非增殖期糖尿病视网膜病变两种分期方法一致性的研究

Study on the consistency of two staging method of non proliferative diabetic retinopathy

目的观察非增殖期糖尿病视网膜病变两种分期方法的一致性。方法回顾性研究2014年1月~2016年6月于我院行FFA检查的非增殖期糖尿病视网膜病变患者共84例162眼。对每例患者每眼的眼底彩照以及FFA图像分别依据我国六期分期法以及国际分期法进行分期。统计两种方法各期的一致性。结果 162眼中,按照六期分类法,以免散瞳下眼底彩照为标准,诊断为Ⅰ期DR患者为59眼,诊断为Ⅱ期DR患眼为37眼,诊断为Ⅲ期DR患眼为66眼;以50°眼底彩照为标准,Ⅰ期DR患者为52眼,Ⅱ期DR患者为38眼,Ⅲ期DR患者为72眼。按照国际分期法,轻度NPDR为34眼,中度NPDR患者为30眼,重度NPDR者为92眼,PDR为6眼。小瞳下眼底彩照以及散瞳下2张50°眼底彩照判断DR临床分期的一致性较好(Kappa=0.91)。六期分期法以及国际分期法两种分期方法的一致性一般(Kappa=0.634)。以轻度NPDR为筛查阈值,Ⅰ期病变的敏感度及特异度分别是100.0%、85.9%;以中度NPDR为筛查阈值,Ⅱ期病变的敏感度及特异度分别66.6%、86.3%;以重度NPDR为筛查阈值,Ⅲ期病变的敏感度及特异度分别71.0%、91.4%。结论 FFA指导下的国际分期法更能够真实、客观地反映糖尿病性视网膜病变的微血管病变情况以及严重程度。对存在弥漫出血点以及微血管瘤的Ⅰ、Ⅱ、Ⅲ期糖尿病视网膜病变患者应及早进行FFA检查。

Objective To observe the consistency of the two staging method of non proliferative diabetic retinopathy. Methods A retrospective study was performed on 162 eyes of 84 patients with non proliferative diabetic retinopathy who were examined by FFA in our hospital from January 2014 to June 2016.The fundus photograph of each eye in each patient and FFA images was confueted staging according to six classification method in our county and international classification method respectively.The consistency of the two methods in each period was examine^t.Results Among 162 eyes,according to the six classification method,nonmydriaticfundus photograph was taken as the standard,DR with phase Ⅰ diagnosed were 59 eyes,phase Ⅱ diagnosed were 37 eyes,and phase m diagnosed were 66 eyes.50° of fundus photo-graph was taken as the standard,DR with phase Ⅰ diagnosed were 52 eyes,phase Ⅱ diagnosed were 38 eyes,and phase Ⅲ diagnosed were 72 eyes.According to the international stage method,mild NPDR, moderate NPDR and severe NPDR patients was 34 eyes,30 eyes and 92 eyes respectively and 6 eyes were in PDR patients.The consistency of fundus pho-tograph under hitomi and 50 °of two fundus photographs under mydriasis judging the clinical staging of DR was better （Kappa=0.91）.The consistency of six classification method and international classification method was general （Kappa= 0.634）.Mild NPDR was seen as the screening threshold,the sensitivity and specificity for lesion at stage 1 was 100.0% and 85,9% respectively,and middle NPDR was seen as the screening threshold,the sensitivity and specificity for lesion at stage Ⅱ was 66.6% and 86.3% respectively,and severe NPDR was seen as the screening threshold,the sensitivity and specificity for lesion at stage Ⅲ was 71.0% and 91.4% respectively.Conclusion The international staging under the guidance of FFA is more able to reflect the microvascular pathological changes and severity of diabetic retinopathy. Early FFA examination should be performed for patients at phase Ⅰ, Ⅱ and Ⅲ diabetic retinopathy with diffuse hemor- rhages and hemangioma.