糖尿病视网膜病变不同筛查方法诊断效果的比较性研究

Comparative study of different diabetic retinopathy screening methods

目的评价单视野免散瞳、三视野免散瞳、单视野散瞳、三视野散瞳45°彩色数码眼底照相4种筛查方法与间接眼底镜相比,检出糖尿病视网膜病变的敏感性和特异度。方法采用前瞻性队列研究,取79例2型糖尿病患者(158眼)作为研究对象,用4种筛查方法检查后,以间接眼底镜诊断结果作为参考标准,评价眼底照相的敏感性和特异度。结果与间接眼底镜相比,眼底照相筛查糖尿病视网膜病变的灵敏度和特异度分别为:单视野免散瞳为77.50%和99.15%;三视野免散瞳为93.50%和97.46%;单视野散瞳为90.00%和98.31%;三视野散瞳为97.50%和98.31%。4种筛查方法的一致性结果分别为0.82、0.90、0.90和0.95。对于视网膜病变,眼底照相检出硬性渗出和静脉出血的灵敏度较高,而检出微血管瘤、斑点出血、棉绒斑和毛细血管异常的敏感度较低。结论 4种筛查方法中,三视野免散瞳45°彩色数码眼底照相的检出效果较好,具有合理的灵敏度且患者的依从性较好。

Objective To evaluate the sensitivities and specificities of one-field without mydriasis, three-field without mydriasis, one-field mydriasis and three-field mydriasis of 45° digital color photography for diabetic retinopathy （DR） screening compared with indirect ophthalmoscopy. Methods Prospective cohort study was taken. Seventy-nine diabetic patients （158 eyes） were treated with 4 screening methods to evaluate the sensitivity and specificity of fundns ophthalmoscopy by comparing the results with indirect ophthalmoscopy. Results The sensitivity and specificity of digital photography compared with indirect ophthalmoscopy for detection of DR were 77.50% and 99. 15% using one-field without mydriasis,93.50% and 97.46% using three-field without mydriasis,90.00% and 98.31% using one-field mydriasis,97.50% and 98.31% using three-field mydriasis, respectively. The degrees of agreement for the 4 methods were 0. 82,0. 90,0. 90 and 0. 95, respectively. For retinopathy, sensitivity was greater for detection of hard exudates and venous beading, and lower for detection of microaneurysms,spot hemorrhage, cotton wool spots and abnormality of blood capillaries with fundns ophthalmoscopy. Conclusion In 4 screening methods, three-field mydriasis and 45° digital color photography has a high detection efficacy,reliable sensitivity and good compliance of patients.