甲状腺功能障碍性视神经病变的视觉功能改变及早期诊断指标的ROC曲线分析

王沙; 王津伟; 陈露; 谭佳

doi:10.11817/j.issn.1672-7347.2023.230140

您当前的位置：

首页 >

文章列表页 >

甲状腺功能障碍性视神经病变的视觉功能改变及早期诊断指标的ROC曲线分析

扫描看全文

文章被引用时，请邮件提醒。

提交

论著 | 更新时间：2023-10-24

甲状腺功能障碍性视神经病变的视觉功能改变及早期诊断指标的ROC曲线分析
Visual function changes of dysthyroid optic neuropathy and ROC curve analysis for early diagnostic indicators
中南大学学报(医学版) 中南大学学报(医学版) 2023年48卷第8期页码：1197-1202
作者机构：

1.中南大学湘雅医院眼科中心,长沙 410008
2.湖南省眼科学重点实验室,长沙 410008
3.国家老年疾病临床医学研究中心,长沙 410008
作者简介：

王沙，Email: wangsha_1982@csu.edu.cn, ORCID: 0000-0001-5568-6503
谭佳，Email: tanjia1009@126.com, ORCID: 0000-0001-6482-818X
基金信息：

湖南省自然科学基金(2022JJ30964;2022JJ30959)
DOI：10.11817/j.issn.1672-7347.2023.230140
中图分类号：
CSTR：
纸质出版日期： 2023-08-28 ，

收稿日期： 2023-04-07 ，

王沙, 王津伟, 陈露, 谭佳. 甲状腺功能障碍性视神经病变的视觉功能改变及早期诊断指标的ROC曲线分析[J]. 中南大学学报(医学版), 2023, 48(8): 1197-1202.

WANG Sha, WANG Jinwei, CHEN Lu, TAN Jia. Visual function changes of dysthyroid optic neuropathy and ROC curve analysis for early diagnostic indicators[J]. Journal of Central South University. Medical Science, 2023, 48(8): 1197-1202.
王沙, 王津伟, 陈露, 谭佳. 甲状腺功能障碍性视神经病变的视觉功能改变及早期诊断指标的ROC曲线分析[J]. 中南大学学报(医学版), 2023, 48(8): 1197-1202. DOI：10.11817/j.issn.1672-7347.2023.230140

WANG Sha, WANG Jinwei, CHEN Lu, TAN Jia. Visual function changes of dysthyroid optic neuropathy and ROC curve analysis for early diagnostic indicators[J]. Journal of Central South University. Medical Science, 2023, 48(8): 1197-1202. DOI：10.11817/j.issn.1672-7347.2023.230140

摘要

目的

甲状腺功能障碍性视神经病变(dysthyroid optic neuropathy，DON)严重危害甲状腺相关眼病患者视力。本研究观察DON患者的视觉功能改变，并评价DON检测指标的诊断价值。

方法

回顾性分析2017年1月至2019年12月在中南大学湘雅医院就诊的49例DON患者(98眼)的临床资料。所有患者均行最佳矫正视力(best corrected visual acuity，BCVA)、Humphrey视野、视觉诱发电位(visual evoked potential，VEP)和对比敏感度检测。将98眼分为DON组(45眼)和非DON组(53眼)。采用

检验比较2组患者上述各项检测的相关指标，受试者操作特征(receiver operating characteristic，ROC)曲线分析各指标的敏感度和特异度。

结果

DON组的BCVA和视野指数(visual field index，VFI)均显著低于非DON组(均

0.05)，平均缺损(mean deviation，MD)和模式标准偏差(pattern standard deviation，PSD)均显著高于非DON组(均

0.05)。DON组的低频对比敏感度(low frequency contrast sensitivity，CSL)、中频对比敏感度(medium frequency contrast sensitivity，CSM)、高频对比敏感度(high frequency contrast sensitivity，CSH)均明显低于非DON组(均

0.05)，CSH尤为明显。在15°、30°和60°空间频率时，与非DON组比较，DON组的N135波幅显著降低，N75波、P100波、N135波的潜伏期显著延长(均

0.05)；在15°和30°空间频率时，DON组较非DON组P100波幅明显降低(均

0.05)。ROC曲线分析结果显示：VFI、CSL、CSM、CSH和15°P100波幅诊断DON的曲线下面积(area under the curve，AUC)分别为0.812、0.841、0.880、0.784和0.791，以CSM的敏感度和特异度最高。

结论

DON患者的视觉功能均存在不同程度的受损。VFI、CSL、CSM、CSH和 15°P100波幅可能成为早期诊断DON的有效指标。

Abstract

Objective

Dysthyroid optic neuropathy (DON) is a class of diseases that makes seriously endanger to the vision of patients with thyroid-associated ophthalmopathy. This study aims to observe the visual function changes in patients with DON

and to evaluate the diagnostic value of indicators diagnosing DON.

