圆锥角膜与健康角膜生物力学的对比研究要点

DOI：10.3760/cma.j.issn.0412-4081.2016.09.007

作者单位：710004西安市第四医院眼科激光视力矫正中心通信作者：刘建国，Email:drljg@ ·论著·

圆锥角膜与健康角膜生物力学的对比研究魏升升李勇李晶刘建国叶璐万雅群李娟杜婧

【摘要】目的探讨圆锥角膜患者的角膜生物力学改变特点及角膜生物力学眼压分析仪Corvis ST在圆锥角膜诊断中的价值。方法病例对照研究。选取圆锥角膜患者32例（41只眼）作为圆锥角膜组，健康角膜人群41例（41只眼）作为对照组。应用角膜生物力学眼压分析仪Corvis ST对两组人群角膜的第一次压平宽度（1stA length）、第二次压平宽度（2stA length）、第一次压平时速率（Vin）、第二次压平时速率（Vout）、最大变形幅度（Def.Ampl）、顶点距离（P.Dist）和曲率半径（Radius）等进行测量，两组生物力学参数之间采用单因素方差分析进行对比分析，生物力学参数与角膜形态学参数之间采用Pearson或Spearman相关性分析，绘制生物力学参数的受试者工作特征曲线（ROC）。结果在圆锥角膜组中，Vin、Vout和Def.Ampl分别为（0.201±0.268）、（0.463±0.121）和（1.146±0.113）mm，明显高于对照组的（0.151±0.017）、（0.418±0.060）和（1.146±0.113）mm，差异有统计学意义（F=6.028，20.724，10.606；P< 0.05）。圆锥角膜组中的Radius为（5.898±0.976）mm，与健康角膜组的（7.012±0.728）mm相比明显减小，差异有明显统计学意义（F=5.277，P=0.023）。圆锥角膜组的1stA length、Vout、Def.Ampl和Radius与角膜最薄点厚度之间具有明显相关性（r=0.330，-0.490，-0.482，0.676；P=0.035，0.001，0.001，0.000），Def. Ampl和Radius与角膜前表面曲率Km之间具有明显的相关性（r=0.751，-0.528；P=0.044，0.019）。Vin、Vout、Def.Ampl和Radius与后表面最大高度之间均具有明显的相关性（r=0.475，-0.552，-0.399，0.273；P=0.021，0.015，0.001，0.000）。Radius、Def.Ampl、Vout和Vin的ROC下面积均>0.9。结论圆锥角膜的Vin、Vout、Def.Ampl和Radius较健康角膜均有明显的改变，其中Radius对于角膜生物力学变化具有较高的敏感性，在圆锥角膜的诊断中应有较大的参考价值。（中华眼科杂志，2016，52：669-673）

【关键词】圆锥角膜；角膜；生物力学；眼压测量法

基金项目：陕西省社会发展攻关项目（2016SF-274）（2013K14-02-18）；西安市社会发展引导项目SF1315（3）；陕西省卫生厅科技攻关课题（2014D49）

Corneal biomechanical properties in keratoconic and normal eyes Wei Shengsheng,Li Yong,Li Jing, Liu Jianguo,Ye Lu,Wan Yaqun,Li Juan,Du Jing.Department of Ophthalmology,Xi'an Fourth Hospital, Xi'an710004,China

Corresponding author：Liu Jianguo,Email:drljg@

【Abstract】Objective To compare the corneal biomechanical properties of keratoconic and normal eyes,and to explore the changing characteristics in keratoconic eyes.Methods Case-control study.Thirty-two keratoconic subjects(41eyes)and41subjects(41eyes)with normal corneas were enrolled in this study. Scheimpflug noncontact tonometry(Corvis ST)was performed to measure the length of Appl1(1st A length), velocity of Appl1(Vin),length of Appl2(2nd A length),velocity of Appl2(Vout),deformation amplitude (DA),peak distance,and parison of the biomechanical property values between the keratoconic and normal eyes was performed using One-Way ANOVA.Pearson or Spearman correlations were used to evaluate the relationship between corneal biomechanical properties and corneal morphology parameters.The areas under ROC curves of the biomechanical properties of Corvis ST were calculated.Results In the keratoconic group,the values of Vin,Vout,and DA were(0.201±0.268),(0.463±0.121),and(1.146±0.113) mm,respectively,which were obviously greater than the normal group[(0.151±0.017),(0.418±0.060),and (1.146±0.113)mm,respectively;F=6.028,20.724,10.606,P=0.016,0.000,0.001].The radius in the keratoconic eyes was(5.898±0.976)mm,apparently shorter than the normal eyes[(7.012±0.728)mm;F= 5.277,P=0.023].In the keratoconic eyes,there were significant correlations between the1st A length,Vout, DA,radius and the thickness of the thinnest cornea(r=0.330,-0.490,-0.482,0.676,P=0.035,0.001, 0.001,0.000).There were significant correlations between the DA,radius and the anterior surface refractive