【摘要】 

視神經(jīng)鞘具有特殊的解剖結(jié)構(gòu)，顱內(nèi)壓增高時(shí)視神經(jīng)鞘直徑（optic nerve sheath diameter，ONSD）會出現(xiàn)增粗，故超聲檢查視神經(jīng)鞘直徑可以無創(chuàng)、床旁評估顱內(nèi)壓增高。國內(nèi)外相關(guān)領(lǐng)域的研究對于診斷高顱壓的ONSD的最佳臨界值有差異，故我們建議在運(yùn)用此技術(shù)評估顱內(nèi)壓增高時(shí)需要考慮種族差異，建立適合不同種族的診斷標(biāo)準(zhǔn)。超聲檢測ONSD具有廣闊的應(yīng)用和研究前景。

《超聲評估中國健康成年人視神經(jīng)鞘直徑》

（Ultrasound Med Biol. 2016 Mar;42(3):683-8）

【摘要】

目的 確定中國正常成人視神經(jīng)鞘直徑（optic nerve sheath diameter，ONSD）的參考值范圍，并且探索與其相關(guān)的影響因素。

方法 以2013年1月-2014年1月健康體檢的成年人作為研究對象，每位受試者的雙眼視神經(jīng)鞘的矢狀位和橫斷面均由兩位醫(yī)生分別測量兩次。每位受試者ONSD的最終報(bào)告值是雙眼視神經(jīng)鞘的16個(gè)測量值的平均值。

結(jié)果 共有230例受試者，獲得3680個(gè)ONSD測量值，ONSD平均值 為( 3.4580± 0.2767 )m m ，其 9 5 % 可 信 區(qū) 間 為 3.420~3.493 mm。ONSD的上限值低于以往白種人及黑人的研究結(jié)果。簡單線性回歸分析發(fā)現(xiàn)ONSD與性別、體質(zhì)指數(shù)（body mass index，BMI）、腰圍、頭圍相關(guān)。在調(diào)整了其他可能的影響因素后發(fā)現(xiàn)性別（偏回歸系數(shù)0.189，P<0.001）、BM（I 偏回歸系數(shù)0.032，P <0.001）是ONSD的獨(dú)立影響因素。低體重組的女性O(shè)NSD最小。

結(jié)論 在確立ONSD的正常值標(biāo)準(zhǔn)時(shí)應(yīng)考慮種族、性別、BMI的差別。

《中國高顱壓患者視神經(jīng)鞘直徑的診斷價(jià)值》

（PLoS One，2015,10(2)：e0117939-e0117939）

【Abstract】

目的 確定視神經(jīng)鞘直徑（optic n erve s heath d iameter，ONSD）評估顱內(nèi)壓（intracranial p ressure，ICP)增高的診斷標(biāo)準(zhǔn)并研究其相關(guān)影響因素。

方法 本研究為雙盲橫斷面研究，收集2013年3月-12月可疑高ICP需要進(jìn)行腰椎穿刺測量腦脊液壓力的患者為研究對象，記錄患者的個(gè)體相關(guān)信息及腦脊液壓力值，分為ICP正常組及增高組，比較兩組患者相關(guān)因素的差異。運(yùn)用接受者操作特性曲線（receiver operating characteristic，ROC）確定高ICP的ONSD最佳診斷值。

結(jié)果 共收錄了279例患者，其中包括101例高ICP患者。比較顯示，ONSD是ICP的獨(dú)立預(yù)測因素（P＜0.001），不受性別、年齡、體質(zhì)指數(shù)（body mass index，BMI）、頭圍、腰圍、高血壓和病因分型的影響。ONSD能夠有效準(zhǔn)確地評估高ICP。運(yùn)用超聲檢測ONSD診斷高ICP的最佳臨界值是4.1 mm（敏感度95%，特異度92%）。

結(jié)論 我國高ICP患者的ONSD的診斷值比白種人低，因此建議檢測ONSD評估高ICP時(shí)應(yīng)該注意種族差異。

We aimed to quantitatively assess intracranial pressure (ICP) using optic nerve sheath diameter (ONSD)measurements. We recruited 316 neurology patients in whom ultrasonographic ONSD was measured before lumbar puncture. They were randomly divided into a modeling and a test group at a ratio of 7:3. In the modeling group, we conducted univariate and multivariate analyses to assess associations between ICP and ONSD, age, sex, BMI, mean arterial blood pressure, diastolic blood pressure. We derived the mathematical function “Xing & Wang” from the modelling group to predict ICP and evaluated the function in the test group. In the modeling group, ICP was strongly correlated with ONSD (r = 0.758, p < 0.001), and this association was independent of other factors. The mathematical function was ICP = ?111.92 + 77.36 × ONSD (Durbin-Watson value = 1.94). In the test group, a significant correlation was found between the observed and predicted ICP (r = 0.76, p < 0.001). Bland-Altman analysis yielded a mean difference between measurements of ?0.07 ± 41.55 mmH2O. The intraclass correlation coefficient and its 95%CIs for noninvasive ICP assessments using our prediction model was 0.86 (0.79–0.90). Ultrasonographic ONSD measurements provide a potential noninvasive method to quantify ICP that can be conducted at the bedside.

