重度非增生性与增生性糖尿病视网膜病变多焦视网膜电图一阶函数核的特征分析

Characteristics of first order kernel in multifocal electroretinogram between severe non-proliferative diabetic retinopathy and proliferative diabetic retinopathy

目的对比并分析糖尿病视网膜病变（diabetic retinopathy，DR）重度非增生期及增生期的多焦视网膜电图（multifocal electroretinogram，mERG）一阶函数核的变化特征。方法选取DR患者46例72眼分为2组：一组为重度非增生性糖尿病视网膜病变（non-proliferative diabetic retinopathy，NPDR）患者23例38眼，另一组为增生性糖尿病视网膜病变（proliferative diabetic retinopathy，PDR）患者23例34眼。设立对照组为正常健康人23例34眼。采用罗兰的多焦视觉电生理检查仪进行mERG一阶函数核反应检查，提取数据后分析比较2组患者mERG1～5环的N1波、P1波的振幅密度值及峰时值。结果PDR组的N1波和P1波的振幅密度值比NPDR组下降，第1环的差异均有显著统计学意义，2～5环N1波的差异无统计学意义，P1波的差异有统计学意义；PDR组的N1渡和P1波的潜伏期比NPDR组延迟，2种波形第1环的差异均无统计学意义，2～5环的差异有统计学意义（N1波4环除外）。结论DR从非增生期进入增生期，mERG一阶函数的N1和P1波在黄斑中心凹区振幅密度值下降明显，而在黄斑区外视网膜则以潜伏期的延长为明显。N1和P1波的振幅密度值对反映视细胞功能更为敏感，而潜伏期则可能与视网膜缺血的关系相对密切。

Objective To compare and analysis the characteristics of the first order kernel （ FOK） in multifocal electroretinogram （mERG） between severe non-proliferative diabetic retinopathy （ NPDR ） and proliferative diabetic retinopathy （PDR）. Methods mERGs were recorded from 38 eyes of 23 individuals with severe NPDR and 34 eyes of 23 individuals with PDR. Also, 34 eyes of 23 healthy persons were choosed as control subjects. The dates of FOK were recorded, and the variability of parameters of N1 and P1 waves were analyzed from the first to fifth rings in mERG between two groups with DR, which included amplitudes and peak implicit times. Results The amplitude of N1 and P1 waves were reduced more in PDR eyes than in NPDR eyes. The differences of the first ring in the two waves both had high signifiance, the differences in the second to fifth rings of P1 waves had statistical significance, but did not in N1 waves. The implicit times of N1 and P1 waves were more prolonged in PDR subjects than in NPDR eyes, the differences in the first ring of the two xvaves both had no signiflance, otherwise the second to fifth rings were significantly different （ the fourth ring of N1 waves were not included）. Conclusions When the severity of retinopathy progressed from NPDR to PDR, the amplitudes of N1 and P1 waves were reduced significantly in central fovea of macula, and the implicit time was prolonged significantly in the outside of the macular are a. Accordingly, we can presume that the amplitude of N1 and P1 waves can be more sensitive to evaluate the function of photoreceptor cells, and the extension of implicit time possibly has intimate relationship with retinal ischemia.