三硝基甲苯白内障患者眼部的超声检查分析

Analysis of eye ultrasonography in patients with trinitrotoluene cataract

目的 探讨超声检查对三硝基甲苯（TNT）白内障的诊断价值.方法 应用超声和裂隙灯对比观察45例90只TNT白内障及60例120只健康成人眼晶状体的形态及内部回声,同时测量眼球后动脉血流动力学参数以裂隙灯显微镜检查结果为诊断标准,计算超声对TNT白内障诊断的敏感性、特异性和诊断符合率. 结果 超声检出 TNT白内障的敏感性为93.33％,特异性为100.00％,诊断符合率为97.14％,阳性预测值为100％,阴性预测值为95.23％,阳性似然比为93.33,阴性似然比为0.67.超声显示：随着TNT白内障期别的增加,晶状体出现梭形、球形、盘状等形态改变,后囊膜弧形回声带逐渐增厚、回声增强眼动脉（OA）、视网膜中央动脉（CRA）的收缩期峰值流速（PSV）、舒张末期流速（EDV）明显低于正常组（P＜0.01）,阻力指数（RI）增高（p＜0.05）,差异有统计学意义.结论 超声对TNT白内障晶状体病变的敏感性与眼科裂隙灯相近.超声能客观真实反映出晶状体混浊的形态、范围、密度程度,且容易观测,有助于裂隙灯明确TNT白内障的诊断与分期,还可提供眼球后动脉血流动力学信息,为临床医生判断病情、估测治疗效果及探索治疗途径提供新的思路.

Objective To evaluate the diagnostic value of ultrasonography for trinitrotoluene （TNT） cataract.Methods The morphology and internal echoes of 90 lenses of 45 TNT cataract patients and 120 lenses of 60 healthy adults were observed and compared using ultrasonography and slit lamp,and the hemodynamic parameters of the post-ophthalmic artery were also measured.The findings of the slit-lamp microscope were regarded as diagnostic criteria,and the sensitivity,specificity,and accordance rate of ultrasonography in the diagnosis of TNT cataract were calculated.Results The sensitivity,specificity,and accordance rate of uhrasonography in the diagnosis of TNT cataract were 93.33%,100.00%,and 97.14%,respectively;the positive and negative predictive values were 100% and 95.23%,respectively;the positive and negative likelihood ratios were 93.33 and 0.67,respectively.With the progression of TNT cataract,ultrasonography showed that the lenses demonstrated morphological changes （spindle-shaped,spherical,and discoid morphologies）,and the arc echoes of the posterior capsule were thickened and enhanced.The TNT cataract patients showed significantly lowerpeak systolic velocity and end-diastolic velocity of the ophthalmic artery （OA） and central retinal artery （P〈0.01） and a significantly higher resistance index （P〈0.05） than the healthy adults.Conclusion The sensitivity of ultrasonography in the diagnosis of TNT cataract is similar to that of slit lamp.Ultrasonography can demonstrate objectively the shape,range,and degree of lens opacity in an efficient manner,which is conducive to the diagnosis and staging of TNT cataract by slit lamp,and can also provide hemodynamic information of the OA.thus providing new ideas for clinical physicians in evaluating the disease and clinical efficacy as well as exploring therapies.