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[超声视神经鞘直径与颅内压的相关性]

[Correlation between ultrasonographic optic nerve sheath diameter and intracranial pressure].

作者信息

Li Z, Zhang X X, Yang H Q, Zhao L P, Jia J P, Sun F, Liu D C

机构信息

Department of Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.

出版信息

Zhonghua Yan Ke Za Zhi. 2018 Sep 11;54(9):683-687. doi: 10.3760/cma.j.issn.0412-4081.2018.09.009.

Abstract

To evaluate the association of the ultrasonographic optic nerve sheath diameter (ONSD) and intracranial pressure (ICP), and the feasibility of ultrasonographic ONSD in predicting high ICP. A prospective study. The outpatients who planned to measure ICP by lumbar puncture in Department of Neurology, Xuanwu Hospital, Capital Medical University were selected from January 2011 to May 2012. All the retrobulbar ONSD measurement with B-scan ultrasound was performed just before lumbar puncture. When high ICP was defined as ICP more than 200 mmHO(1 mmHO=0.009 8 kPa), the participants were divided into the high ICP group and the normal ICP group. The Pearson correlation coefficient analysis was used to analyze the correlation between ICP and postbulbar ONSD measurements. The difference in ONSD was compared between the high ICP and normal ICP groups with the test. The receiver operating characteristic (ROC) curve was used to calculate the cutoff value of mean ONSD and evaluate the sensitivity and specificity of the method. A total of 130 participants were involved in this study. There were 71 males and 59 females, aged (38±14) years.The mean ICP was (209.84±79.99) mmHO. The mean ONSD was (5.68±0.78) mm in the right eyes, (5.78±0.78) mm in the left eyes, and (5.73±0.71) mm in both eyes. The ICP had a significant correlation with ONSD in the right eyes (0.54, 0.001), ONSD in the left eyes (0.56, 0.001) and ONSD in both eyes (0.60, 0.001), but no correlation with age (0.14, 0.114) and gender (0.20, 0.817). The ONSD in the high ICP group (65) was (6.11±0.66) mm, (6.22±0.56) mm and (6.17±0.50) mm in the right eyes, left eyes, and both eyes, respectively. Compared with the ONSD in the normal ICP group (65), which was (5.26±0.64) mm in the right eyes, (5.34±0.72) mm in the left eyes and (5.30±0.62) mm in both eyes, there was a significantly enlarged ONSD in the high ICP group (=-7.507, -7.778, -8.779, all 0.001). The ROC analysis showed the ONSD of 5.6 mm was the best cutoff value with a sensitivity of 86% and a specificity of 71% for identifying high ICP. There is a significantly positive correlation between ICP and postbulbar ONSD measured by ultrasound. This non-invasive method may be an alternative approach to predicting the ICP value of patients whose ICP measurement via lumbar puncture is at high risk. However, it can not replace the direct ICP measurement with the invasive method. .

摘要

评估超声测量的视神经鞘直径(ONSD)与颅内压(ICP)之间的相关性,以及超声测量ONSD预测高颅内压的可行性。一项前瞻性研究。选取2011年1月至2012年5月在首都医科大学宣武医院神经内科计划行腰椎穿刺测量颅内压的门诊患者。所有患者均在腰椎穿刺前用B超进行球后ONSD测量。将颅内压高于200 mmH₂O(1 mmH₂O = 0.009 8 kPa)定义为高颅内压,将患者分为高颅内压组和正常颅内压组。采用Pearson相关系数分析颅内压与球后ONSD测量值之间的相关性。采用t检验比较高颅内压组和正常颅内压组的ONSD差异。绘制受试者工作特征(ROC)曲线计算平均ONSD的截断值,并评估该方法的敏感性和特异性。本研究共纳入130例患者。其中男性71例,女性59例,年龄(38±14)岁。平均颅内压为(209.84±79.99)mmH₂O。右眼平均ONSD为(5.68±0.78)mm,左眼为(5.78±0.78)mm,双眼为(5.73±0.71)mm。颅内压与右眼ONSD(r = 0.54,P = 0.001)、左眼ONSD(r = 0.56,P = 0.001)及双眼ONSD(r = 0.60,P = 0.001)均呈显著正相关,但与年龄(r = 0.14,P = 0.114)和性别(r = 0.20,P = 0.817)无相关性。高颅内压组(65例)右眼、左眼及双眼的ONSD分别为(6.11±0.66)mm、(6.22±0.56)mm和(6.17±0.50)mm。与正常颅内压组(65例)右眼(5.26±0.64)mm、左眼(5.34±0.72)mm及双眼(5.30±0.62)mm的ONSD相比,高颅内压组ONSD显著增大(t = -7.507、-7.778、-8.779,P均<0.001)。ROC分析显示,ONSD为5.6 mm时为最佳截断值,用于识别高颅内压的敏感性为86%,特异性为71%。超声测量的球后ONSD与颅内压之间存在显著正相关。这种非侵入性方法可能是预测经腰椎穿刺测量颅内压风险较高患者颅内压值的一种替代方法。然而,它不能替代有创方法直接测量颅内压。

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