儿童视网膜血管管径测量一致性分析

目的分析不同观察者使用计算机辅助的视网膜图像分析技术测量儿童视网膜血管管径的临床可靠性和一致性。方法横断面研究。1名熟练研究者和3名新培训研究者背靠背应用IVAN定量测量软件对100例4~8岁儿童的眼底图像视网膜血管进行测量。测量4个象限靠近视盘的视网膜中央动脉直径当量和视网膜中央静脉直径当量。通过半自动软件计算动静脉管径比例。计算组内相关系数（ICC）评价观察者间的一致性；将数据从低到高平均三等分转换成有序多分类资料，绘制列联表，并计算Kappa系数，评价3名新培训研究者分别与熟练研究者之间一致性；绘制Bland-Altman图评价观察者间的一致性。结果熟练研究者与3名新培训的研究者测量结果一致性良好。视网膜中央动脉直径当量分别为121.14±17.03、120.40±17.68、120.45±17.61、120.79±19.05，各研究者间ICC为0.943（0.923～0.960），Kappa值分别为0.702、0.745、0.744。视网膜中央静脉直径当量分别为181.66±29.33、181.55±29.31、181.23±30.12、181.53±31.46，各研究者间ICC为0.939（0.917～0.956），Kappa值分别为0.822、0.860、0.860。动静脉比值分别为0.67±0.06、0.66±0.07、0.67±0.06、0.67±0.06，各研究者间ICC为0.685（0.625～0.715），Kappa值分别为0.753、0.604、0.601。结论利用IVAN软件对儿童视网膜血管直径进行测量一致性高，是可行和可靠的，可以为眼科医生定量分析视网膜血管直径提供依据。

Agreement on retinal vessel measurement in children

Objective To assess retinal vessel caliber using computer-assisted software; to study clinical reliability and consistency between different reasearchers. Methods In this cross-sectional study, the retinal vessel diameters of 100 fundus pictures of children aged from 4 to 8 years were measured independently by 4 researchers using IVAN (University of Wisconsin, Madison, WI) computer-assisted quantitative assessment software. The arteriolar/venular caliber was measured and the ratio was calculated with the semi-automated software. Intraclass correlation coeffient were calculated to assess agreement between different researchers. Kappa test analysis was performed to assess agreement between new researchers and skilled researcher. Bland-Altman plots were drawed. Results Analysis of the retinal arteriolar and venular can be performed and reproduced on routine retinal photographs. The mean central retinal arteriolar (CRAE) measurements by the 4 researchers were 121.14 ±17.03, 120.40±17.68, 120.45±17.61, 120.79±19.05; the ICC value was 0.943 (0.923-0.960). The mean central retinal venular equivalents (CRVE) were 181.66±29.33, 181.55±29.31, 181.23±30.12, 181.53±31.46; the ICC value was 0.939(0.917-0.956). The mean arteriolar/venular measurements were 0.67 ±0.06, 0.66±0.07, 0.67± 0.06, 0.67±0.06; the ICC was 0.685(0.625-0.715). The Kappa values of CRAE were 0.702, 0.745 and 0.744, respectively; the values of CRVE were 0.822, 0.860 and 0.860, respectively; the values of the arteriolar/venular were 0.753, 0.604 and 0.601. Conclusion Retinal vessel measurements with IVAN software are reliable early in life. It can be helpful for future retinal vessel caliber assessment from a young age.