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基于眼部图像特征的肝肾疾病病证比较研究
朱会明,刘 平,高 悦
0
(上海中医药大学附属曙光医院/上海中医药大学肝病研究所/肝肾病证教育部重点实验室/上海市中医临床重点实验室,上海,201203)
摘要:
目的:基于五轮学说及眼部图像特征提取技术,探讨不同证候(湿热内蕴证、肝郁脾虚证、肝肾阴虚证)的肝硬化及慢性肾脏疾病患者眼部图像特征及其差异性,以期从眼部图像特征上为肝硬化临床诊断及证候辨识提供数据支持。方法:选取2017年10月至2018年3月在上海中医药大学附属曙光医院肝硬化科住院的湿热内蕴证、肝郁脾虚证及肝肾阴虚证3种证候的肝硬化患者118 例为研究对象,运用眼科裂隙灯采集受试者的眼部图像,并以年龄、性别、体质量指数匹配的非肝病(慢性肾脏疾病)患者115 例及健康志愿者112 例眼部图像特征为对照进行比较研究。剔除因受到各种因素干扰眼部图像不符合要求的患者,最终3组各纳入60 例进行眼部图像分析。基于图像局部二值模式(LBP)特征提取法,将彩色图像转化为共生矩阵,计算图像LBP特征面积百分比。通过方差分析、秩和检验等统计学方法对相关指标进行比较分析,找出组间差异性。结果:肝硬化患者、慢性肾脏疾病患者与健康人3组眼部图像LBP特征面积百分比差异均有统计学意义(P<0.05)。与健康人组相比,在255层面积百分比中,肝硬化组有245层差异有统计学意义(P<0.05),慢性肾脏疾病组有246层差异有统计学意义(P<0.05)。肝硬化组与慢性肾脏疾病组相比,2组共有15层面积百分比差异有统计学意义(P<0.05)。对2种疾病间不同证候的LBP特征频数面积百分比进行比较,慢性肾脏疾病患者湿热内蕴证、肝郁脾虚证及肝肾阴虚证3组证候间共19层差异有统计学意义(P<0.05),而肝硬化组患者3组证候间差异无统计学意义(P>0.05)。比较3种证候不同疾病间的LBP特征频数面积百分比,湿热内蕴证中,肝硬化与慢性肾脏疾病组患者间有54层差异有统计学意义(P<0.05);肝肾阴虚证中共有46层差异有统计学意义(P<0.05);而肝郁脾虚证的2种疾病间差异无统计学意义(P>0.05)。比较湿热内蕴证、肝郁脾虚证与肝肾阴虚证3种证候间频数面积百分比,发现有2层差异存在统计学意义(P<0.05)。结论:基于眼部图像LBP特征发现,肝硬化及慢性肾脏疾病2种疾病间存在明显差异,且2种疾病的相同证候间比较亦有显著性差异,但同一疾病的3种不同证候间比较,仅肾脏病患者在一定程度上有差异,而肝硬化患者各证候间区分不明显。提示运用眼部图像LBP特征提取技术对不同疾病区分的敏感性优于对证候的区分。
关键词:  肝硬化  慢性肾脏疾病  眼部图像特征  病证比较  局部二值模式
DOI:
A comparative study of different syndromes of liver and kidney diseases based on ocular imaging features
ZHU Huiming,LIU Ping,GAO Yue
(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine;Institute of Liver Diseases,Shanghai University of Traditional Chinese;Key Laboratory of Liver and Kidney Diseases)
Abstract:
Objective:To investigate the differences in ocular imaging features between patients with liver cirrhosis and chronic kidney diseases with different syndromes (internal retention of damp-heat, liver depression and spleen deficiency, and liver-kidney Yin deficiency) based on the five-wheel theory and techniques for extraction of ocular imaging features, and to provide data support for the clinical diagnosis and syndrome differentiation of liver cirrhosis based on ocular imaging features.Methods:A total of 118 liver cirrhosis patients with the syndrome of internal retention of damp-heat, liver depression and spleen deficiency, or liver-kidney Yin deficiency who were hospitalized in Department of Liver Cirrhosis, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, from October 2017 to March 2018 were enrolled as subjects, and a slit lamp was used to collect ocular images.A total of 115 patients with non-liver diseases (chronic kidney diseases) and 112 healthy volunteers, matched for age, sex, and body mass index, were enrolled as controls, and their ocular imaging features were collected for comparative analysis.After the exclusion of the patients whose ocular images didnt meet the requirements by various factors, 60 patients in each group were included in the analysis of ocular images.The feature extraction method based on local binary pattern (LBP) was used to transform color images into co-occurrence matrix, and the area percentage of LBP features was calculated.Statistical methods including an analysis of variance and the rank sum test were used for comparison of related indices to identify differences between groups.Results:There was a significant difference in the area percentage of LBP features of ocular images between the liver cirrhosis patients, the patients with chronic kidney diseases, and the healthy volunteers (P<0.05).There were significant differences in the area percentage of 245 out of the 255 slices between the liver cirrhosis group and the healthy group (P<0.05), and there were significant differences in the area percentage of 246 out of the 255 slices between the chronic kidney disease group and the healthy group (P<0.05).There were significant differences in the area percentage of 15 slices between the liver cirrhosis group and the chronic kidney diseasegroup (P<0.05).The comparison of the area percentage of LBP features between the different syndromes of the two diseases showed that for chronic kidney diseases, there were significant differences in 19 slices between the three syndromes of internal retention of damp-heat, liver depression and spleen deficiency, and liver-kidney Yin deficiency (P<0.05), while for liver cirrhosis, there were no significant differences between the three syndromes (P>0.05).The comparison of the area percentage of LBP features between the two diseases with the same syndrome showed that for internal retention of damp-heat, there were significant differences in 54 slices between the patients with liver cirrhosis and the patients with chronic kidney diseases (P<0.05);for liver-kidney Yin deficiency, there were significant differences in 46 slices between the two groups of patients (P<0.05);for liver depression and spleen deficiency, there were no significant differences between the two groups of patients (P>0.05).The comparison of area percentage between the three syndromes of internal retention of damp-heat, liver depression and spleen deficiency, and liver-kidney Yin deficiency showed significant differences in 2 slices (P<0.05).Conclusion:An analysis based on the LBP features of ocular images shows a significant difference between liver cirrhosis and chronic kidney diseases, as well as a significant difference between the two diseases with the same syndrome, while the comparison of different syndromes for the same disease shows a difference in patients with kidney diseases, with no significant difference between syndromes in liver cirrhosis patients.The technique based on the LBP features of ocular images are more sensitive differentiation between diseases than syndromes.
Key words:  liver cirrhosis  chronic kidney disease  ocular imaging feature  syndrome comparison  local binary model

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