Liu Dachuan, Li Zhen, Zhang Xuxiang, Zhao Liping, Jia Jianping, Sun Fei, Wang Yaxing, Ma Daqing, Wei Wenbin
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing key Laboratory of Intraocular Tumor Diagnosis and Treatment; Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, 100730, China.
Department of Ophthalmology,Xuanwu Hospital, Capital Medical University, Beijing, China.
BMC Neurol. 2017 Sep 29;17(1):188. doi: 10.1186/s12883-017-0964-5.
Ultrasonograpic retrobulbar optic nerve sheath diameter (ONSD) measurement is considered to be an alternative noninvasive method to estimate intracranial pressure,but the further validation is urgently needed. The aim of the current study was to investigate the association of the ultrasonographic ONSD and intracranial pressure (ICP) in patients.
One hundred and ten patients whose intracranial pressure measured via lumbar puncture were enrolled in the study. Their retrobulbar ONSD with B-scan ultrasound was determined just before lumber puncture. The correlation between the ICP and the body mass index (BMI), ONSD or age was established respectively with the Pearson correlation coefficient analysis. The discriminant analysis was used to obtain a discriminant formula for predicting ICP with the ONSD、BMI、gender and age. Another 20 patients were recruited for further validation the efficiency of this discriminant equation.
The mean ICP was 215.3 ± 81.2 mmHO. ONSD was 5.70 ± 0.80 mm in the right eye and 5.80 ± 0.77 mm in the left eye. A significant correlation was found between ICP and BMI (r = 0.554, p < 0.001), the mean ONSD (r = 0.61, P < 0.001), but not with age (r = -0.131, p = 0.174) and gender (r = 0.03, p = 0.753). Using receiver operating characteristic (ROC) curve analysis, the critical value for the risk mean-ONSD was 5.6 mm from the ROC curve, with the sensitivity of 86.2% and specificity of 73.1%. With 200 mmHO as the cutoff point for a high or low ICP, stepwise discriminant was applied, the sensitivity and specificity of ONSD predicting ICP was 84.5%-85.7% and 86.5%-92.3%.
Ophthalmic ultrasound measurement of ONSD may be a good surrogate of invasive ICP measurement. This non-invasive method may be an alternative approach to predict the ICP value of patients whose ICP measurement via lumbar puncture are in high risk. The discriminant formula, which incorporated the factor of BMI, had similar sensitivity and higher specificity than the ROC curve.
超声测量球后视神经鞘直径（ONSD）被认为是一种估计颅内压的非侵入性替代方法，但仍急需进一步验证。本研究旨在探讨患者超声测量的ONSD与颅内压（ICP）之间的关系。
本研究纳入了110例通过腰椎穿刺测量颅内压的患者。在腰椎穿刺前，用B超测定其球后ONSD。分别采用Pearson相关系数分析建立ICP与体重指数（BMI）、ONSD或年龄之间的相关性。采用判别分析，以ONSD、BMI、性别和年龄为指标，获得预测ICP的判别公式。另外招募20例患者进一步验证该判别方程的有效性。
平均ICP为215.3±81.2mmH₂O。右眼ONSD为5.70±0.80mm，左眼为5.80±0.77mm。ICP与BMI（r=0.554，P<0.001）、平均ONSD（r=0.61，P<0.001）显著相关，但与年龄（r=-0.131，P=0.174）和性别（r=0.03，P=0.753）无关。采用受试者工作特征（ROC）曲线分析，ROC曲线显示风险平均ONSD的临界值为5.6mm，敏感性为86.2%，特异性为73.1%。以200mmH₂O作为高或低ICP的截断点，采用逐步判别法，ONSD预测ICP的敏感性和特异性分别为84.5%-85.7%和86.5%-92.3%。
眼科超声测量ONSD可能是有创ICP测量的良好替代方法。这种非侵入性方法可能是预测经腰椎穿刺测量ICP存在高风险患者ICP值的一种替代方法。纳入BMI因素的判别公式与ROC曲线相比，具有相似的敏感性和更高的特异性。
