眼底荧光血管造影及光学相干断层扫描在糖尿病视网膜病变检查中的应用

Application of fundus fluorescein angiography and OCT in the examination of diabetic retinopathy

目的探讨眼底荧光血管造影(FFA)及光学相干断层扫描(OCT)在糖尿病视网膜病变(DR)检查中的应用情况及临床价值。方法以糖尿病患者76例(152眼)为研究对象,同期健康体检者30例(60眼)为对照组,均完成FFA和OCT检查,分别观察眼底血管结构和功能变化及视网膜神经纤维层(RNFL)厚度,以临床诊断结果为“金标准”,采用Kappa检验分析FFA与OCT单独及联合应用对DR诊断价值。结果152眼经临床确诊为DR者115眼,FFA检查显示DR阳性109眼(71.71%),用于DR诊断的灵敏度为83.64%,特异度为88.10%,准确度为84.87%,一致性Kappa值为0.655,其中NPDR为80眼(73.39%),PDR为29眼(26.61%);OCT检查显示152眼中DR阳性者123眼(80.92%),最常见发病部位为鼻侧1/4象限,其余依次为上1/4象限,下1/4象限及颞侧1/4象限,FFA和OCT联合诊断DR的灵敏度为97.39%,特异度为78.38%,准确度为92.76%,一致性Kappa值为0.794;PDR组上侧、下侧及鼻侧RNFL低于NPDR组和对照组,颞侧和中心区RNFL低于对照组,NPDR组上侧、下侧及鼻侧RNFL低于对照组(P<0.05);FFA和OCT检查对局灶性黄斑水肿、弥漫性黄斑水肿和黄斑缺血进行诊断的一致性Kappa值分别为0.685、0.690和0.829。结论FFA和OCT均是DR检查有效方法,其中FFA可直接观察眼底血管结构和功能改变,而OCT可准确反映RNFL变化情况,两者联合应用有利于提升诊断准确率,明确病变严重程度和分析黄斑水肿情况。

Objective To explore the application and clinical value of fundus fluorescein angiography(FFA)and optical coherence tomography(OCT)in the examination of diabetic retinopathy(DR).Methods We selected 76 patients(152 eyes)with diabetes mellitus in our hospital as study group and 30 healthy examiners(60 eyes)at the same period were selected as control group.FFA and OCT were performed,and the changes of fundus vascular structure and function and thickness of retinal nerve fiber layer(RNFL)were observed.The clinical diagnostic results were taken as gold standards,and the Kappa test was used to analyze the diagnostic value of single and combined application of FFA and OCT on DR.Results In the 152 ayes,115 DR eyes were clinically confirmed.FFA examination showed that there were 109(71.71%)positive DR eyes,and the sensitivity,specificity,accuracy and Kappa value for DR diagnosis were 83.64%,88.10%,84.87%and 0.655,respectively,including 80(73.39%)NPDR eyes and 29(26.61%)PDR eyes.OCT examination showed that there were 123(80.92%)positive DR eyes,and the most common site of onset was the 1/4 quadrant of nasal side followed by upper 1/4 quadrant,lower 1/4 quadrant and temporal 1/4 quadrant.The sensitivity,specificity,accuracy and Kappa value of FFA combined with OCT for DR diagnosis were 97.39%,78.38%,92.76%and 0.794,respectively.The RNFL in the upper,lower and nasal sides in the PDR group were significantly lower than those in the NPDR group and control group(P<0.05).RNFL in temporal and central regions were significantly lower than those in the control group(P<0.05),and the RNFL of upper,lower and nasal sides in NPDR group were significantly lower than those in the control group(P<0.05).The Kappa values of FFA and OCT in the diagnosis of focal macular edema,diffuse macular edema and macular ischemia were 0.685,0.690 and 0.829,respectively.Conclusion s Both FFA and OCT are effective methods for DR examination.FFA can directly observe the changes of fundus vascular structure and function,and OCT can accurately reflect the changes of RNFL.The combination of the two is helpful to improve the accuracy rate of diagnosis,clarify the severity of the lesion and analyze the situation of macular edema.