Informativnost TP the HORN for differential diagnostic miopii
In clinical practice at diagnosis statement miopii first of all are oriented on value of level of a refraction. However, refraction change can be connected as with miopicheskimi changes, and, for example, with abnormalities of a cornea.
Therefore the researches spent by method TP the HORN are necessary for correct statement of the diagnosis and competent formulation of tactics of treatment. In communications by emersion of possibility of research of system of blood circulation of fast-head department of an eye, algorithm of statement of the differentialThe diagnosis has got additional links (Drawing 4.4 see) Drawing 4.4 - Algorithm of conducting of differential diagnostic with
Application transpalpebralnoj reooftalmografii
In the researches spent on the basis of department of a pathology of a refraction, a binocular sight and oftalmoergonomiki the Moscow scientific research institute of eye sicknesses it. Gelmgoltsa, 104 patients at the age from 5 till 22 years with the various clinical refraction which middle age has made 12,7 yo 4,8 years participated. Conducting of diagnostic studies at children was more younger five years is complicated in connection with complexity of observance of methodical recommendations at registration reooftalmogrammy patients (not to blink, fix a sight at one point). What have been gained on patients at whom infringement of a blood-groove as a result of any manipulations which are not referring to to spent researches is revealed were expelled From the general file of the registered signals. Patients by whom diagnostic procedures with application of the specimens calling a muscular spasm for expansion of a pupil were carried out, or in most cases referred to to them the patients who were passing shortly before diagnostic study any physiotherapeutic procedure.
In medical practice depending on refraction extent the following classification is applied:
- Weak gipermetropija (a refraction less than +2 dptr);
- miopija weak extent (a refraction-0,5...-3,0 dptr);
- miopija average extent (a refraction-3,25...-6,0 dptr);
- miopija high extent (a refraction more-6,0 dptr).
Patients by whom such diagnosis as weak gipermetropija is installed, pass treatment, as a rule, with a view of preventive maintenance, and any essential infringements in blood circulation system is not observed. Moreover, weak gipermetropija for teenage age it is considered norm, and with the years vanishes. In this connection, patients with such diagnosis have been referred to in control group. By results of the spent researches in this group 12 patients at the age from 5 till 22 years (by average age - 11,5 years), a mean of a spherical equivalent +0,75 dptr at which 41 record the HORN has been analysed are referred to.
According to the above-stated classification, i.e. depending on extent miopii, patients have been divided into three groups. In groups with the diagnosis miopija 32 patients with miopiej weak extent (0,5 are surveyed... 3,0 dptr, 124
Records the HORN); 23 patients with miopiej average extent (3,25... 6,0 dptr, 84 records the HORN); 30 patients with high miopiej (more 6,25дптр, 71 record the HORN). It is necessary to note, that in group with miopiej high extent of 25 patients (53 records) had the diagnosis progressing miopija, i.e.
It is considered [14], that sensitivity of nonparametric criterion more low and makes 95 % from parametric analogues, but allows to refuse the assumption of normality of distribution of the registered data and similarity of their dispersions. Nonparametric analogue of a Student t-test number is the criterion the God-send-uitni. Advantage of this method consists in possibility of the analysis of groups of small quantity. But, as in observed groups quantity more than 8 it is considered [14], that distribution comes nearer to normal with an average: has normal distribution that allows to compare it to the critical values of normal distribution used for a double-end Student t-test number.
In the capacity of a zero hypothesis it is supposed, that observable differences in observed groups are not statistically significant. According to formulas (4.1), (4.2) and (4.3) pays off ZTи it is compared to critical values for a Student t-test number. For the analysis of results the criterion the God-send-uitni was used.
Each of development stages miopii has the characteristic appearance of a curve reflecting extent krovenapolnenija of fast-head department of an eye (Drawing 4.5 see), results of the spent researches are resulted in Table 11. The big magnitude of a standard deviation reograficheskogo an index speaks that in groups with miopiej presence of spasmodic transition in parametres of blood circulation from one extent of development miopii to another as the difference between patients with miopiej weak and average extent can make only 0,25 dptr is impossible for various extent.
Drawing 4.5 - the Characteristic aspect the HORN at various extents miopii:
reooftalmogramma the patient with gipermetropiej;
reooftalmogramma the patient with miopiej weak extent;
reooftalmogramma the patient with miopiej average extent;
reooftalmogramma the patient with miopiej high extent
Table 11 - Results provednnyh researches
RI, mom | PMN, with. | PMU, otn.ed. | UOK, ml | |
Control group | 57,70±15,60 | 0,18±0,08 | 0,21±0,07 | 2,17±0,75 |
Miopija the weak item | 48,29±23,39 | 0,14±0,04 | 0,17±0,03 | 1,68±0,75 |
Miopija the average item | 43,31±19,62 | 0,11±0,03 | 0,13±0,03 | 1,61±0,73 |
Miopija the high item | 37,68±17,13 | 0,13±0,04 | 0,16±0,04 | 1,47±0,79 |
It is necessary to note, that in the spent researches an aetiology miopii at surveyed children and teenagers the various: got or congenital. The important factors are speed of development of a pathology (progressing, not progressing), predisposition presence on a parental line, presence of accompanying diseases, individual variability etc.
All these factors can to straight lines or indirect in the image to influence blood-groove parametres. Within one gated out above group strong enough spread in observed parametres, in particular at RI. In dissertational work agency of these factors was not observed.
Mean and standard deviations in the gated out groups are close, and they are recoated. It gives the bases to assume, that differences between groups are not statistically significant. As the gained results do not submit to normal distribution (Drawing 4.6) see, application of a nonparametric method of statistical machining is necessary to confirm or deny it.
For comparison parametres of group of the control and group with miopiej average extent are observed. It is proved by that refraction changes at miopii average extent are already essential, at this stage rigidity changes sklery, increase in size PZO etc. are observed, but there are no serious morphological infringements.
Drawing 4.6 - RI at the surveyed patients: 1) RI patients with gipermetropiej;
2) RI patients with miopiej weak extent; 3) RI patients with miopiej average extent; 4) RI patients with miopiej high extent
Zero hypothesis is absence of statistically significant differences between observed groups. Critical value for a significance value 0,05 makes 1,960. Thus, as counted ZTбольше critical for RI, PMN, PMU and UOK (Table 12 see) the zero hypothesis for these parametres can be rejected. It means, that for miopichnyh patients for diagnosis refinement miopii average extent use of parametres RI, PMN, PMU and UOK is informative.
Table 12 - Counted values ZTдля of groups of the control and miopii average extent
RI | PMN | PMU | UOK | |
Zt | 2,062 | 2,0142 | 3,494 | 1,965 |
If to carry out calculation for control and group group miopii weak extent results are gained analogous, but with that difference, that differences between groups for reograficheskogo an index originate only at a significance value of 50 %, for shock volume statistical significant differences will be at a significance value of 20 %.
This result shows, that the offered hardware-software and methodical means are informative in diagnosis refinement miopii average
Extents.
4.4.2.
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