糖尿病视网膜病变筛查方法分析

Analysis of Diabetic Retinopathy Screening

目的通过对散瞳直接或间接眼底镜检查、眼底照相及眼底荧光造影3种检查方法,对疑似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2009-02～2011-02间,就诊我院门诊和住院确诊的496例糖尿病患者进行散瞳直接或间接眼底镜检查、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。主要指标散瞳直接或间接眼底镜检查、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,散瞳直接或间接眼底镜检查和眼底照相的敏感度分别是65.7%、87.1%,特异度分别是77.2%9、3.5%,Youden指数分别是42.3%7、8.9%,Kappa检验一致性分别是43.3%、81.7%;以糖尿病视网膜病变2期为筛查阈值时,直接或间接眼底镜检查和眼底照相的敏感性分别是66.4%、94.2%,特异性分别是94.9%、98.4%,Youden指数分别61.7%、91.5%,Kappa检验的一致性分别是40.2%6、2.3%。结论眼底彩色照相可做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。

Objective To evaluate the methods of direct or indirect funduscopy,fundus photography and fundus fluorescein angiography in the detection of suspect diabetic retinopathy（DR） patienta.Methods 496 cases with diabetes underwent non-mydriatic photography,FFA,and direct or indirect funduscopy with dilation of their pupils.Then the contrast study of direct funduscopy or indirect funduscopy and FFA,non-mydriatic photography and FFA were carried out respectively.Results In comparison with FFA,mild non proliferative DR being taken as referable DR,direct funduscopy or indirect funduscopy with dilation of pupils gave a sensitivity of 65.7%,a specificity of 87.1%,and a Kappa statistic of 43.3%、81.7%,a Youden index of 42.3%、78.9%,digital fundus photography gave a sensitivity of 77.2%,a specificity of 93.5%,moderate non proliferative DR being taken as referable DR,direct funduscopy with dilation of pupils gave a sensitivity of 66.4%,a specificity of 94.2%,a Youden of 61.7%、91.5%,and digital fundus photography gave a sensitivity of 94.9%,a specificity of 98.4%,and a Kappa statistic of 40.2%、62.3%.Conclusion Digital fundus photography centered at fovea for screening of early DR especially stage DR Ⅱ or more severe.