Belin角膜扩张分析鉴别早期圆锥角膜的敏感性与特异性

Sensitivity and specificity of Belin / Ambrosio Enhanced Ectasia Display in discriminating subclinical keratoconus

目的探讨Belin角膜扩张分析鉴别早期圆锥角膜的敏感性和特异性。方法选取2011年1月至2014年6月在我院眼科门诊就诊的圆锥角膜患者46例(46眼)为研氉究对象,其中临床期组23例23眼,亚临床期组23例23眼,同时选取正视或低度近视50例(50眼)为对照组。应用Pentacam三维眼前节分析系统,对每个患者进行双眼Belin角膜扩张分析检测,并将角膜前表面扩张分析差异值(difference-front,Bf)、角膜后表面扩张分析差异值(difference-back,Bb)、角膜前表面差异偏差值(deviation of front elevation difference map,Df)、角膜后表面差异偏差值(deviation of back elevation difference map,Db)、角膜平均进展差异偏差值(deviation of average pachymetric progression,Dp)、角膜最薄点偏差值(deviation of minimum thickness,Dt)、ARTmax偏差值(deviation of ARTmax,Da)、总偏差值(total deviation value,Final D)进行Mann-Whitney U检验及受试者工作特征(receiver operating characteristic,ROC)曲线分析。结果临床期组、亚临床期组和对照组Belin角膜扩张分析参数,除亚临床期组与对照组中Dt(P=0.545)、Da(P=0.235)差异无统计学意义外,其余参数在3组间两两比较差异均有统计学意义(均为P<0.05)。临床期组相对于对照组中Final D的曲线下面积最大,为0.997,Bb、Df、Db、Dp、Da均>0.900,Bf、Dt均>0.800。亚临床期组相对于对照组Db的曲线下面积最大,为0.839,Bb为0.812,Final D为0.789,Bf、Df、Dp均>0.600,Dt与Da均>0.500。亚临床期组相对于对照组Db的敏感性最大,为0.870,Dp的特异性最大,为0.920。结论 Belin角膜扩张分析可以将早期圆锥角膜从正常角膜中区分开来,具有较高的敏感性和特异性,但需要复诊进一步鉴别。

Objective To estimate the sensitivity and specificity of Belin/Ambro- sio Enhanced Ectasia Display in discriminating subclinical keratoconus from normal corneas. Methods Forty-six keratoconus patients （46 eyes） at subclinical stage and clinical stage （Rabinowitz diagnosis standards）, and 50 normal eyes from 50 subjects with emmetropia or low myopia from the first Affiliated Hospital of China Medical Uni- versity during January 2014 to June 2014 were enrolled in this research. Belin/Ambrosio Enhanced Ectasia Display of both eyes from each patient were examined by Pentacam i Scheimpfiug. The Mann-Whitney U test, ROC curve were used to compare the mean ： measurements and evaluate the sensitivity and specificity of difference-front （ Bf）, i difference-back （Bb）, deviation of average map （Df）, deviation of back elevation differ- i ence map （ Db）, deviation of average pachymetric progression （ Dp）, deviation of mini- i mum thickness （Dt） ,deviation of ARTmax （Da） , total deviation value （FinalD）. Re- i suits Except for Dt（P = 0. 545 ） and Da（P = 0.235 ）, other parameters had more signif- i icant changes among subclinical keratoconus, clinical keratoconus and normal group（ all P 〈 0.05 ）. The ROC curve analyses showed FinalD had the best AUC （ 0.997 ）, Bb, Df, i Db, Dp, Da 〉 0. 900 in clinical keratoconus and normal group. Db had the highest AUC （0.839）, Bh 〉 0. 800, FinalD 〉 0.700, Bf, Df, Dp 〉 0. 600, Dr, Da 〉 0. 500 in subclinical i keratoconus and normal group. The best sensitivity and specificity in subclinical kerato- i conus nd normal group was Db （ 0. 870 ） and Dp （ 0. 920 ）, respectively. Conclusion Belin/Ambrosio Enhanced Ectasia Display can discriminate subclinicl keratoconus from normal corneas, however, the subsequent visit is needed to reconfuTa.