评估,采用临床决策曲线(DCA)评估模型的临床收益情况。

结果：年龄、高血压、肾病、收缩压(SBP)、糖化血红蛋白(HbA1c)、高密度脂蛋白胆固醇(HDL-C)、血尿素(BU)是糖尿病患者发生视网膜病变的影响因素。建模组AUC值为0.792(95%CI：0.763-0.821),验证组AUC值为0.769(95%CI：0.716-0.822); Hosmer-Lemeshow检验和校准曲线提示模型拟合度较高(建模组：χ²=14.520,P=0.069; 验证组：χ²=14.400,P=0.072),DCA曲线结果显示,建模组和验证组的阈值概率分别为0.09-0.89和0.07-0.84,临床净收益较高。

结论：本研究构建包含年龄、高血压、肾病、SBP、HbA1c、HDL-C、BU的风险预测模型,该模型有较高的区分度和一致性,可用于预测糖尿病患者发生视网膜病变的风险。     

极低出生体质量儿出生后体质量增长速率与阈值病变早产儿视网膜病变的相关性研究

目的：探讨极低出生体质量儿出生后体质量增长速率与阈值病变早产儿视网膜病变(TDROP)的相关性,评估其预测TDROP发生的价值。

方法：回顾性病例分析。收集2017-01/2018-12于厦门大学附属第一医院住院的早产儿386例,出生体质量<1 500g,分析其性别、出生体质量、胎龄、分娩方式、是否吸氧、Apgar评分、是否试管婴儿、是否双生、有无合并新生儿肺炎及出生后1～4wk的体质量增长速率等与TDROP的相关性。将入组患儿分为无ROP组298例和TDROP组88例。多因素Logistic回归分析TDROP的相关危险因素。ROC曲线确定临床诊断临界值,通过ROC曲线下面积(AUC)评估出生后2wk体质量增长速率对TDROP的预测价值。

结果：两组患儿出生体质量(t=2.264,P=0.024)、出生胎龄(t=3.158,P=0.002)、出生后2wk体质量增长速率(t=3.517,P<0.001)、是否吸氧(χ²=20.514,P<0.001)差异有统计学意义。多因素Logistic回归分析显示,出生体质量(β=0.699,P=0.016),出生胎龄(β=-0.631,P=0.039),出生后2wk体质量增长速率(β=-0.636,P=0.039),是否合并吸氧(β=-1.542,P<0.001)与TDROP显著相关,其OR(95%CI)分别为2.013(1.140～3.553)、0.532(0.292～0.970)、0.529(0.289～0.969)和0.214(0.113～0.404)。进一步分析出生后2wk体质量增长速率的ROC曲线,结果显示AUC为0.710,诊断临界值为4.14g/d,敏感性为70.8%,特异性为65.9%。

结论：出生体质量是TDROP发生的独立危险因素之一,而极低出生体质量儿出生2wk体质量增长速率与TDROP的发生有显著相关,对其发生具有一定的预测价值。     

FS-LASIK矫正中高度近视术后1年屈光回退危险因素及其预测模型构建

目的：探讨飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)矫正中高度近视术后1 a屈光回退的危险因素并构建预测模型。

方法：回顾性分析2017-06/2018-11于西安高新医院行FS-LASIK手术矫正中高度近视患者400例800眼临床资料,将患者按照3：1的比例随机分为建模组(n=300例)和验证组(n=100例),依照患者术后1 a屈光回退发生情况将建模组分为回退组与未回退组两个亚组,观察其角膜曲率和角膜厚度变化情况,采用Logistic回归分析筛选FS-LASIK矫正中高度近视患者术后1 a屈光回退的危险因素,基于回归系数构建预测模型,采用受试者工作特征曲线(ROC)评估模型区分度。

结果：建模组44眼、验证组15眼于术后1 a发生屈光回退。建模组中未回退组术后6、12 mo时角膜前表面曲率低于回退组(均P<0.05); 术后1、3、6、12 mo时回退组角膜增生程度大于未回退组(均P<0.05); FS-LASIK矫正中高度近视患者术后1 a屈光回退发生概率值回归方程为：P=1/\〖1+e^{-(-5.989+0.127×年龄+2.019×术前屈光度-0.022×术前角膜中央厚度+0.043×切削深度-1.569×切削光学区直径)}\〗,Hosmer-Lemeshow检测回归方程拟合优度(P=0.818),利用建模组数据进行内部验证,ROC曲线下面积为0.890(95%CI 0.843-0.937),灵敏度为81.82%,特异度为84.71%; 利用验证组数据进行外部验证,ROC曲线下面积为0.838(95%CI 0.717-0.959),灵敏度为80.00%,特异度为87.57%。

