不同程度糖尿病视网膜病变的多焦视网膜电图一阶kernel反应的特征

Characteristics of the first-order kernel of multifocal electroretinogram in different severity grade of early diabetic retinopathy

目的:观察不同程度早期糖尿病视网膜病变(diabetic retinopathy,DR)的多焦视网膜电图(multifocal electroretinograms,mf-ERG)一阶kernel反应(f irst order kernel,FOK)的变化特征,探讨糖尿病患者的视网膜组织形态学改变与功能学检查的关联,及早期DR视功能受损的敏感监测指标。方法:横断面研究,采用多焦视觉电生理检查系统测量分析16例无DR组、15例轻度非增殖性DR(non-proliferative diabetic retinopathy,NPDR)组和15例中度非增殖性DR(中度NPDR组),正常对照组16例FOK反应,选右眼测量,比较不同程度DR的N1,P1波潜伏期、振幅密度差异。结果:与正常组相比,无DR组、轻度NPDR组、中度NPDR组的N1,P1波潜伏期延长分别1.42,1.35,2.75 ms和0.98,1.01,2.71 ms(P<0.001),N1,P1波振幅密度差异无统计学意义(P>0.05)。随DR程度加重,N1,P1波潜伏期逐渐延长。no DR组虽尚未出现可见视网膜病变,但FOK的N 1,P 1波潜伏期已出现异常。结论:糖尿病患者早期眼底尚未出现可见视网膜血管病变,mf-ERG的FOK的N1,P1波潜伏期已出现异常。FOK的N1,P1波的潜伏期的延长与DR的血管病变的严重程度呈正相关。FOK的N1,P1波的潜伏期可能是较振幅密度更为敏感视网膜功能异常的观察指标。

Objective： To investigate the change of the first-order kernel（FOK） in multifocal electroretinogram（mf-ERG） in different severity grade of early diabetic retinopathy. Methods： The FOK of mf-ERG were performed in 16 eyes with no diabetic retinopathy（non-DR group）, 15 with mild non-proliferative diabetic retinopathy（mild NPDR group） and 15 with moderate NPDR; 15 age-matched healthy subjects were selected in the control group. Results： Compared with the control group, N1 and P1 implicit times in the non-DR group, the mild NPDR group and the moderate NPDR group were delayed by 1.42, 1.35, 2.75 ms and 0.98, 1.01, 2.71 ms（all P〈0.001）. N1 and P1 amplitudes did not significantly change（both P〉0.05）. Conclusion： Implicit times of N1 and P1 of mf-ERG delay before diabetic patients have no visible retinal vascular lesions. There is a significant correlation between retinopathy severity and the magnitude of the delays of N1 and P1 implicit times. Compared with the amplitude, implicit time of FOK yields high sensitivity in predicting the incidence of abnormal retinal function. Sensitivity to abnormal retinal function.