视网膜电图明视负波反应在检测原发性开角型青光眼中的应用

Clinical application of photopic negative response to the flash electroretinogram in primary open-angle glaucoma

目的探讨视网膜电图（Electroretinogram，ERG）明视负波反应（Photopic Negative Response，PhNR）在检测原发性开角型青光眼（Primary Open—angle Glaucoma，POAG）中的应用。方法应用德国罗兰视觉电生理仪测量52例（67只眼）正常人及137例（173只眼）POAG患者的a波振幅、b波振幅、PhNR振幅和潜时。全视野刺激器由LED光源发光，选用白色背景光和白色刺激光。采用HumphreyC24—2程序检查患者视野的平均缺失Mean Deviation，MD）和（Pattern Standard Deviation．PSD），并根据视野检查结果将POAG患者分为早期组55例（62只眼），进展期组40例（60只眼）和晚期组42例（51只眼）。应用频域OCT（Cirrus OCT）检测全部POAG患者的平均视网膜神经纤维层mean retinal nerve fiber layer，mRNFL）厚度。结果四组中a波振幅、b波振幅、PhNR潜时、PhNR振幅的差异均具有统计学意义（P〈0．05）。a波振幅、b波振幅、PhNR潜时的变异程度较大。MD、mRNFL与PhNR振幅均呈正的直线关系（P=0．000），相关系数分别为0．59、0．45。PSD与PhNR振幅呈负的直线关系（P=0．016）相关系数为-0．37。a波、b波振幅、PhNR振幅的ROC曲线下面积分别为0．853、0．830和0．918。其中，PhNR振幅的诊断价值较高。在设定特异性≥95％的情况下，其敏感性分别为60．4％、54．2％和85．4％。结论POAG组PhNR振幅和潜时较正常对照组明显降低和延迟；PhNR振幅降低与青光眼病变的严重程度相关；PhNR振幅在POAG早期诊断方面具有较高的敏感性，因此PhNR可以作为一个评价POAG视功能的有用指标。

Objective TO evaluate the clinical application of the photopic negative response of electroretinogram in Primary Open-angle Glaucoma （POAG）. Methods Fifty-two normal subjects （67eyes） and 137 with POAG （173eyes） were included in the study. Flashes were produced by light emitting diodes （LEDs）, white stimulus flash on a white background was used. The Humphrey perimetry C24-2 procedure to test the visual field results including Mean Deviation （MD） and Pattern Standard Deviation （PSD） were used. All the patients were divided into three groups according to the resuits： early stage group, 55 patients （62 eyes）, advanced stage group, 40 patients （60 eyes）, and late stage group, 42 patients （51 eyes）. Using spectral domain optical coherence tomography （Cirrus OCT） to test the mean retinal nerve fiber layer （mRNFL） thickness of POAG. Results The amplitudes of a-waves, b-waves, PhNR and the implicit times of PhNR were different among the four groups （P 〈0.05）. The variation degree of a-waves, b-waves amplitudes and the PhNR implicit times was larger. The MD and mRNFL thickness were positively correlated with the amplitudes for the PhNR （P =0.000）, the correlation coefficient was 0.59 and 0.45 respectively. The PSD was negatively correlated with the amplitudes for PhNR （P =0.000）, the correlation coefficient was -0.37. The area under the ROC curve of the amplitudes of a-waves, b-waves, PhNR was 0.853, 0.830 and 0.918 respectively. Among the three parameters, the diagnostic value of the amplitudes for PhNR was higher. In the case of setting specificity ≥95%, the sensitivity of the three parameters was 60.4%, 54.2% and 85.4% respectively. Conclusions Compared to normal subjects, the PhNR amplitudes are reduced, and the PhNR implicit times are prolonged in the POAG groups. The decreases in PhNR amplitudes are correlated to the severity of POAG. The PhNR amplitudes has higher sensitivity in POAG early diagnosis, so which can be served as a useful evaluation index of visual fimction of POAG.