结论：构建的风险模型判别效度良好,可用于识别中高度近视患者行FS-LASIK术后1 a屈光回退高危人群。     

甘草甜素对小鼠角膜急性碱烧伤后新生血管的抑制作用

目的：研究甘草甜素(Gly)对小鼠角膜急性碱烧伤后角膜新生血管(CNV)的抑制作用。

方法：采用碱烧伤法制备小鼠碱烧伤模型60只,随机平均分为Gly组和PBS组,分别隔天结膜下注射2g/L Gly溶液或PBS溶液,共14d。裂隙灯显微镜下观察角膜炎症反应和CNV。实验结束后取角膜行HE染色法和免疫组织化学法CD34及髓过氧化物酶(MPO)染色并计算角膜微血管密度(MVD)及中性粒细胞数。

结果：造模后第7、14d Gly组CNV面积分别是4.16±0.00、7.33±0.13mm²,显著低于PBS组(7.58±0.20、9.24±0.08mm²,均P<0.05)。HE病理染色显示正常小鼠角膜结构完整,未见新生血管形成及炎症细胞浸润; Gly组角膜新生血管数量及炎症细胞浸润较少,胶原排列较规则,而PBS组角膜基质中可见大量炎症细胞浸润及新生血管。免疫组织化学CD34染色结果显示Gly组MVD为11.13±1.46条/mm²,显著低于PBS组(34.08±2.46条/mm²,P<0.001); 免疫组织化学MPO染色结果显示Gly组中性粒细胞计数为每200倍视野17.50±1.98个,明显少于PBS组(59.56±4.79个,P<0.001)。

结论：Gly能减轻小鼠角膜急性碱烧伤模型中的角膜炎症反应,并抑制角膜新生血管形成,这为临床上有效防治角膜新生血管类疾病提供了一种新的思路。     

Centurion主控液流系统应用于白内障手术的临床研究

目的：观察Centurion超声乳化仪主控液流系统应用于白内障手术的有效性和安全性。

方法：前瞻性研究。于2018-10/12选取年龄相关性白内障(Emery核硬度分级Ⅱ～Ⅳ级)患者133例133眼,随机分为两组,试验组采用主控液流系统,对照组采用重力液流系统。术中记录累积释放能量(CDE)、抽吸时间(AT)、灌注液用量(EFU),分别于术前和术后1d测量角膜内皮细胞计数(ECD)和中央角膜厚度(CCT)。

结果：术中试验组患者的CDE、AT、EFU明显低于对照组(均P<0.05),术后1d试验组和对照组患者ECD均较术前轻度减少,CCT均较术前轻度增加,但两组间均无差异(2056.06±308.10cells/mm² vs 1997.26±297.55cells/mm²,532.75±12.02μm vs 531.02±13.00μm; 均P>0.05),且两组患者术中及术后均未发生严重的眼部并发症。

结论：Centurion主控液流系统在整个手术过程中能够维持恒定的眼内压,有效提高了前房稳定性,比传统重力液流系统更加安全高效。     

Clinical features and clinical course of thyroid-associated ophthalmopathy: a case series of 3620 Chinese cases

ObjectivesTo determine the clinical features and course of thyroid-associated ophthalmopathy (TAO) in a large sample of Chinese patients.Design and methodsWe retrospectively identified a cohort of consecutive patients diagnosed with TAO at the West China Hospital from October 1, 2009 to October 1, 2019. We analysed clinical data from 3620 patients, including demographic data, clinical manifestations, ophthalmology examinations, and prognosis.ResultsTAO most frequently occurred with hyperthyroidism, with most patients developing TAO after thyroid disease (TD). The TAO phenotype was asymmetric in 375 (50.7%) euthyroid patients, 25 (27.8%) hypothyroid patients, and 314 (12.1%) hyperthyroid patients (p < 0.0001). The most frequent symptom was lid lag and the most commonly involved extraocular muscle was the inferior rectus. Severity assessment (NOSPECS score) and clinical activity assessment (Clinical Activity Scores, CAS) differed significantly between male and female patients (P < 0.000). The majority (88.8%) of patients had clinically inactive TAO, and only 3.2% of cases were sight-threatening. Regarding the clinical process, 75.5% of patients had an active phase time less than 12 months and 2.1% showed complete remission.ConclusionsTAO most commonly develops in females and is closely related to hyperthyroidism. Euthyroid TAO often has an asymmetric clinical phenotype. CAS combined with magnetic resonance imaging can improve the detection of TAO. NOSPECS scores should be slightly refined regarding the criteria for corneal involvement. Clinical management of TAO should be individualized according to CAS or NOSPECS assessments and a multidisciplinary approach is paramount. A minority of patients showed complete remission.Subject terms: Eye manifestations, Epidemiology     

