经眼眶超声测量视神经鞘直径在诊断妊娠期高血压疾病患者颅内压增高中的价值

Value of transorbital ultrasonography of optic nerve sheath diameter in the diagnosis of intracranial hypertension in patients with hypertensive disorder complicating pregnancy

目的探讨经眼眶超声测量视神经鞘直径(ONSD)在诊断妊娠期高血压疾病(HDCP)患者颅内压(ICP)增高的价值。方法选取70例疑似ICP增高的HDCP孕妇作为研究组,同时纳入30例无合并症单胎孕妇为对照组。对每位研究组的孕妇均行MRI及经眼眶超声测量ONSD检查,并根据MRI的检查结果将研究组分为ICP正常组及ICP增高组;对照组仅行经眼眶超声测量ONSD。比较三组间ONSD值差异,并采用受试者工作特征(ROC)曲线探究ONSD检测HDCP患者ICP增高的最佳阈值。结果对照组、ICP正常组和ICP增高组的ONSD值分别为(4.62±0.51)mm、(4.70±0.66)mm、(5.80±0.40)mm;ICP增高组高于对照组及ICP正常组(P<0.05),但对照组及ICP正常组的ONSD值无差异(P>0.05)。以ONSD≥5.3 mm为诊断ICP增高的最佳阈值,灵敏度为86.7%(26/30)、特异度为85.0%(34/40),阳性预测值为81.3%(26/32),阴性预测值为89.5%(34/38),准确度为85.7%(60/70)。结论经眼眶超声测量ONSD对诊断HDCP患者ICP增高具有较高的价值。

Objective To explore the value of transorbital ultrasonography of optic nerve sheath diameter（ ONSD） in the diagnosis of intracranial pressure（ ICP） hypertension in patients with hypertensive disorder complicating pregnancy（ HDCP）. Methods A total of70 HDCP patients suspected with ICPH were enrolled as the study group,and 30 singleton pregnant women without complications were selected as the control group. Patients in the study group were examined by MRI and transorbital ultrasonography,and then divided into ICP normal group or ICP increased group according to the results of the MRI. The control group was only examined with transorbital ultrasonography.ONSD value of the three groups were compared,and the optimal diagnosis threshold of ONSD in predicting ICP hypertension was determined by the receiver operating characteristic（ ROC） curve. Results ONSD values of control group,ICP normal group and ICP increased group were（ 4.62 ±0.51） mm,（ 4.70 ±0.66） mm,（ 5. 80 ± 0. 40） mm,respectively. ONSD value of ICP increased group was higher than that of control group and ICP normal group,but no significant difference existed between the control group and the ICP normal group（ P〈0. 05）. ROC curve showed that ONSD≥5. 3 mm was the optimal diagnostic threshold for the diagnosis of ICP hypertension,with a sensitivity of 86. 7%（ 26 /30）,a specificity of 85%（ 34 /40）,a positive predictive value of 81. 3%（ 26 /32）,a negative predictive value of 89. 5%（ 34 /38）,and an accuracy of 85. 7%（ 60 /70）. Conclusion Transorbital ultrasonography of ONSD has a high value in diagnosing ICP hypertension in HDCP patients.