颅内病变所致昏迷患者视神经鞘直径及其与眼球横径比值的临床及预后价值。
The clinical and prognostic values of optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio in comatose patients with supratentorial lesions.
机构信息
Department of Neurology, Peking University People's Hospital, No. 11 South Avenue, Xi Zhi Men Xicheng District, Beijing, 100044, China.
Department of Radiology, Peking University International Hospital, Beijing, China.
出版信息
BMC Neurol. 2021 Jul 2;21(1):259. doi: 10.1186/s12883-021-02285-7.
BACKGROUND
The optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse diameter (ETD) ratio have been proven to be correlated with intracranial pressure. This study aimed to evaluate the prognostic roles of ONSD and the ONSD/ETD ratio in comatose patients with supratentorial lesions and to determine the relationship of these two indices with the prognosis of such patients.
METHODS
A total of 54 comatose patients with supratentorial lesions and 50 healthy controls were retrospectively included in this study. ONSD and ETD were measured by unenhanced computed tomography (CT). The differences in ONSD and the ONSD/ETD ratio between the two groups were compared. The prognosis of comatose patients was scored using the Glasgow Outcome Scale (GOS) at the 3-month follow-up, and these patients were classified into good (GOS score ≥ 3) and poor (GOS score < 3) prognosis groups. The differences in ONSD and the ONSD/ETD ratio were compared between comatose patients with good prognoses and those with poor prognoses.
RESULTS
The ONSD and ONSD/ETD ratios in the comatose patients were 6.30 ± 0.60 mm and 0.27 ± 0.03, respectively, and both were significantly greater than those in the healthy controls (5.10 ± 0.47 mm, t = 11.426, P < 0.0001; 0.22 ± 0.02, t = 11.468, P < 0.0001; respectively). ONSD in patients with poor prognosis was significantly greater than that in patients with good prognosis (6.40 ± 0.56 vs. 6.03 ± 0.61 mm, t = 2.197, P = 0.032). The ONSD/ETD ratio in patients with poor prognosis was significantly greater than that in patients with good prognosis (0.28 ± 0.02 vs. 0.26 ± 0.03, t = 2.622, P = 0.011). The area under the receiver operating characteristic (ROC) curve, used to predict the prognosis of comatose patients, was 0.650 (95% confidence interval (CI): 0.486-0.815, P = 0.078) for ONSD and 0.711 (95% CI: 0.548-0.874, P = 0.014) for the ONSD/ETD ratio.
CONCLUSIONS
The ONSD and ONSD/ETD ratios were elevated in comatose patients. The ONSD/ETD ratio might be more valuable than ONSD in predicting the prognoses of comatose patients with supratentorial lesions.
背景
视神经鞘直径（ONSD）和 ONSD/眼球横径（ETD）比值已被证明与颅内压相关。本研究旨在评估 ONSD 和 ONSD/ETD 比值在幕上病变昏迷患者中的预后作用，并确定这两个指数与这些患者预后的关系。
方法
回顾性纳入 54 例幕上病变昏迷患者和 50 例健康对照者。采用非增强 CT 测量 ONSD 和 ETD。比较两组间 ONSD 和 ONSD/ETD 比值的差异。对昏迷患者在 3 个月随访时采用格拉斯哥预后量表（GOS）进行预后评分，并将这些患者分为预后良好（GOS 评分≥3）和预后不良（GOS 评分<3）两组。比较预后良好和预后不良的昏迷患者的 ONSD 和 ONSD/ETD 比值的差异。
结果
昏迷患者的 ONSD 和 ONSD/ETD 比值分别为 6.30±0.60mm 和 0.27±0.03，均显著大于健康对照组（5.10±0.47mm，t=11.426，P<0.0001；0.22±0.02，t=11.468，P<0.0001）。预后不良患者的 ONSD 显著大于预后良好患者（6.40±0.56 比 6.03±0.61mm，t=2.197，P=0.032）。预后不良患者的 ONSD/ETD 比值显著大于预后良好患者（0.28±0.02 比 0.26±0.03，t=2.622，P=0.011）。用于预测昏迷患者预后的受试者工作特征（ROC）曲线下面积，ONSD 为 0.650（95%置信区间（CI）：0.486-0.815，P=0.078），ONSD/ETD 比为 0.711（95%CI：0.548-0.874，P=0.014）。
结论
昏迷患者的 ONSD 和 ONSD/ETD 比值升高。ONSD/ETD 比值在预测幕上病变昏迷患者的预后方面可能比 ONSD 更有价值。
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