mfERG在亚临床型糖尿病视网膜病变中的诊断价值及临床意义
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摘要
目的:利用多焦视网膜电图测量正常人和亚临床期糖尿病视网膜病变患者以及背景期糖尿病视网膜病变患者的一阶响应,分析上述三组的mfERG的差异。
方法:使用德国Ronland公司的RETscan3.20多焦视觉电生理测量仪。记录90只眼3个组(正常人组、亚临床期组、背景期组)患者的mfERG一阶响应波形,具体为以中心凹为中心的六个环及四个象限的反应波,分析P_1波、N_1波的反应密度及潜伏期的变化。对于数据结果进行统计学分析,应用SPSS软件进行统计学处理。结果以P＜0.05为显著性差异界限,P＜0.01为高度显著性差异界限。
结果:实验研究观察到在六个不同离心度的环形区和四个象限中,NDR与正常组对比,NDR的P_1波反应密度在各个环相对于正常组显著降低,变异较大,在鼻上、鼻下象限也显著降低,颞上、颞下象限无显著差异;P_1波潜伏期在各环之间及各个象限之间均比正常组显著延迟,其中4-5环潜伏期延迟更为显著;N_1波潜伏期在各环之间及各象限之间比正常组显著延迟。NDR与BDR对比,P_1波反应密度有所升高;P_1波和N_1波潜伏期有所缩短,但均无统计学意义。BDR与正常组比,P_1波反应密度在各个环及鼻上、鼻下象限降低高度显著,N_1波、P_1波潜伏期在各环及各个象限之间均比正常组高度显著延迟。
结论:mfERG一阶相应的P_1波反应密度可能是诊断早期DR的敏感指标。
Objective:To measure the distinction of first order kernels for the healthy people,subclinical diabetic r etinopathy and background diabetic retinopathy by the miultifocal electroretinogram,and analyze the difference among the above three groups.
Methods:Using RETscan3.20 system made in germany Ronland company to record the first order kernels of about 90 eyes separately which divided into three groups(the healthy,the NDR,the BDR),concretely by the six ring waveform which circle the central visual filed and four quadrant wave.Analyze the diversity of amplitude and implicit time of P_1 and N_1 wave.As to the statistic analysis,we use spss software.The result is:the much difference limit according to P＜0.05,the high difference limit according to P＜0.01.
Results:the empirical study observe the result as bellow at different ring and quadrant:the NDR contrasted to the healthy,P_1 amplitude density of NDR is decreased notably and the viriation is evidently as all six ring waveform and Inf.nasal,Sup.nasal quadrant wave,but no evident difference as Inf.temp and Sup.temp quadrant wave.P_1 implicit time of NDR is delayed,especially the four-five ring waveform.N_1 implicit time of NDR is delayed as all six ring waveform and four quadrant wave with statistical significance.NDR contrasted to BDR,P_1 amplitude density of NDR is increased limited,P_1 and N_1 implicit time is shorten,but no statistical significance.BDR contrasted to the healthy,P_1 amplitude density of NDR is decreased notably as all six ring waveform and Inf.nasal,Sup.nasal quadrant wave, P_1 and N_1 implicit time of NDR is delayed notably with statistical significance.
Conlusion:the first order kernels P1 amplitude density maybe sensitive index for NDR diagnose.
方法:使用德国Ronland公司的RETscan3.20多焦视觉电生理测量仪。记录90只眼3个组(正常人组、亚临床期组、背景期组)患者的mfERG一阶响应波形,具体为以中心凹为中心的六个环及四个象限的反应波,分析P_1波、N_1波的反应密度及潜伏期的变化。对于数据结果进行统计学分析,应用SPSS软件进行统计学处理。结果以P＜0.05为显著性差异界限,P＜0.01为高度显著性差异界限。
结果:实验研究观察到在六个不同离心度的环形区和四个象限中,NDR与正常组对比,NDR的P_1波反应密度在各个环相对于正常组显著降低,变异较大,在鼻上、鼻下象限也显著降低,颞上、颞下象限无显著差异;P_1波潜伏期在各环之间及各个象限之间均比正常组显著延迟,其中4-5环潜伏期延迟更为显著;N_1波潜伏期在各环之间及各象限之间比正常组显著延迟。NDR与BDR对比,P_1波反应密度有所升高;P_1波和N_1波潜伏期有所缩短,但均无统计学意义。BDR与正常组比,P_1波反应密度在各个环及鼻上、鼻下象限降低高度显著,N_1波、P_1波潜伏期在各环及各个象限之间均比正常组高度显著延迟。
结论:mfERG一阶相应的P_1波反应密度可能是诊断早期DR的敏感指标。
Objective:To measure the distinction of first order kernels for the healthy people,subclinical diabetic r etinopathy and background diabetic retinopathy by the miultifocal electroretinogram,and analyze the difference among the above three groups.