【作者注：建立并驗(yàn)證數(shù)學(xué)模型，通過視神經(jīng)鞘檢測，可定量評估高顱壓】

《超聲檢測視神經(jīng)鞘直徑無創(chuàng)、動態(tài)評估顱內(nèi)壓》

（JAMA Ophthalmol. 2018 Mar 1;136(3):250-256）

背景及目的：有創(chuàng)性的顱內(nèi)壓（intracranialpressure, ICP）監(jiān)測可導(dǎo)致多種并發(fā)癥。因此臨床急需無創(chuàng)、可重復(fù)性的評估ICP的方法，近些年超聲檢查視神經(jīng)鞘直徑（opticnerve sheath diameter, ONSD）評估ICP成為研究熱點(diǎn)，我們證實(shí)了這種無創(chuàng)性技術(shù)可有效地診斷高ICP，然而該技術(shù)是否可動態(tài)監(jiān)測ICP變化以及評估高ICP治療效果尚不清楚。因此，本研究將探討超聲檢測ONSD能否有效動態(tài)評估ICP的變化。

方法：研究對象為2015年8月1日到2015年10月31日在我院神經(jīng)內(nèi)科就診，可疑高ICP需進(jìn)行腰椎穿刺的患者，在腰椎穿刺之前由2名經(jīng)驗(yàn)豐富的超聲醫(yī)生進(jìn)行ONSD檢測，運(yùn)用Philips超聲系統(tǒng)9-3MHz線陣探頭輕柔地置于患者閉合的眼瞼上，進(jìn)行橫斷面及矢狀面掃查，保存雙側(cè)視神經(jīng)鞘清晰的圖像。于球后3mm處測量ONSD，每個(gè)掃查方向測量兩次。根據(jù)ICP結(jié)果患者被隨機(jī)分為2組：第1組（200＜ICP≤300mmH₂O），第2組（ICP> 300 mmH₂O）。高ICP的患者進(jìn)行常規(guī)治療，我們在1個(gè)月內(nèi)復(fù)查患者的ONSD和ICP，分析入院時(shí)ONSD和ICP之間的相關(guān)性，比較治療前后ONSD以及ICP的變化情況，分析△ONSD和△ICP之間的相關(guān)性，（△ONSD和△ICP是治療前后ONSD和ICP的變化值）。

結(jié)果：我們共收集了60例患者（37例高ICP患者），入院時(shí)ICP與ONSD密切相關(guān)（r= 0.798，P＜0.001）。其中25例高ICP患者（平均年齡35.16±12.4歲；男性13例）完成了隨訪。治療前后ONSD存在顯著性差異（P＜0.001）。△ICP和△ONSD的均值分別為126.64±52.51mmH₂O（范圍：20~210mmH₂O）和1.0±0.512mm（范圍：0.418~ 2.37 mm）。△ONSD與△ICP呈正相關(guān)（r＝0.702，P＜0.001）。兩組患者治療后ICP及ONSD均恢復(fù)至正常范圍，且兩組患者ONSD的均值無顯著性差異。

結(jié)論：超聲檢測ONSD可無創(chuàng)、簡便、動態(tài)評估ICP變化及評估高ICP的治療效果。

《Ultrasonic measurement of optic nerve sheath diameter:a non-invasive surrogate approach for dynamic,real-time evaluation of intracranial pressure》

（The British journal of ophthalmology. Apr 2019;103:437-441）

【Abstract】

The current study aimed to identify whether ultrasonographic measurements of optic nerve sheath diameter (ONSD) could dynamically and sensitively evaluate real-time intracranial pressure (ICP). ONSD

measurements were performed approximately 5 min prior to and after a lumbar puncture (LP). A total of 84 patients (mean±SD age, 43.5±14.7 years; 41 (49%) men; 18 patients with elevated ICP) were included in the study. The Spearman correlation coefficients between the two observers were 0.779 and 0.703 in the transverse section and 0.751 and 0.788 in the vertical section for the left and right eyes, respectively. The median (IQR) change in ONSD (ΔONSD) and change in ICP (ΔICP) were 0.11 (0.05–0.21) mm and 30 (20–40) mmH2O, respectively, for all participants. With a reduction in cerebrospinal fluid pressure, 80 subjects (95%) showed an immediate drop in ONSD; the median (IQR) decreased from 4.13 (4.02–4.38) mm to 4.02 (3.90–4.23) mm (p<0.001). Significant correlations were found between ONSD and ICP before LPs (r=0.482, p<0.01) and between ΔONSD and ΔICP (r=0.451, p<0.01). Ultrasonic measurement of ONSD can reflect the relative real-time changes in ICP.【The ONSD was measured with the Delica MVU-6300 (Shenzhen, Guangzhou, China),】

