超声生物显微镜暗室激发试验

Ultrasound biomicroscopic dark room provocative test

目的比较超声生物显微镜（ｕｌｔｒａｓｏｕｎｄｂｉｏｍｉｃｒｏｓｃｏｐｙ，ＵＢＭ）暗室激发试验与传统暗室激发试验在闭角型青光眼筛选中的应用价值。方法选择２２例（２２只眼）先兆期闭角型青光眼作为患者组，１５例（３０只眼）深前房正常者作为对照组，分别进行传统暗室试验和ＵＢＭ暗室试验。比较两种暗室试验前后房角的变化与眼压差，采用统计学χ２检验比较两者的阳性率。结果两种暗室试验结果显示，闭角型青光眼组２２只眼中，１０只眼试验前后眼压差＞１．０７ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ），１２只眼试验前后眼压差＜１．０７ｋＰａ或无变化。ＵＢＭ暗室试验发现，１５只眼出现房角功能关闭，其中３只眼１个象限关闭，５只眼２个象限关闭，７只眼超过２个象限关闭。传统暗室试验结合Ｇｏｌｄｍａｎｎ房角镜检查发现８只眼房角关闭；其中３只眼２个象限关闭，５只眼２个以上象限关闭。对照组３只眼试验前后眼压差＞１．０７ｋＰａ，ＵＢＭ及Ｇｏｌｄｍａｎｎ房角镜检查均未发现房角功能关闭。以两种暗室试验下诱发的房角关闭为判断标准，ＵＢＭ暗室试验诊断的敏感性为６８．２％，特异性为１００．０％；传统暗室试验的阳性率为３１．８％，两者间敏感性差异有显著性。结论研究结果?

Objective To compare the clinical application of ultrasound biomicroscopic (UBM) dark room provocative test and traditional one in screening primary angle closure glaucoma (PACG). Method 22 eyes (22 cases) with PACG in prodromal stage and 30 eyes (15 cases) with deep anterior chamber and wide angle of 15 normal persons were observed in this trial. Traditional dark room provocative test and UBM dark room provocative test were performed on all the 52 eyes at the same day time on separate days. With different positive diagnostic criteria, the sensitivity of the two methods was compared by using chi square analysis. Results After staying in dark room for 2 hours, in PACG group, the intraocular pressure (IOP) in 10 of 22 eyes raised more than 1.07 kPa (1 kPa= 7.5 mmHg), and in 12 eyes less than 1.07 kPa or had no changes; appositional angle closure was found by Goldmann gonioscopy in 8 eyes; 3 eyes in two quadrants, 5 eyes in more than two quadrants; the appositional angle closure was found by ultrasound biomicroscopy in 15 eyes; 3 eyes in one quadrant, 5 eyes in two quadrants, 7 eyes in more than two quadrants. In the control group, IOP raised more than 1.07 kPa in 3 eyes. There was no appositional angle closure found in the control group. With the appositional angle closure as a positive diagnostic criterion, the sensitivity of the traditional test and UBM dark room test was 31.8% and 68.2%, respectively. With statistic chi square test, there is a statistically significant difference between the two methods ( P <0.05). Conclusions The sensitivity of UBM dark room provocative test is higher than that of the traditional one. The specificity of both methods is 100%. UBM dark room provocative test elevates the sensitivity and specificity of traditional dark room test, and reduces the false negative or positive rate in screening PACG, that is helpful to its accurate diagnosis.