糖尿病视网膜病变筛查方式探讨

Study of diabetic retinopathy screening modes

目的:通过对散瞳直接眼底镜检查、免散瞳数码眼底照相及眼底荧光造影3种检查方法对可疑糖尿病视网膜病变患者进行检查和评估比较,优化检查程序和方法。方法:对2007-01/2009-01就诊我院门诊和住院确诊的264例糖尿病患者进行散瞳直接眼底镜检查、免散瞳数码眼底照相及眼底荧光造影检查。眼底病专科医师阅片进行诊断,以眼底血管荧光造影诊断为标准。主要指标散瞳直接眼底镜检查、免散瞳数码眼底照相方法进行筛查诊断的敏感性、特异性及与眼底血管荧光造影诊断结果的一致性。结果:以糖尿病视网膜病变Ⅰ期为筛查阈值时直接眼底镜检查和免散瞳眼底照相的敏感度分别是63.4%,86.8%,特异度分别是76.9%,92.3%,Youden指数分别是41.1%,79.1%,Kappa检验的一致性分别是41.9%,80.7%。以糖尿病视网膜病变2期为筛查阈值时,直接眼底镜检查和免散瞳眼底照相的敏感性分别是65.5%,93.1%,特异性分别是94.7%,97.4%,Youden指数分别是60.3%,90.5%,Kappa检验的一致性分别是39.1%,61.2%。结论:免散瞳数码眼底彩色照相可作为糖尿病视网膜病变Ⅱ期以上糖尿病视网膜病变优化筛查诊断方法。

AIM： To evaluate the ability of digital fundus photography and direct funduscopy to detect diabetic retinopathy（DR） in patients with diabetic mellitus （ DM compared with fundus fluorescein angiography（FFA）. METHODS： All 264 cases with diabetes underwent nonmydriatic digital fundus photography, FFA, and direct funduscopy with dilation of their pupils. Then statistics contrast study of direct funduscopy and FFA, nonmydriatic digital fundus photography and FFA were carried out respectively. RESULTS： In comparison with FFA, mild nonproliferative DR being taken as referable DR, direct funduscopy with dilation of pupils gave a sensitivity of 63.4%,a specificity of 76.9%, and a Kappa statistic of 41.9%, a Youden of 41.1%, digital fundus photography gave a sensitivity of 86.8%, a specificity of 92. 3%, and a Kappa statistic of 80. 7% ,a Youden of 79.1% ; moderate nonproliferative DR being taken as referable DR, direct funduscopy with dilation of pupils gave a sensitivity of 65.5%, a specificity of 94.7%, and a Kappa statistic of 39.1%, a Youden of 60. 3%, and digital fundus photography gave a sensitivity of 93.1%, a specificity of 97.4%, and a Kappa statistic of 61.2% ,a Youden of 90.5%. CONCLUSION： Digital fundus photography centered at fovea for screening of early DR especially stage DR Ⅱ or more severe.