对比敏感度联合视觉电生理在亚临床期糖尿病视网膜病变诊断中的意义

The significance of contrast sensitivity combined with visual electrophysiology tests on sub-clinical stage of diabetic retinopathy

目的探讨对比敏感度联合多种视觉电生理检查在亚临床期糖尿病视网膜病变诊断中的变化特点，为临床早期诊断提供客观敏感的指标。方法选择内分泌科确诊为Ⅱ型糖尿病患者59例（118只眼），经检眼镜检查、眼底荧光血管造影检查后分为三组，其中无糖尿病性视网膜病变（NDR）40只眼，非增殖性糖尿病性视网膜病变（BDR）38只眼，增殖性糖尿病性视网膜病变（PDR）40只眼，分别对其行对比敏感度（CS）、闪光视网膜电图（F—ERG）、图形视觉诱发电位（P—VEP）检测，并和16名（32只眼）正常对照组进行对比。结果糖尿病各组和对照组CS比较差异均有统计学意义：分别为NDR组在中频差异具有统计学意义（P〈0．05），BDR组在中频和高频时差异具有统计学意义（P〈O．05），PDR组在各个空间频率差异均具有统计学意义（P〈0．05）；NDR、BDR、PDR组患者F—ERGb波潜时和对照组相比差异均有统计学意义（P〈0．05），表现为潜时延长，各组之间比较b波潜时差异有统计学意义（P〈0．05），糖尿病各组之间P—ERG的b波波幅比较差异无统计学意义（P〉0．05）；NDR、BDR、PDR组患者P—VEP的P100潜时延长和对照组比较差异均有统计学意义（P〈0．001），随着糖尿病视网膜病变程度的进一步发展，P—VEPP100潜时延迟但差异无统计学意义，DR各期P—VEPP100波幅下降不显著；糖尿病三组F—ERGb波潜时延长变化率大于P—VEPP100潜时变化率。结论CS、F—ERG及P—VEP在亚临床期糖尿病视网膜病变时即有改变，CS联合P—ERG检查在早期糖尿病视网膜病变诊断中的异常率较高。

Objective To investigate the change of contrast sensitivity （CS） test combined with the clinical value different kinds of electro-Physiological in sub-clinical stage of diabetic retinopathy, and find some more objective and sensitive parameters in early diagnosis of diabetic retinopathy （DR）. Methods Selected 59 patients （118 eyes） with type II diabetes mellitus （DM） diagnosed by Department of Endocrinology,were divided into three groups by ophthalmoscopy and fundus fluores- cein angiography,including 40 eyes without diabetic retinopathy （NDR）,38 eyes with background DR （BDR） and 40 eyes with proliferative DR （BDR）, 16 cases （32 eyes） of normal controls group had also been taken, to compare the difference of the CS, F-ERG, P-VEP between four groups. Results There were significant differences between the normal control group and the DM group in CS： The differences in middle frequency were significant （P 〈0.05） difference between NDR and normal group,low frequency and high frequency were significant （P 〈0.05） difference between BDR and normal group, each spatial frequency were significant （P 〈0.05） difference between PDR and normal group. The b-wave latency of F-ERG were significant （P 〈0.05） difference between normal control group and NDR, BDR, PDR group. The b-wave amplitude of F-ERG were no significant （P 〉0.05） difference between diabetic groups. The P100 wave latency of P-VEP were significant （P 〈0.001） dif- ference between normal control group and NDR, BDR, PDR group. As of the further development of diabetic retinopathy, the P100 wave latency of P-VEP was significantly delayed but had no signifi- cant difference. The P100 wave amplitude of P-VEP in diabetic retinopathy decreased but was not obvious. Latency change rate in b-wave of F-ERG were greater than P100 wave latency of P-VEP in DR groups. Conclusions Contrast sensitivity, F-ERG and P-VEP has changed in patient with sub-clinical stage of diabetic retinopathy. Contrast sensitivity combined with P-ERG is sensitive pa- rameters in diagnosis of early diabetic retinopathy.