Methods

A retrospective study was conducted on 98 eyes of 49 patients with dysthyroid optic neuropathy (DON) who were treated in Xiangya Hospital of Central South University from January 2017 to December 2019. All patients were received the examination of best corrected visual acuity (BCVA)

Humphrey visual field

visual evoked potential (VEP)

and contrast sensitivity. Ninety-eight eyes were divided into a DON group (45 eyes) and a non-DON group (53 eyes).

-test was used to compare the related indicators between the 2 groups. The sensitivity and specificity of each indicator were analyzed by receiver operating characteristic (ROC) curve.

Results

The BCVA and visual field index (VFI) of the DON group were significantly lower than those of the non-DON group (all

0.05). The mean deviation (MD) and pattern standard deviation (PSD) of the DON group were significantly higher than those of the non-DON group (all

0.05). The low frequency contrast sensitivity (CSL)

medium frequency contrast sensitivity (CSM)

and high frequency contrast sensitivity (CSH) of the DON group were significantly lower than those of the non-DON group (all

0.05)

with CSH being particularly prominent. Compared with the non-DON group

at spatial frequencies of 15°

30°

and 60°

the amplitude of N135 wave was significantly reduced

and the latency of N75 wave

P100 wave

and N135 wave was significantly prolonged in the DON group (all

0.05); at spatial frequencies of 15° and 30°

the amplitude of P100 wave was significantly reduced in the DON group (

0.05). The ROC curve analysis results showed that the area under the curve (AUC) of VFI

CSL

CSM

CSH and 15° P100 amplitude diagnosing DON were 0.812

0.841

0.880

0.784

and 0.791

respectively

with CSM possessing the highest sensitivity and specificity.

Conclusion

The visual function of patients with DON is decreased. VFI

contrast sensitivity of low

medium

and high frequency

and 15° P100 wave amplitude might be effective indicators for early diagnosis of DON.

关键词

甲状腺功能障碍性视神经病变甲状腺相关眼病视觉诱发电位受试者操作特征曲线

Keywords

dysthyroid optic neuropathythyroid-associated ophthalmopathyvisual evoked potentialreceiver operating characteristic curve

references

Mourits MP, Koornneef L, Wiersinga WM, et al. Clinical criteria for the assessment of disease activity in Graves’ ophthalmopathy: a novel approach[J]. Br J Ophthalmol, 1989, 73(8): 639-644. https://doi.org/10.1136/bjo. 73.8.639https://doi.org/10.1136/bjo.73.8.639.

Bartalena L, Wiersinga WM, Pinchera A. Graves’ ophthalmopathy: state of the art and perspectives[J]. J Endocrinol Invest, 2004, 27(3): 295-301. https://doi.org/10.1007/BF03345280https://doi.org/10.1007/BF03345280.

Boulos PR, Hardy I. Thyroid-associated orbitopathy: a clinicopathologic and therapeutic review[J]. Curr Opin Ophthalmol, 2004, 15(5): 389-400. https://doi.org/10.1097/01.icu.0000139992.15463.1bhttps://doi.org/10.1097/01.icu.0000139992.15463.1b.

Neigel JM, Rootman J, Belkin RI, et al. Dysthyroid optic neuropathy. The crowded orbital apex syndrome[J]. Ophthalmology, 1988, 95(11): 1515-1521. https://doi.org/10.1016/s0161-6420(88)32978-7https://doi.org/10.1016/s0161-6420(88)32978-7.

Kazim M, Trokel S, Moore S. Treatment of acute Graves orbitopathy[J]. Ophthalmology, 1991, 98(9): 1443-1448. https://doi.org/10.1016/s0161-6420(91)32114-6https://doi.org/10.1016/s0161-6420(91)32114-6.

