视网膜振荡电位与图形诱发电位在糖尿病性视网膜病变中的比较

Comparison of retinal oscillatory potentials and pattern visual evoked potentials in the treatment of diabetic retinopathy

目的:比较视网膜振荡电位和图形视觉诱发电位在糖尿病性视网膜病变中变化情况,分析两者在诊断评估中的价值。方法:选择2002-01/2004-12江苏省无锡市第一人民医院内分泌科住院患者111例。按眼底改变将患者分为三组,糖尿病无视网膜病变组48例(96眼),背景型糖尿病性视网膜病变组41例(82眼),增殖型糖尿病性视网膜病变组22例(44眼)。健康体检者35例(70眼),为正常对照组。用眼底摄片或眼底荧光血管造影检查糖尿病患者的视网膜病变,进行视网膜振荡电位和图形视觉诱发电位检查。观察视网膜振荡电位总波及其子波波幅和图形视觉诱发电位P100潜伏期和振幅在各组的变化情况。结果:纳入患者111例和正常对照者35例,均进入结果分析。①视网膜振荡电位:在糖尿病性视网膜病变前期眼底尚未发现异常时视网膜振荡电位总波和子波2已出现振幅下降,与对照组比较差异显著[糖尿病无视网膜病变组、正常对照组视网膜振荡电位总波分别为(186.86±43.15),(205.64±33.95)μV;子波2分别为(53.26±17.81),(61.89±19.38)μV,P<0.05],子波1,3则在背景型糖尿病性视网膜病变组和增殖型糖尿病性视网膜病变组较正常对照组振幅明显下降[子波1分别为(11.07±7.20),(5.84±4.60),(16.85±8.97)μV,子波3分别为(24.51±10.88),(13.26±7.87),(30.81±15.13)μV,P<0.05],子波4在各组振幅变化无明显差异。②图形视觉诱发电位:图形视觉诱发电位P100潜伏期在背景型糖尿病性视网膜病变组和增殖型糖尿病性视网膜病变组较正常对照组明显延长[分别为(118.72±9.00),(120.27±9.63),(112.45±6.99)ms,F=16.287,P=0.000]和图形视觉诱发电位P100振幅在背景型糖尿病性视网膜病变组和增殖型糖尿病性视网膜病变组较正常对照组明显下降[分别为(6.89±2.46),(3.65±1.96),(9.52±4.11)ms,F=32.014,P=0.000]。并随视网膜病变严重程度增加,潜伏期延长和振幅降低更明显。结论:①视网膜振荡电位总波及子波2能较早期发现糖尿病患者的糖尿病性视网膜病变前期改变,当然是糖尿病性视网膜病变早期诊断的敏感指标。②图形视觉诱发电位P100潜伏期及振幅能提示糖尿病性视网膜病变的严重程度,故可作为判断糖尿病性视网膜病变的发展和预后的重要指标。

AIM： To compare the difference between retina oscillatory potentials and pattern visual evoked potentials in the diabetic retinopathy, and analyze their value in diagnosis evaluation. METHODS. 111 patients, who were hospitalized in Department of Ophthalmology, First People＇s Hospital of Wuxi between January 2002 and December 2004, were selected. The patients were assigned into 3 groups according to changes of fundus of eye： 48 cases （96 eyes） in no diabetic retinopathy （NDR） group, 41 cases （82 eyes） in background diabetic retinopathy （BDR） group and 22 cases （44 eyes） in proliferative diabetic retinopathy （PDR） group. Eyes with no opthalmic abnormal 35 cases （70 eyes） were in nounal control （NC） group. Retinopathy severity in diabetic patients was measured in color fundus photographs or fluorescence fundus angiography. Variation of the summed amplitudes of the oscillatory potentials, the amplitudes of the suboscillatory potentials, and the latency and amplitude of the pattern visual evoked potentials P100 in different groups were observed. RESULTS： 111 included patients and 35 nornlal cootrolled people were all involved in the result analysis, ①Retina oscillatory potential： The summed amplitudes of the oscillatory potentials and the amplitude of the second oscillatory, potentials 2 decreased and had significant difference as compared with the control group before diabetic retinopathy and without abnormal at fundus of eye [The summed amplitudes of the oscillatory, potentials in the NDR group and normal control group were （186.86±43.15）, （205.64±33.95）μV, respectively; the second oscillatory potentials 2 was （53.26±17.81）, （61.89±19.38）μV.P 〈 0.05, respectively.]. The amplitudes of the first and third oscillatory potential in BDR and PDR group reduced significantly compared with those in the uomml control group [the first oscillatory potential was（11.07±7.20）, （5.84±4.60）, （ 16.85±8.97）μV; the third oscillatory potential was （24.51±10.88）, （13.26±7.87）, （30.81±15.13）μV, P 〈 0.05]. The amplitude of the fourth oscillatory potential in the diabetic groups did not significantly differ from that in the control group. ②Pattern reversal visual evoked potentials： The latency and the amplitudes of pattern visual evoked potentials P100 in the BDR and PDR group were significantly delayed and lower compared with those in the normal control group [latency （ 118.72±9.00 ）, （ 120.27±9.63 ）, （ 112.45±6.99） ms, F=16.287, P=0.000; amplitudes（6.89±2.46）, （3.65±1.96）, （9.52±4.11） ms, F=32.014 P=0.000], and the latency extended progressively as the retinupathy severity increased and the amplitudes lower markedly. CONCLUSION：①The oscillatory potentials sunmecd amplitudes and the second oscillatory amplitude measures can find early alteration of diabetic retinopathy in diabetic patients, and it is the sensitive index of early diagnosis of diabetic rctinopathy. ②The pattern visual evoked potentials P100 latency and amplitude, which can indicate the severe degree of diabetic retinopathy, can be used as the key index in judging the development and prognosis of diabetic retinopathy.