视网膜神经纤维层及神经节细胞–内丛状层厚度在预测垂体瘤患者视野改变程度中的应用

Application of Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexus Layer Thickness in Predicting the Degree of Visual Field change in Patients with Pituitary Adenoma

目的:探讨视网膜神经纤维层(RNFL)及神经节细胞–内丛状层(GCIPL)厚度在预测垂体瘤患者视野改变程度中的临床应用价值。方法:收集垂体瘤患者103例(199眼)的视野及光学相干断层扫描检查结果,分为视野正常组、视野轻度(MD ≥ −5 dB)、中度(−15 dB < MD < −5 dB)和重度(MD ≤ −15 dB)缺损组。统计分析RNFL及GCIPL厚度在各组间的差异、其与视野平均缺损(MD)的相关性及其预测视野改变程度的效能和临界值。结果:平均、上方、下方、鼻侧、颞侧RNFL厚度及平均、最小GCIPL厚度在4组中均存在差异(P < 0.05),其与MD呈正相关(P < 0.01)。在预测MD < −5 dB与否时,平均RNFL及平均GCIPL厚度的受试者工作特征曲线下面积(AUC)最大,分别为0.771和0.823 (P < 0.01),95%CI:0.705~0.837、0.765~0.880,临界值86.5 μm、76.5 μm,敏感度86.6%、80.4%,特异度62.7%、69.6%;进一步预测MD ≤ −15 dB与否时,颞侧RNFL及最小GCIPL厚度的AUC分别为0.634和0.639 (P < 0.05),95%CI:0.520~0.748、0.531~0.747,临界值62.5 μm、59 μm,敏感度56.5%、62.3%,特异度72.7%、66.7%。结论:RNFL及GCIPL厚度可用于初步预测垂体瘤患者视野改变程度。

Objective: To explore the clinical value of retinal nerve fiber layer (RNFL) and ganglion cell inner plexus layer (GCIPL) thickness in predicting the degree of visual field change in patients with pitu-itary adenoma. Methods: The visual field and optical coherence tomography results of 103 patients (199 eyes) with pituitary adenoma were collected and divided into normal visual field group, mild (MD ≥ −5 dB), moderate (−15 dB < MD < −5 dB) and severe(MD ≤ −15 dB) visual field defect group. Statistically analyze the differences of RNFL and GCIPL thickness among the four groups, their cor-relation with mean deviation (MD) of visual field, and their efficiency and cut-off value in predict-ing the degree of visual field change. Results: There were differences in average, superior, inferior, nasal and temporal RNFL thickness as well as average and minimum GCIPL thickness among the four groups (P < 0.05), which were positively correlated with MD (P < 0.01). When predicting whether MD < −5 dB or not, the area under the receiver operating characteristic curve (AUC) with average RNFL thickness and average GCIPL thickness was the largest, which was 0.771 and 0.823 (P < 0.01), 95%CI: 0.705~0.837 and 0.765~0.880, the cut-off value was 86.5 μm and 76.5 μm, sen-sitivity was 86.6% and 80.4%, specificity was 62.7% and 69.6%, respectively;When further pre-dicting whether MD ≤ −15 dB or not, the AUC of temporal RNFL thickness and minimum GCIPL thickness was 0.634 and 0.639 (P < 0.05), 95%CI: 0.520~0.748 and 0.531~0.747, the cut-off value was 62.5 μm and 59 μm, sensitivity was 56.5% and 62.3%, specificity was 72.7% and 66.7%, re-spectively. Conclusion: RNFL and GCIPL thickness can be used to preliminarily predict visual field change in patients with pituitary adenoma.