频域OCT对鞍区占位性病变患者视神经损伤早期诊断的价值

Early diagnostic value of spectral domain optical coherence tomography for optic nerve injury in patients with sellar-occupied lesions

目的:评估频域光学相干断层扫描(SD-OCT)对鞍区占位性病变患者视神经损伤早期诊断的价值。方法:回顾性病例对照研究。选取山西省人民医院2014年7月至2018年12月鞍区占位性病变患者中眼科常规检查及视野检查无异常的22例(44只眼)为观察组;本院健康职工中选取22例(44只眼)为健康对照组。应用SD-OCT检测视盘周围和其四个象限视网膜神经纤维层平均厚度及黄斑区视网膜神经节细胞复合体(mGCC)各层平均厚度,对检测结果进行对比,评估视神经的损伤。采用受试者工作特征(ROC)曲线下面积(AUC)评估视盘周围神经纤维层(pRNFL)和mGCC对鞍区占位视神经损伤的诊断价值。结果:观察组pRNFL平均厚度[(96.19±16.86)μm]低于健康对照组[(109.59±7.79)μm],差异有统计学意义(t=4.785,P=0.000)。观察组mGCC、黄斑区神经纤维层(mRNFL)、黄斑区神经节细胞层-内丛状层(GCL+)的平均厚度与健康对照组比较,差异均有统计学意义(t=2.894,3.478,3.557;P=0.005,0.001,0.001)。pRNFL、mRNFL、GCL+、mGCC的AUC值分别为0.757、0.643、0.702、0.688,诊断价值依次为pRNFL>GCL+>mGCC>mRNFL。结论:SD-OCT在鞍区占位性病变患者视神经损伤的早期诊断中具有临床价值,其中pRNFL的诊断价值高于mGCC。

Objective To evaluate the early diagnosis value of spectral domain optical coherence tomography(SD-OCT)for optic nerve injury in patients with sellar occupied lesions.Methods This was a retrospective case-control study.Forty-four eyes of 22 patients diagnosed as the occupying lesion in the sellar region from Jul.2014 to Dec.2018 in Shanxi Provincial People’s Hospital were collected as the observation group.The general routine examination and both visual field examination were performed and both showed no abnormalities.Another 44 eyes of 22 normal staff were selected as the healthy control group.The average peripapillary thickness,the average thicknesss of the retinal nerve fiber layer on the four quadrants and of each layer of macular ganglion cell complex(mGCC)were detected with SD-OCT.The results were compared to evaluate the damage of the optic nerve.The area under the receiver operating characteristic(ROC)curve(AUC)was evaluated to detect the diagnostic efficacy of peripapillary retinal nerve fiber layer(pRNFL)and mGCC for sellar occupying optic nerve damage.Results The average thickness of pRNFL in the observation group was(96.19±16.86)μm,which was lower than the(109.59±7.79)μm in the control group.The difference was statistically significant between the two groups(t=4.785,P=0.000).The differences of mean thickness of mGCC,macular retina nerve fiber layer(mRNFL),ganglion cell layer and inner plexiform layer(GCL+)were statistically significant between the two groups(t=2.894,3.478,3.557;P=0.005,0.001,0.001).The AUC values of pRNFL,mRNFL,GCL+and mGCC were 0.757,0.643,0.702 and 0.688,respectively.The diagnostic value sequenced as pRNFL>GCL+>mGCC>mRNFL.Conclusion SD-OCT has clinical value on early diagnosis of optic nerve injury in patients with sellar-occupied lesions.The diagnostic value of pRNFL is higher than that of mGCC.