Chan LL, Tan HE, Fook-Chong S, et al. Graves ophthalmopathy: the bony orbit in optic neuropathy, its apical angular capacity, and impact on prediction of risk[J]. AJNR Am J Neuroradiol, 2009, 30(3): 597-602. https://doi.org/10.3174/ajnr.A1413https://doi.org/10.3174/ajnr.A1413.

Bartley GB, Gorman CA. Diagnostic criteria for Graves’ ophthalmopathy[J]. Am J Ophthalmol, 1995, 119(6): 792-795. https://doi.org/10.1016/S0002-9394(14)72787-4https://doi.org/10.1016/S0002-9394(14)72787-4.

Ben Simon GJ, Syed HM, Syed H, et al. Clinical manifestations and treatment outcome of optic neuropathy in thyroid-related orbitopathy[J]. Ophthalmic Surg Lasers Imaging, 2006, 37(4): 284-290. https://doi.org/10.3928/15428877-20060701-04https://doi.org/10.3928/15428877-20060701-04.

McKeag D, Lane C, Lazarus JH, et al. Clinical features of dysthyroid optic neuropathy: a European Group on Graves’ Orbitopathy (EUGOGO) survey[J]. Br J Ophthalmol, 2007, 91(4): 455-458. https://doi.org/10.1136/bjo.2006.094607https://doi.org/10.1136/bjo.2006.094607.

Tramunt B, Imbert P, Grunenwald S, et al. Sight-threatening Graves' orbitopathy: twenty years’ experience of a multidisciplinary thyroid-eye outpatient clinic[J]. Clin Endocrinol, 2019, 90(1): 208-213. https://doi.org/10.1111/cen. 13880https://doi.org/10.1111/cen.13880.

Choi CJ, Oropesa S, Callahan AB, et al. Patterns of visual field changes in thyroid eye disease[J]. Orbit, 2017, 36(4): 201-207. https://doi.org/10.1080/01676830.2017.1314510https://doi.org/10.1080/01676830.2017.1314510.

Salvi M, Spaggiari E, Neri F, et al. The study of visual evoked potentials in patients with thyroid-associated ophthalmopathy identifies asymptomatic optic nerve involvement[J]. J Clin Endocrinol Metab, 1997, 82(4): 1027-1030. https://doi.org/10.1210/jcem.82.4.3877https://doi.org/10.1210/jcem.82.4.3877.

Iao TWU, Rong SS, Ling AN, et al. Electrophysiological studies in thyroid associated orbitopathy: a systematic review[J]. Sci Rep, 2017, 7(1): 12108. https://doi.org/10.1038/s41598-017-11998-0https://doi.org/10.1038/s41598-017-11998-0.

Drucker MD, Savino PJ, Sergott RC, et al. Low-contrast letter charts to detect subtle optic[corrected]neuropathies[J]. Am J Ophthalmol, 1988, 105(2): 141-145. https://doi.org/10.1016/0002-9394(88)90176-6https://doi.org/10.1016/0002-9394(88)90176-6.

Skalka HW. Comparison of Snellen acuity, VER acuity, and Arden grating scores in macular and optic nerve diseases[J]. Br J Ophthalmol, 1980, 64(1): 24-29. https://doi.org/10.1136/bjo. 64.1.24https://doi.org/10.1136/bjo.64.1.24.

Zimmern RL, Campbell FW, Wilkinson IM. Subtle disturbances of vision after optic neuritis elicited by studying contrast sensitivity[J]. J Neurol Neurosurg Psychiatry, 1979, 42(5): 407-412. https://doi.org/10.1136/jnnp.42.5.407https://doi.org/10.1136/jnnp.42.5.407.

Nordmann JP, Saraux H, Roullet E. Contrast sensitivity in multiple sclerosis. A study in 35 patients with and without optic neuritis[J]. Ophthalmologica, 1987, 195(4): 199-204. https://doi.org/10.1159/000309813. PMID:https://doi.org/10.1159/000309813.PMID:3431817.

Suttorp-Schulten MS, Tijssen R, Mourits MP, et al. Contrast sensitivity function in Graves’ ophthalmopathy and dysthyroid optic neuropathy[J]. Br J Ophthalmol, 1993, 77(11): 709-712. https:/doi.org/10.1136/bjo.77.11.709. PMID: 8280684; PMCID:https://doi.org/10.1136/bjo.77.11.709.PMID:8280684;PMCID:PMC504629.

浏览量

151

下载量

CSCD

工具集

关联资源

肠道菌群与甲状腺相关眼病