糖皮质激素改善活动期甲状腺相关眼病患者IL-17和IL-21的意义及其与效果的相关性

目的:探讨IL-17、IL-21在糖皮质激素治疗活动期甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)中的临床意义及与其治疗效果的相关性分析.方法:将我院收治的TAO患者67例134眼,按临床活动度评分标准(clinical activity score, CAS)分为活动期组和非典型活动期组,同时以30例60眼健康者为对照组,对活动期组患者采用糖皮质激素冲击疗法进行治疗,并于治疗前后进行CAS评分,测量突眼度和眼裂宽度,同时比较各组患者IL-17、IL-21的表达水平,并分析IL-17、IL-21与CAS评分的相关性. 结果:与对照组相比,TAO患者IL-17和IL-21表达均显著升高,差异有统计学意义(P<0.05);活动期TAO患者IL-17和IL-21的表达水平均高于非典型活动期,差异有统计学意义(P<0.05);糖皮质激素治疗后,活动期TAO患者IL-17和IL-21表达水平较治疗前均降低,差异有统计学意义(P<0.05),且活动期TAO患者IL-17的表达与CAS评分呈显著正相关(治疗前:r =0.8847,P=0.0462,治疗后:r=0.8886,P=0.0439),活动期TAO患者IL-21的表达与CAS评分呈显著正相关(治疗前:r=0.8893,P=0.0435;治疗后:r=0.8876,P=0.045). 结论:IL-17和IL-21与TAO病情活动密切相关,而糖皮质激素冲击治疗可通过降低活动期TAO患者IL-17和IL-21表达发挥作用,IL-17和IL-21可作为反映TAO患者病情和预测疗效的指标之一.     

甲状腺相关眼病患者泪腺参数眼眶磁共振成像的临床研究

目的:应用眼眶磁共振成像(MRI)技术评估甲状腺相关眼病(TAO)患者泪腺参数及其与临床检查的相关性。方法:选取TAO患者38例76眼为病例组,选取与病例组性别与年龄段匹配的自愿参与接受检查的体检人群中的26例52眼作为正常对照组。根据改良疾病临床活动性评分(CAS)将其分为活动期TAO组、非活动期TAO组。采集MRI图像后在T1WI测量眼球突出度,在T2WI横断位与冠状位测量泪腺最大横截面时的最大横径、纵径与面积,并记录泪腺最大T2值与平均T2值。结果:活动期TAO组和非活动期TAO组年龄、性别、眼球突出度均无差异(P>0.05)。冠状面及横断面下的泪腺面积,活动期TAO组较非活动期TAO组、正常对照组升高,非活动期TAO较对照组升高(均P<0.01)。冠状面及横断面下的泪腺纵径,活动期TAO组较非活动期TAO组、正常对照组升高(均P<0.05)。活动期TAO组与非活动期TAO组冠状面与横断面下的泪腺横径均较正常对照组升高(均P<0.05)。活动期TAO组最大T2值较非活动期TAO、正常对照组升高,非活动期TAO较正常对照组升高(均P<0.05)。活动期...     

Clinical features of thyroid-associated ophthalmopathy in clinically euthyroid Korean patients

Aim

To compare clinical characteristics and thyroid-stimulating hormone receptor antibodies (TRAbs) in thyroid-associated ophthalmopathy (TAO) in euthyroid Korean patients with those in hyperthyroid patients.

Methods

Clinical activity scores (CASs), modified NOSPECS scores, exophthalmometry values, prevalence of optic neuropathy, restrictive myopathy and lid retraction, and the positivity and levels of TRAb (thyrotropin-binding inhibitor immunoglobulin (TBII) and thyroid-stimulating immunoglobulin (TSI)) were compared in 24 euthyroid (group A) and 139 clinical/subclinical hyperthyroid TAO patients (group B).

Results

Group A presented more clinically unilateral involvement than group B (79.2% vs 27.3%, P<0.001), less active (CAS 1.50 vs 2.26, P=0.014) and less severe clinical course (NOSPECS 3.38 vs 4.13, P=0.037). Lid retraction was more prevalent in group A than group B (91.7% vs 66.2%, P=0.014). Prevalence of optic neuropathy and restrictive myopathy, and the mean value of exophthalmometry were not different. Mean TBII levels were lower (7.20 IU/l) in group A than in group B (44.58 IU/l, P<0.001). A similar difference was found in the TSI bioassay (201.40% vs 425.19%, P=0.001). The positive rate of TBII in group A (34.8%) was significantly lower than in group B (90.8%, P<0.001). The positive rate of TSI was high in both group A (83.3%) and B (91.7%), with no significant difference (P=0.337).

