基于视网膜神经纤维层厚度及神经节细胞复合体诊断POAG的效能分析

目的：比较原发性开角型青光眼( primary open angle glaucoma,POAG)与正常对照组盘周视网膜神经纤维层厚度( retinal nerve fiber layer thickness,RNFL)及黄斑区神经节细胞复合体( ganglion cell complex,GCC)厚度差异,并评价盘周 RNFL 厚度及黄斑 GCC 厚度在 POAG 中的诊断价值。
　　方法：采用横断面研究。连续的POAG患者56例纳入研究。选择同期年龄、性别、屈光度及眼轴匹配的正常人60名60眼作为正常对照组。用RTVue-100光学相干断层扫描技术( optical coherence tomography,OCT)检测并比较POAG组及对照组盘周RNFL厚度及黄斑GCC厚度。采用受试者工作特征曲线( receiver operating characteristic curve,ROC)及ROC曲线下面积( area under curve,AUC)评价盘周 RNFL 厚度及黄斑 GCC 厚度对青光眼的诊断价值。
　　结果：POAG组患者盘周所有象限RNFL均薄于正常对照组,差异有统计学意义( P<0.001)。 POAG组患者黄斑所有区域GCC厚度均小于正常对照组,差异有统计学意义(P<0.001)。多因素线性回归分析结果,PAOG诊断是盘周RNFL厚度与黄斑GCC厚度的独立相关因素。 ROC及AUC分析提示：杯盘比AUC值最大( AUC=0.936；95%CI=0.903~0.964),其次为上方 RNFL 厚度( AUC=0.910；95%CI=0.889~9.455),诊断价值高,盘周鼻侧,下方,颞侧RNFL厚度以及黄斑上方,下方平均GCC厚度AUC值均大于0.8,具有较好的诊断价值。
　　结论：POAG患者盘周RNFL厚度与黄斑GCC厚度均明显变薄,变薄的盘周RNFL厚度与黄斑GCC厚度与POAG诊断存在相关性。盘周RNFL厚度与黄斑GCC厚度均有较好的诊断价值。

Analysis on detecting primary open angle glaucoma based on retinal nerve fiber layer and ganglion cell complex thickness

AIM:To investigate the peripapillary retinal nerve fiber layer(RNFL)thickness and the macular ganglion cell complex(GCC)thickness in primary open angle glaucoma(POAG)eyes and to compare them with normal control eyes, and to evaluate the diagnostic ability of peripapillary RNFL thickness and macular GCC thickness in POAG.

METHODS:This was a cross-sectional study consisting of 56 POAG patients. The control group consisted of 60 normal subjects(60 eyes)were matched in terms of age, sex, diopter and axial length. The peripapillary RNFL thickness and the macular GCC thickness of POAG eyes and normal control eyes were measured and compared by RTVue-100 optical coherence tomography(OCT). To assess the diagnostic utility of peripapillary RNFL thickness and macular GCC thickness in POAG, receiver operating characteristic curves(ROC)and areas under the ROC(AUC)were used.

RESULTS:The POAG eyes had a thinner peripapillary RNFL and macular GCC than the control eyes at all the regions(P<0.001). Multivariable linear regression analysis showed that the peripapillary RNFL thickness and macular GCC thickness was significantly thinner in association with the POAG diagnosis. ROC and AUC analysis showed that the best AUC parameters were C/D(AUC=0.936; 95% CI=0.903, 0.964)and superior RNFL thickness(AUC=0.910; 95% CI=0.889, 9.455). The AUC of nasal RNFL thickness, inferior RNFL thickness, temporal RNFL thickness, superior GCC thickness, inferior GCC thickness, and average GCC thickness were all above 0.8 with a good diagnostic value.

CONCLUSION:The peripapillary RNFL thickness and macular GCC thickness in POAG eyes are thinner than that of normal control eyes. Decreased peripapillary RNFL thickness and macular GCC thickness may be associated with POAG. The peripapillary RNFL thickness and macular GCC thickness have a good diagnostic value.