Methods:Using RETscan3.20 system made in germany Ronland company to record the first order kernels of about 90 eyes separately which divided into three groups(the healthy,the NDR,the BDR),concretely by the six ring waveform which circle the central visual filed and four quadrant wave.Analyze the diversity of amplitude and implicit time of P_1 and N_1 wave.As to the statistic analysis,we use spss software.The result is:the much difference limit according to P＜0.05,the high difference limit according to P＜0.01.
Results:the empirical study observe the result as bellow at different ring and quadrant:the NDR contrasted to the healthy,P_1 amplitude density of NDR is decreased notably and the viriation is evidently as all six ring waveform and Inf.nasal,Sup.nasal quadrant wave,but no evident difference as Inf.temp and Sup.temp quadrant wave.P_1 implicit time of NDR is delayed,especially the four-five ring waveform.N_1 implicit time of NDR is delayed as all six ring waveform and four quadrant wave with statistical significance.NDR contrasted to BDR,P_1 amplitude density of NDR is increased limited,P_1 and N_1 implicit time is shorten,but no statistical significance.BDR contrasted to the healthy,P_1 amplitude density of NDR is decreased notably as all six ring waveform and Inf.nasal,Sup.nasal quadrant wave, P_1 and N_1 implicit time of NDR is delayed notably with statistical significance.
Conlusion:the first order kernels P1 amplitude density maybe sensitive index for NDR diagnose.
引文
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[3]M.Loren,C.Gerhardinger.Early celluar and molecular changes induced by diabetes in the retina[J].Diabetologia,2001,44:791-804
[4]Greenstein VC,Karen Holopigian,Donald C.Hood,William Seiple,and Ronald E.Carr.The nature and extent of rentinal dysfunction associated with diabetic Macular Edema[J].Invest Ophthalmol Vis Sci,2000,41:3643-3654
[5]Li Q,Zemel E,Miller B,Perlman I,Early retinal damage in experimental diabetes:electroretinographical and morphological observations[J].Exp Eye Res,2002,74:615-625
[6]吴乐正,视网膜电图发展史[M].北京:人民卫生出版社,临床视觉电生理学,1998;3-10
[7]吴乐正,正常人多焦视网膜电图[M].北京:人民卫生出版社,临床多焦视觉电生理学,2004:49-65
[8]张梅芳,糖尿病视网膜病变[M].北京:人民卫生出版社,眼科与耳鼻喉科专病中医临床诊治,2000;152-153
[9]李传课.中西医结合眼科学[M].北京:中国中医药出版社,2001,8:294-295
[10]韦企平,韦玉英眼科经验集[M].北京:人民卫生出版社,2001,10:231-232
[11]董彦敏,糖尿病眼病的防治[M].北京:中国中医药出版社,2003,8:83-85
[12]肖家翔,王利民.糖尿病局部辨证与-的关系分析[J].中国中医眼科杂志,2000,10(1):33-34
[13]李志英,糖尿病视网膜病变中医证型与视觉电生理的关系[J].陕西中医学院学报,2002,5(1):39-41
[14]张承芬,糖尿病视网膜病变[M].北京:人民卫生出版社,眼底病学,1998:224-257
[15]惠延年,王琳.糖尿病视网膜病变和糖尿病黄斑水肿的国际临床分法[J].眼学继续教育,2004,19(10):10-19
[16]陈力,糖尿病视网膜病变[J].中国城乡企业卫生,2006,6(3)27-29
[17]高翔,糖尿病视网膜病变相关危险因素分析[J].眼科研究,2003:21(3)299-301
[18]Stratton E,Kohner EM,Aldington SJ,et al.UKPDS50:Risk factors fir incidence and progression sf retinopathy in type 2 diabetes over 6 years from diagnosis[J].2001,44(2):156-163
[19]Klein R,Klein BEK,Moss SE,etal.The Wisconsin epidemiologic study of diabetic retinopathy Ⅲ.Prevalence and risk factors of diabetic retionopathy when age at diagnosis 30years of more[J].Arch Ophthalmol,1984,102(4):527-532
[20]Cbung HS,Harri S,Halter P,et al.Regional differentes in retinal vas cular reactivity[J].Invest Ophthalmol Vis Sci,1999,40(10):2448-2453
[21]Pfeifer MA,Schumer MP,Gelber DA[J].Diabetes,1997,46(suppl 2):82-89
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