Conclusions

Patients with euthyroid TAO showed a less active and severe clinical course, more unilateral involvement, and lower levels of TRAb than those in patients with hyperthyroid TAO. These distinct clinical and biochemical characteristics might be useful in assessment of euthyroid TAO, and the TSI might be more sensitive for diagnosing these patients.     

Ultrasound measurement of the horizontal external eye muscles in patients with thyroid disease. Is orbital involvement associated with thyroid autoantibodies?

PURPOSE: To describe ophthalmic findings with emphasis on exophthalmometry and ultrasonic assessment of extraocular eye muscle diameter in a consecutive group of females with Graves' disease (GD), compared with healthy controls and patients with other thyroid diseases. We also investigated the relationship with biochemical markers of thyroid autoimmunity such as TSH receptor antibodies (TRAb) and anti-thyroid peroxidase antibodies (anti-TPO). METHODS: Seventy adult women (age 26-74 years) with various types of thyroid disease consecutively entered the study at a tertiary referral center for thyroid-associated ophthalmopathy (TAO). Twenty-three had long-standing GD with TAO. Clinically, TAO was mainly absent in 22 with newly diagnosed GD and in seven with relapse of GD. Nine with Hashimoto's thyrolditis and nine with multinodular goiter were included for comparison and 18 healthy females served as controls. A full ophthalmic status included B-scan ultrasonic assessment of the four horizontal rectus muscle thicknesses, and a clinical NOSPECS score was attempted for each. RESULTS AND CONCLUSIONS: Besides higher NOSPECS scores, the TAO subgroup had higher exophthalmometry and muscle thickness. The GD groups without significant TAO also scored higher in these ratings compared to controls. Hertel recordings, NOSPECS and muscle thicknesses were all correlated in GD but showed no correlation to thyroid antibodies (TRAb and anti-TPO). Thus, the muscle thickness did not correlate with thyroid autoimmune activity. Nevertheless, we found extraocular muscle assessment useful since a) thicker muscles were usually found in patients with GD, with or without evidence of TAO, and b) other space-occupying orbital lesions could be excluded, thereby reducing the need for the more elaborate imaging techniques (CT, MRI, etc.).     

血清淀粉样蛋白A检测对感染性眼内炎诊断的临床价值

目的：探讨血清淀粉样蛋白A(SAA)在感染性眼内炎诊断中的临床应用价值。

方法：收集2016-06/2019-03我院就诊的270例患者,其中116例感染性眼内炎患者作为研究组,154例非感染性患者作为对照组。采用胶体金免疫层析法检测SAA水平,用受试者工作特征(ROC)曲线分析诊断效能。

结果：感染性眼内炎患者和对照组SAA值中位数分别为14.98、2.56mg/L,两组比较有差异(P<0.001); CRP值和WBC值中位数两组比较均有差异(P<0.001)。SAA、CRP和WBC计数诊断感染性眼内炎的ROC曲线下面积分别为0.772、0.638、0.618,SAA检测取Youden指数最大值所对应的最佳临界值为6.975mg/L,其灵敏度为63.79%,特异度为84.42%。

结论：SAA联合CRP和WBC计数有助于提高感染性眼内炎的诊断效能。SAA可为感染性眼内炎的辅助诊断提供有用的参考信息。     

基因重排检测技术联合玻璃体液中IL-10和IL-6检测对PIOL的诊断价值

目的：研究基因重排检测技术联合玻璃体液中白介素-10(IL-10)、白介素-6(IL-6)细胞因子检测对原发性眼内淋巴瘤(PIOL)的诊断价值。

方法：研究对象为本院2015-01/2019-12收治的拟诊断为PIOL患者27例的临床资料,经诊断性玻璃体切割术病理检查确诊PIOL 患者21例,葡萄膜炎6例; 回顾性分析其基因重排检测结果及玻璃体液中IL-10、IL-6水平,绘制受试者工作特征(ROC)曲线分析基因重排检测技术、玻璃体液中IL-10、IL-6水平及两者联合对PIOL的诊断价值。

