青光眼视野指数与视野形态分期的关系及其诊断价值

Relationship between visual field index and visual field morphological stages of glaucoma and their diagnostic value

目的探讨青光眼视野指数与视野损伤形态分期的关系及其合理性以及视野指数分期诊断的临床价值。方法回顾性系列病例研究。采用Humphrey视野计标准自动检查法，选取2014年3月至9月健康无眼病者100名（正常组）和青光眼患者274例（患者组），患者组依据视野损伤形态特征分为4期，分别观察各组视野平均缺损和视野指数的数据分布特征，采用受试者特性工作曲线（ROC）方法分析视野形态分期与视野指数的匹配关系，并比较两个视野指标的分期诊断价值。对各组受试者一般情况基本数据进行比较，计数资料用χ^2检验，计量资料用方差分析；各组之间视野平均缺损和视野指数差异的检验均用方差分析检验，多重比较用最小显著差数法；两个视野指数与视野各组之间的关系即视野指数分期诊断性能的评价，采用ROC的分析方法，两个视野指标分期诊断性能的比较，采用曲线下面积（AUC）的比较方法。结果正常组视野无特征性损伤，相应的平均缺损和视野指数分别为平均缺损=（-0.06±1.24）dB，视野指数=（99.15±0.76）%；青光眼视野损伤按照形态特征分为早期、中期、晚期和末期，各期相应的平均缺损分别为平均缺损早期=（-2.83±2.00）dB、平均缺损中期=（-9.70±3.68）dB、平均缺损晚期=（-18.46±2.90）dB、平均缺损末期=（-27.96±2.76）dB，视野指数分别为视野指数早期=（93.84±3.61）%、视野指数中期=（75.16±10.85）%、视野指数晚期=（49.36±11.26）%、视野指数末期=（17.65±10.59）%；正常组与患者组4期之间、视野平均缺损和视野指数各自任意两期之间，差异均有统计学意义（对平均缺损F=1 165.53，P〈0.01；对视野指数F=1 028.04，P〈0.01）。平均缺损的ROC的AUC为AMD=0.91、标准误为Se平均缺损=0.01，视野指数的ROC曲线下面积为A视野指数=0.97、标准误为Se视野指数=0.01；两个面积的95%可信区间（95%CI）分别为95%CI平均缺损=0.89~0.94、95%CI视野指数=0.94~0.10，两相比较为A视野指数〉A平均缺损（P〈0.05）。结论Humphrey视野计青光眼视野损伤形态的临床分期可以分为早期、中期、晚期和末期，各期平均缺损和视野指数的数据分布对于青光眼视野损伤的分期诊断均有较高的准确性，同时视野指数稍优于平均缺损，能够更好地反映青光眼视野损伤的轻重程度。

Objective To investigate the rationality of visual field morphological stages of glaucoma, its relationship with visual field index and their diagnostic value. Methods Retrospective series case study. Two hundred and seventy-four glaucoma patients and 100 normal control received visual field examination by Humphrey perimeter using standard automatic perimetry （SAP） program from March 2014 to September 2014. Glaucoma patients were graded into four stages according to characteristic morphological damage of visual field, distribution of mean defect （MD） and visual field index （VFI） of each stage were plotted and receiver operation characteristic curve （ROC） was used to explore its correlation with MD and VFI. The diagnostic value of MD and VFI was also compared. For the comparison of general data of subjects, categorical variables were compared using X^2 test, numerical variables were compared using F test. MD and VFI were compared using ANOVA among stages according to visual field, followed by multiple comparisons using LSD method. The correlation between MD and VFI and different stages according to visual field defined their diagnostic value, and compared using area under the curve （AUC） of ROC. Results No characteristic visual field damage was found in normal control group, and MD and VFI was （-0.06±1.24） dB and （99.15±0.76） %, respectively. Glaucomatous visual field damage was graded into early, medium, late and end stage according to morphological characteristic. MD for each stage were （-2.83±2.00） dB, （-9.70±3.68） dB, （-18.46±2.90） dB, and （-27.96±2.76） dB, respectively. VFI for each stage were （93.84±3.61）%, （75.16± 10.85）%, （49.36±11.26）% and （17.65± 10.59）%, respectively. MD and VFI of each stage of glaucomatous group and normal control group were all significantly different （F=I 165.53 and P〈 0.01 for MD; F=1028.04 and P〈0.01 for VFI）. AUC of ROC was AMp=0.91 and SeMD=0.01 （95% confident interval was 0.89-0.94） for MD, and Avn=0.97, SeVFI=0.01 （95% confident interval was 0.94-0.10） for VFI. So, AUC〉AUCMD （P〈0.05）. Conclusions It is feasible and rational of glaucomatous visual field damage to be graded into early, medium, late and end stage using Humphrey perimeter. Distribution of MD and VFI for each stage was relatively concentrative. Both MD and VFI were useful for grading glaueomatous visual field damage with preference for VFI.