【作者注：腰穿前后對比視神經(jīng)鞘變化，發(fā)現(xiàn)超聲檢測視神經(jīng)鞘直徑可以實(shí)時(shí)顯示顱內(nèi)壓改變，也進(jìn)一步證實(shí)了關(guān)于視神經(jīng)鞘研究的規(guī)范操作流程，應(yīng)該在腰穿之前進(jìn)行視神經(jīng)鞘測量】。

《 Reliability of Assessing Non-severe Elevation of Intracranial Pressure Using Optic NerveSheath Diameter and Transcranial Doppler Parameters》

（Frontiers in Neurology.2019.Oct 22;10）

Background/Aims: Non-invasive measurement of intracranial pressure (ICP) usingultrasound has garnered increasing attention. This study aimed to compare the reliability of ultrasonographic measurement of optic nerve sheath diameter (ONSD) and transcranial Doppler (TCD) in detecting potential ICP elevations.

【Delica MVU-6300 (Shenzhen, Guangdong, China) was used to obtain both TCD and ONSD measurements】

Methods: Patients who needed lumbar puncture (LP) in the Department of Neurology were recruited from December 2016 to July 2017. The ONSD and TCD measurements were completed before LP.

Results: One hundred sixty-five participants (mean age, 41.96 ± 14.64 years; 80 men; 29 patients with elevated ICP) were included in this study. The mean ICP was 170 ± 52 mmH2O (range, 75–400 mmH2O). Univariate analyses revealed that ICP was non-significantly associated with TCD parameters and significantly associated with ONSD (r = 0.60, P < 0.001). The mean ONSD of the elevated ICP group was significantly higher than that of the normal ICP group (4.53 ± 0.40mm vs. 3.97 ± 0.23mm; P < 0.001). Multivariate linear regression determined that the difference between ICP and ONSD is significant.

Conclusions: In the early stage of intracranial hypertension, ONSD is more reliable for evaluating ICP than TCD.

《The prevalence of intracranial stenosis in patients at low and moderate risk of stroke 》

（Ther Adv Neurol Disord.2019,Vol.12: 1–11）

【Abstract】

Background: Previous studies assessing the risk of stroke in the general population performed screening with Doppler ultrasonography only for high-risk patients and neglected low- and moderate-risk patients. The aims of this study were to explore the current prevalence of intracranial arterial stenosis (ICAS) and analyze its association with different levels of stroke risk and risk factors based on the risk assessment scale for stroke used inChina.

Methods: A total of 3654 participants who underwent transcranial Doppler ultrasound (TCD)【Delica EMS-9PB (Shenzhen, Guangdong, China)】were eligible for inclusion. Information regarding demographic characteristics and risk factors such as alcohol consumption and hypertension was collected through interviews and questionnaires and used to analyze the association of ICAS with different levels of stroke risk

and risk factors.

Results: The mean age of 501 subjects diagnosed with at least one ICAS was higher than that of participants without ICAS (57.13 ± 9.56 years and 55.52 ± 9.35 years, respectively). After adjusting for confounding factors, gender, education, residence, hypertension and personal history of stroke were associated with ICAS. The odds ratios for ICAS in patients with hypertension and a personal history of stroke were 1.655 [95% confidence interval (CI):1.341–2.043] and 1.854 (95% CI: 1.371–2.508), respectively. In addition, participants in the lowand moderate-risk stroke groups accounted for an unexpectedly high proportion of individuals with ICAS (up to 38.3%). Results from multivariate analyses indicated that the adjusted odds ratios for ICAS in patients with moderate and high stroke risks versus those with a low stroke risk were 1.603 (95% CI: 1.171–2.195) and 1.612 (95% CI: 1.272–2.042), respectively.

Conclusion: The prevalence of ICAS is high in northeast China and increases with the level of stroke risk. However, the proportion of patients with ICAS among those with low and moderate stroke risks should also be noted.

【作者注：對東北地區(qū)人群進(jìn)行血管超聲篩查。發(fā)現(xiàn)顱內(nèi)血管狹窄患病率較高，且在顱內(nèi)血管狹窄的人群中，中低危人群比例高達(dá)38.3%，故提示對于中低危人群血管篩查不容被忽視】。