目的：评估利用高分辨率相干光断层扫描(Cirrus-HD OCT)测量黄斑区神经节细胞层-内丛状层(GCIPL)厚度参数对早期和中晚期青光眼的诊断意义。

方法：本研究共纳入20例健康个体，26例早期青光眼患者，29例中晚期青光眼患者。对所有纳入个体均测量黄斑区GCIPL厚度参数，视盘(ONH)区参数以及视盘周围神经纤维层(RNFL)厚度参数。最后将所有数据利用SPSS 17.0统计学软件进行分析，分别计算各参数诊断早期和中晚期青光眼的AUC值，以比较和评价各参数的诊断意义。

结果：对于早期青光眼组，AUC值最高的为RNFL平均值(0.871)和7：00位值(0.896)，GCIPL各参数也表现出较高的AUC值，其中GCIPL平均值和最小值相应的AUC值分别为0.847和0.812。对于中晚期青光眼组，AUC值最高为盘沿面积(0.992)，其次为RNFL平均值(0.991)，而GCIPL各参数中平均值与最小值的AUC值分别为0.967和0.983。对于早期青光眼诊断，灵敏度最高的指标为RNFL平均值(76.9%)，而特异度最高的指标为GCIPL平均值(93.5%)。

结论：GCIPL作为诊断青光眼的新指标在诊断早期和中晚期青光眼时，具有与RNFL相似的诊断意义。对于早期青光眼，诊断时应重点观察RNFL平均值，而在筛查时应重点观察GCIPL的平均值。

AIM: To evaluate the diagnostic accuracy of macular ganglion cell-inner plexiform layer(GCIPL)measurements using high-definition optical coherence tomography(Cirrus HD-OCT)ganglion cell analysis algorithm for detecting early and moderate to severe glaucoma.

METHODS:Twenty normal control persons, 26 patients with early glaucoma and 29 patients with moderate to severe glaucoma were enrolled in this study. Macular GCIPL, optic nerve head(ONH)parameters and peripapillary retinal nerve fiber layer(RNFL)thickness were measured in each subject. Then all measured results of each parameter were calculated using SPSS17.0. Areas under the receiver operating characteristic curves(AUC)of each parameter were calculated to compare the diagnostic accuracy for detecting early and moderate to severe glaucoma.

RESULTS:For detecting early glaucoma, AUC of average RNFL and seven clock value of RNFL were the biggest(0.871 and 0.896 respectively), the AUC of parameters in GCIPL were also significant, among them, the average GCIPL showed bigger AUC(0.847)than the minimum GCIPL(0.812). For diagnosing moderate to severe glaucoma, the AUC of rim area was 0.992, which was bigger than that of average RNFL(0.991). The minimum GCIPL showed bigger AUC(0.983)than the average GCIPL(0.967). For early glaucoma diagnosis, the sensitivity of average RNFL was the highest(76.9%), while the average GCIPL has the highest specificity(93.5%).

CONCLUSION:AS a new diagnostic parameter for detecting glaucoma, GCIPL shows similar diagnostic potential compared with RNFL. For early glaucoma diagnosis, average RNFL is the most important parameter, while screening early glaucoma, average GCIPL should be paid more attention.

国家自然科学基金项目(No. 81470632)