Behcet病后葡萄膜炎的多焦视网膜电图研究

Findings from multifocal electroretinography of posterior uveitis in Behcet’s disease

目的观察Behcet病后葡萄膜炎对后极部视网膜功能的影响。方法对39例(68眼)活动期Behcet病患者进行多焦视网膜电图(mfERG)检测。受试眼根据荧光素眼底血管造影(FFA)表现分为Behcet病合并囊样黄斑水肿(CME)组和Behcet病合并弥漫黄斑水肿(DME)组,分析其mfERG特点。17名年龄和性别匹配的正常受试者作为正常对照组。mfERG的检测遵循国际临床视觉电生理学会标准化的要求。结果与正常对照组相比,Behcet病患者mfERG1～6环P1波振幅明显降低,差异均有统计学意义(P<0.01);1～5环N1波振幅明显降低,差异均有统计学意义(P<0.01);Behcet病患者1～6环P1波隐含时缩短,但差异无统计学意义(P>0.05)。Behcet病合并DME组mfERG1～6环P1波、N1波振幅较Behcet病合并CME组均明显降低(P<0.05,P<0.01)。Behcet病合并CME组患者视力与1环的N1波隐含时及振幅均呈负相关(r=-0.36,r=-0.37,P<0.05),与1环的P1波振幅呈正相关(r=0.43,P<0.05)。Behcet病合并DME组患者的视力与1环的N1波振幅、隐含时及P1波振幅均呈负相关(r=-0.41,r=-0.35,r=-0.40;P<0.05),与1环P1波振幅呈正相关(r=0.48,P<0.05)。结论黄斑中心凹是Behcet病患者视网膜功能降低最严重的部位。Behcet病患者mfERG的异常主要表现为视网膜电位的幅度改变,对视网膜电活动的时程无明显延迟作用。

Background Beheet＇ s disease is a refractory panuveitis with high blindness rate. Multifoeal electroretinography （mfERG） is a useful tool for the evaluation of the function of the posterior retina. Objective The aim of this study is to assess the characteristics of Behcet＇ s disease using the mfERG. Methods mfERG was recorded in 68 eyes of 39 cases with active stage of Beheet＇ s disease. All of the patients were diagnosed based on the Standard of International Study Group for Behcet＇ s Disease and assigned to the cystoid macular edema （CME） group and the diffuse macular edema （DME） group after assessment by fundus fluoreseein angiography （FFA）. Seventeen normal subjects were used as controls. Oral informed consent was obtained from all of the subjects prior to this trial, mfERG recording followed the ISCEV Guidelines for Clinical Multifocal Electroretinography （2007 edition）. The response density and latency of P1 and Nl waves in 6 rings were analyzed and compared. Results The amplitudes of N1 waves from rings 1 through 6 and N1 wave from rings 1 through 5 were significantly declined in patients with Behcet＇ s disease compared with normal control （P 〈 0.01 ）. All of the lateneies of Pj waves from rings 1 through 6 were insignificantly shortened in patients with Behcet ＇ s disease compared with normal control （P 〉 0. 05 ）. The amplitudes of Pt and N^waves from rings 1 through 6 in diffuse macular edema group were considerably lower than those in the cystoid macular edema group （P 〈 0.05 ,P 〈 0.01 ）. A test of visual acuity showed a negative correlation to the amplitude and latency of N~ wave （r= -0.36, -0.37,P〈0.05 ） and a positive correlation with the amplitude of N1 wave （r =0.43,P〈 0.05） in the DME group. In the CME group,a test of visual acuity presented a negative correlation to the amplitude and latency ofN1 wave and latency of P1（r= -0.41, -0.35, -0.40,P〈0.05 ） and a positive correlation with the amplitude of P1 wave （r = 0.48,P 〈 0.05 ）. Conclusion mfEGR demonstrates that retinal electro-activity is abnormal in eyes with Behcet＇ s disease. The distinct functional disorder is situated around the fovea.