24小时眼压监测对原发性开角型青光眼的诊断价值

Diagnostic Value on 24-Hour Monitoring of Intraocular Pressure for Primary Open Angle Glaucoma

目的评价24小时眼压监测对原发性开角型青光眼的诊断价值。方法前瞻性连续纳入2012年1月至2015年5月行24小时眼压监测的372例受试对象,其中青光眼组137例(271眼),对照组235例(470眼)。分别采用视野、OCT及房角镜等金标准与24小时眼压监测比较两组的诊断准确性和特异性。采用SPSS 13.0软件分析数据,应用Kappa检验诊断结果的一致性。结果 24小时眼压监测诊断青光眼的敏感度和特异度分别为97%和78.7%,且与金标准的诊断结果具有一致性(k值=0.707)(P<0.000 1)。与对照组相比,青光眼组在各监测时段眼压均值均更高,差异有统计学意义(P<0.001)。青光眼组的眼压在早上6点和10点出现两个峰值。女性患者的夜间眼压值波动幅度(尤其夜晚22点时)高于男性(t=2.064,P=0.04)。结论 24小时眼压监测是一种有效和便捷的检测手段,可单独或联合其他诊断工具用于早期原发性开角型青光眼疑诊患者的辅助诊断。

Objective To explore the diagnostic value on 24 hour monitoring of intraocular pressure （lOP） for primary open angle glaucoma （POAG）. Methods A prospective study was applied, and a total of 372 subjects through January 2012 to May 2015 for 24 hour IOP monitoring were collected successively, including 137 subjects （271 eyes） with glaucoma （glaucoma group） and 235 subjects （470 eyes） with non-glaucoma （Control group）. Data was analyzed using SPSS 13.0 software, and the Kappa statistics was used to evaluate concordance between 24 hour monitoring of lOP and gold standard for POAG diagnosis. Results The mean value of IOP at all monitoring period in glaucoma group was significant higher than that in the control group （P〈0.001）. The peak of IOP occurred at 6：00 am and 10：00 in the glaucoma group, and the fluctuation value of IOP in women patients at night （especially at 22：00 pm） was higher than that of men （t=2.064, P=0.04）. The sensitivity and specificity of 24 hour lOP monitoring for POAG were 97% and 78.7%, respectively, and with a high consistency comparing to the result of gold standard for POAG diagnosis, with the Kappa values of 0.707 （P〈0.000 1）. Conclusion 24 hour IOP monitoring is efficacy and convenient tool, which can be applied alone or combined with other tools to assist early diagnosis patients who are suspected with POAG, so as to improve the diagnostic accuracy.