Wang Lijuan, Feng Liangshu, Yao Yan, Wang Yuzhi, Chen Ying, Feng Jiachun, Xing Yingqi
The Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China.
Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China.
PLoS One. 2015 Feb 9;10(2):e0117939. doi: 10.1371/journal.pone.0117939. eCollection 2015.
Ultrasonography of the optic nerve sheath diameter (ONSD) is a non-invasive and rapid method that might be helpful in the identification of increased intracranial pressure (ICP). The use of an ONSD greater than 5 mm on ultrasound as an indicator of increased ICP in a Caucasian population has been studied. However, the cut-off point of this predictor in Chinese patients has not been established. Thus, we conducted this study to identify the ONSD criterion for the detection of elevated opening pressure on lumbar puncture (LP) in a Chinese population and to investigate the influencing factors. This study was a blind cross-sectional study. Patients who presented with suspected increased ICP were included. The opening pressure on LP of each participant was confirmed. We analyzed the clinical differences between the groups of patients with abnormal and normal opening pressures on LP. A receiver operating characteristic curve was constructed to determine the ONSD cut-off point for the identification of abnormal opening pressure on LP. In total, 279 patients were recruited, and 101 patients presented with elevated opening pressure on LP. ONSD was a significant independent predictor of elevated opening pressure on LP (p<0.001). However, no statistical significance was observed regarding the factors that might have affected this relationship including gender, age, body mass index, waistline, head circumference, hypertension and pathological subtype. The ONSD cut-off point for the identification of elevated opening pressure on LP was 4.1 mm; this cut-off yielded a sensitivity of 95% and a specificity of 92%. ONSD is a strong and accurate predictor of elevated opening pressure on LP. The cut-off point of this predictor in a Chinese population was remarkably lower than that found in a Caucasian population. Thus, ethnic differences should be noted when using the ONSD as an indicator of increased ICP.
视神经鞘直径（ONSD）超声检查是一种无创且快速的方法，可能有助于识别颅内压（ICP）升高。已对白种人群中超声测量的ONSD大于5 mm作为ICP升高指标的应用进行了研究。然而，该预测指标在中国患者中的截断点尚未确定。因此，我们开展了本研究，以确定中国人群中用于检测腰椎穿刺（LP）时开放压升高的ONSD标准，并调查影响因素。本研究为盲法横断面研究。纳入疑似ICP升高的患者。确认了每位参与者LP时的开放压。我们分析了LP时开放压异常和正常患者组之间的临床差异。构建受试者工作特征曲线以确定用于识别LP时异常开放压的ONSD截断点。总共招募了279例患者，其中101例患者LP时开放压升高。ONSD是LP时开放压升高的显著独立预测指标（p<0.001）。然而，在可能影响这种关系的因素方面，包括性别、年龄、体重指数、腰围、头围、高血压和病理亚型，未观察到统计学意义。识别LP时开放压升高的ONSD截断点为4.1 mm；该截断点的敏感性为95%，特异性为92%。ONSD是LP时开放压升高的强大且准确的预测指标。该预测指标在中国人群中的截断点显著低于白种人群。因此，在将ONSD用作ICP升高指标时应注意种族差异。