结果：纳入的21例PIOL患者中,15例IhH FR2单克隆性重排序列,阳性率为71%(15/21); 4例检出TCRG克隆性基因重排序列; 经ROC曲线分析显示基因重排检测技术诊断PIOL的曲线下面积值(AUC)为0.857,敏感性、特异性分别为71.43%、100.00%; PIOL患者玻璃体液中IL-10及IL-10/IL-6水平均显著高于葡萄膜炎患者,但两种病变患者IL-6水平无差异(P>0.05); 经ROC曲线分析显示IL-10诊断PIOL的AUC值最高,以170.90pg/mL为IL-10的cut-off,其诊断PIOL的敏感性、特异性分别为66.67%、100.00%; 而以1.95为IL-10/IL-6比值的cut-off,其诊断PIOL的敏感性为52.40%、特异性为100.00%; 基因重排检测技术联合玻璃体液中IL-10、IL-10/IL-6水平检测诊断PIOL的AUC为0.893,敏感性、特异性分别为95.24%、83.33%。

结论：单一基因重排检测技术诊断PIOL敏感性欠佳,联合玻璃体液中IL-10、IL-6水平检测可获得更佳的诊断敏感性,且特异性良好。     

Novel use of 3T MRI in assessment of optic nerve volume in glaucoma

Purpose

To measure optic nerve (ON) volume using 3 T magnetic resonance imaging (MRI), to correlate ON volume with retinal nerve fiber layer (RNFL) thickness, and to determine the viability of MRI as an objective tool in distinguishing glaucoma severity.

Methods

In this cross-sectional study, 30 severe glaucoma patients, 30 mild glaucoma patients and 30 age-matched controls were recruited. All subjects underwent standard automated perimetry, RNFL analysis and 3 T MRI examinations. Glaucoma patients were classified according to the Hodapp–Anderson–Parish classification. Pearson’s correlation coefficient was used to correlate ON volume with RNFL, and receiver operating curve (ROC) analysis was performed to determine the sensitivity and specificity of ON volume in detecting glaucoma severity.

Results

Optic nerve volume was significantly lower in both the left and right eyes of the severe glaucoma group (168.70?±?46.28 mm³; 167.40?±?45.36 mm³) than in the mild glaucoma group (264.03?±?78.53 mm³; 264.76?±?78.88 mm³) and the control group (297.80?±?71.45 mm³; 296.56?±?71.02 mm³). Moderate correlation was observed between: RNFL thickness and ON volume (r?=?0.51, p <0.001), and in mean deviation of visual field and optic nerve volume (r?=?0.60, p?<?0.001). ON volume below 236 mm³ was 96 % sensitive and 80 % specific for the detection of severe glaucoma.

Conclusions

MRI measured optic nerve volume is a reliable method of assessing glaucomatous damage beyond the optic nerve head. A value of 236 mm³ and below can be used to define severe glaucoma.     

Isolated superior oblique muscle extranodal marginal zone B cell lymphoma: case report

We describe a rare case of isolated extraocular muscle ocular adnexal lymphoma of a middle-aged female who presented with redness in the left eye associated with progressive proptosis over one year. Magnetic resonance imaging of the orbit indicated isolated enlargement of the left superior oblique (SO) muscle with an apparent diffusion coefficient (ADC) of (0.77?±?0.11?×?10^?3?mm²/s). Histopathology with immunohistochemical staining of the incisional biopsy from the SO muscle belly confirmed the diagnosis of extranodal marginal zone B cell lymphoma.     

血浆胰岛素水平与屈光发育的相关性分析

目的：探讨血浆胰岛素水平与屈光发育的相关性。

方法：收集2019-01/06在我院眼科检查的11～12岁青少年293例,根据屈光度分为正视组(76例)、低、中度近视组(144例)、高度近视组(35例)、远视组(38例)。测定并比较四组受检者空腹及餐后2h血浆胰岛素及其相关指标(血糖、糖化血红蛋白、C肽)水平,分析血浆胰岛素及其相关指标与屈光度的相关性,并采用受试者工作特性(ROC)曲线探讨血浆胰岛素水平对屈光发育异常的诊断价值。

结果：低、中度近视组、高度近视组空腹或餐后2h胰岛素、血糖、糖化血红蛋白、C肽的平均水平均高于正视组、远视组,且高度近视组胰岛素、血糖、糖化血红蛋白含量高于低、中度近视组(均P<0.01)。餐后2h血浆胰岛素、血糖、糖化血红蛋白、C肽水平与屈光度均呈负相关(r=-0.691、-0.756、-0.546、-0.311,均P<0.05)。ROC曲线显示,餐后2h血浆胰岛素水平鉴别屈光不正的截断值为0.367,最大曲线下面积为0.708(P<0.001,95%CI：0.576～0.840),敏感性为63%,特异性为73.7%。

结论：血浆胰岛素水平升高可能影响屈光发育,其水平越高近视程度越高。因此,在生长期经常高糖碳水化合物饮食可能会导致屈光不正的发展及永久性视力损伤。