视网膜电图PhNR和OPs在非增生型DR中的变化特点

Changes of PhNR and OPs in patients with nonproliferative diabetic retinopathy

目的观察非增生型糖尿病视网膜病变（DR）中视网膜电图PhNR和OPs的变化特点,比较OPs、PhNR指标在早期诊断及评估视网膜功能的敏感性和特异性。方法选取经间接检眼镜、荧光素眼底血管造影（FFA）确诊的DR患者30例（30眼）,同时选取与其性别、年龄相匹配的正常对照25例（25眼）作为对照组。2组均进行视力、闪光视网膜电图（F-ERG）、FFA检查。比较2组PhNR振幅、OPs振幅及ERG其他参数指标,并探讨不同DR分级与PhNR振幅、OPs振幅的变化关系。结果在OPs指标中,DRⅠ~Ⅳ级OPs振幅与正常值比较差异均有统计学意义（P〈0.05）,PhNR指标显示,DRⅠ级PhNR振幅与正常值比较,差异无统计学意义（P〉0.05）,DRⅡ~Ⅳ级与正常组比较,差异均有统计学意义（P〈0.05）。在比较各参数ROC下面积（AUC）中,OPs指标的AUC最高,为0.866;其次是PhNR指标,AUC为0.754。OPs诊断NPDR的敏感性和特异性分别为63.6%和80%,而PhNR的敏感性和特异性分别为54.5%和73.3%。结论DR在病变初期即出现血液循环性改变、神经细胞功能障碍,表现为PhNR振幅和OPs振幅均明显降低。OPs指标在DR的早期诊断及评估视网膜功能方面敏感性和特异性更高。

Objective The functional changes of neuron and glial cells have been reported to occur before morphological changes in some patients with diabetic retinopathy. It has been shown that OPs can reflect the early alterations of retina in diabetic patients. PhNR,which originates from the inner retina, can reflect the neural activity of retinal ganglion cells. The goal of this study was to explore the characteristics of PhNR and OPs of ERG in patients with nonproliferation diabetic retinopathy （NPDR） and compare the capability and specificity of PhNR to OPs in diagnosis and assessment of retina function in diabetic retinopathy. Methods Thirty patients with NPDR determined by indirect ophthalmoscopy, fundus fluorescence angiography （FFA） and 25 vision normal and age-matched subjects were involved in this study. Visual acuity, flash electroretinogram （F-ERG） and FFA examination were performed in all subjects. The amplitudes of PhNR and OPs were analysed to explore the relationship between PhNR, OPs and different stages of diabetic retinopathy. Diabetic retinopathy of patients was graded based on Proposed International Diabetic Retinopathy and Diabetic Macular Edema Disease Severity Scales. The recording procedure of F-ERG followed the International Standard Protocol of ERG. The specificity and sensitivity of PhNR and OPs in diagnosis of NPDR were evaluated using the area under receier operating characteristics cure （AUC）. Written informed consent was obtained from all the subjects before initiation of study. Results The OPs amplitudes were significantly attenuated even from stage I through IVof diabetic retinopathy in comparison with normal eyes（P 〈0. 05）. The PhNR amplitudes were significantly declined at stage II to IV of diabetic retinopathy in comparison with normal eyes（ P 〈 0.01 ）. AUC of OPs and PhNR were respectively O. 866,0. 754. The sensitivity and specificity of OPs were 63.6% , 80% and those of PhNR were 54. 5% , 73.3% . Compared with other parameters,OPs had the best sensitivity and specificity. Conclusion The amplitude of OPs is a better indicator than PhNR in detecting retinal function in patients with NPDR.