超声测量视神经鞘直径在诊断重度子痫前期颅内压增高中的应用

目的探讨超声测量视神经鞘直径（ONSD）在诊断重度子痫前期颅内压（ICP）增高的价值。方法选取44例子痫前期的孕妇作为观察组，同时纳入30例无合并症的单胎孕妇作为对照组。对观察组孕妇进行MRI和ONSD检测，根据MRI结果分为ICP正常组和ICP增高组；对照组仅进行ONSD测量。比较3组ONSD值，探究ONSD检测在重度子痫前期病人ICP增高时的最佳阈值。结果3组收缩压、舒张压、孕周和ONSD值差异均有统计学意义（P < 0.01）。其中收缩压和舒张压ICP增高组均显著高于对照组和ICP正常组，且ICP增高组均高于ICP正常组（P < 0.01）；对照组孕周显著高于观察组（P < 0.01）；ONSD值ICP增高组和正常组显著高于对照组，且ICP增高组显著高于ICP正常组（P < 0.01）。ONSD测量方法的曲线下面积0.759（P < 0.01），最大正确指数为0.497，ONSD临界值是4.0 mm，灵敏度为62.2%。结论超声测量ONSD可以用于辅助诊断重度子痫前期ICP增高，当ONSD为4.0 mm时对ICP增高的重度子痫孕妇具有一定的诊断价值。

Study on the application of ultrasound measurment of optic nerve sheath diameter in the severe preeclampsia with intracranial pressure increasing

ObjectiveTo investigate the value ment of ultrasound measurment of optic nerve sheath diameter(ONSD) in the severe preeclampsia with intracranial pressure(ICP) increasing.MethodsForty-four pregnant women with severe preeclampsia and 30 single pregnant women without complications were divided into the observation group and control group, respectively.The MRI and ONSD in observation group were detected, and the observation group was subdivided into the normal ICP group and ICP increasing group according to the MRI results.The ONSD was measured in the control group.The differences of ONSD were compared among three groups.The ROC curve was used to explore the optimal threshold for ONSD detection in severe preepilepsy patients complicated with intracranial pressure increasing.ResultsThe differences of the systolic blood pressure, diastolic blood pressure, gestational weeks and ONSD values among three groups were statistically significant(P < 0.01), and the systolic blood pressure and diastolic blood pressure in ICP increasing group were significantly higher than those in control group and ICP normal group(P < 0.01).The gestational weeks in control group were significantly higher than that in observation group(P < 0.01).The ONSD values in ICP increasing group and normal group were significantly higher than that in control group(P < 0.01), and which in ICP increasing group was significantly higher than that in ICP normal group(P < 0.01).Under the ONSD measurement method, the AUC was 0.759 (95% CI:0.606~0.913, P < 0.01), the maximum Youden index was 0.497, the ONSD critical value was 4.0 mm, and the sensitivity was 62.2%.ConclusionsThe ultrasound measurement of ONSD can be used in the diagnosis of severe preepilepsia with ICP increasing, which has certain diagnostic value when ONSD is 4.0 mm.