视网膜电图振荡电位在糖尿病性视网膜病变早期诊断的价值

EARLY DIAGNOSIS VALUE OF OSCILLATORY POTENTIALS IN DIABETIC RETINOPATHY

目的探讨视网膜电图振荡电位 (oscillatorypotentials ,OPs)在糖尿病性视网膜病变早期诊断中的价值 ,以及与糖尿病病程、血糖和血压的关系。方法测定 10 2例 2型糖尿病患者的视网膜电图振荡电位 ,分析暗适应OPs的波幅及潜时 ,并将OPs、眼底荧光血管造影和检眼镜检查三者对糖尿病性视网膜病变的异常检出率进行比较 ;同时测定患者的血压、空腹血糖及糖化血红蛋白 ,与OPs进行相关分析。结果在糖尿病性视网膜病变前期组 ,暗适应OPs总波幅、OPs各子波波幅 (OP1～OP4 )降低及OP1、OP2 潜时延长 ,均与对照组有显著性差异 (P <0 .0 1) ,且与糖尿病性视网膜病变各期有明显的相关性 ,其中以OPs总波幅的相关性最好 ;OPs、眼底荧光血管造影及检眼镜检查三者对糖尿病性视网膜病变的异常检出率依次为 6 7.6 %、5 2 .9%和 45 .1% ;OPs总波幅与血糖、病程、血压 (包括收缩压和舒张压 )均呈负相关。结论暗适应OPs总波幅是目前诊断早期糖尿病性视网膜病变最敏感的指标 ,它不仅能早期发现病变 ,还能反映视网膜的进行性损害 ;及早发现和控制高血糖、高血压 。

ObjectiveTo investigate the value of oscillatory potentials(OPs) in early diagnosis of diabetic retinopathy(DR) and the correlation of OPs with duration of disease, level of glycemia and blood pressure. MethodsOPs of 102 cases with type 2 diabeties were included in this study.Amplitudes and implicit times were recorded in dark adaptation. The detection rates of DR were compared among OPs, fluorescence fundus angiography(FFA) and funduscopy. Blood pressure, fasting plasma glucose and glycosylated hemoglobin(HbA1C) levels of the patients were measured and the correlation of OPs with them were analysed. ResultsIn dark adaptation, the amplitudes of each OP (OP 1～OP 4), the total amplitudes decreased and the implicit time of OP 1, OP 2 were delayed in the diabetic patients without retinopathy, there was a significant difference between the normal control and preretinopathy groups (P< 0.01 ), significant correlation were observed in each DR group,the correlation of the total amplitudes was the best; the detected rates of OPs, FFA and funduscopy were 67.6 % , 52.9 % and 45.1 % respectively. OPs had negative correlation with fasting plasma glucose, duration of disease, systolic blood pressure and diastolic blood pressure.ConclusionThe total amplitudes of OPs in dark adaptation is the most sensitive marker in diagnosing early DR, not only for early DR, but also for reflecting the progressive lesion in retina. The early detection and control of hyperglycemia and hypertension are valuable to reduce the onset and delay the development of DR.