非增生性糖尿病视网膜病变的视网膜电图特征研究

发布时间：2018-05-27 12:15

本文选题：视网膜电图 + 震荡电位　；参考：《重庆医科大学》2012年硕士论文

【摘要】：目的：探讨非增生性糖尿病视网膜病变视网膜电图的特征及其临床应用价值。方法：选取2010年9月至2011年3月于我病区门诊就诊的连续39例2型糖尿病患者，根据眼科检查结果将其分为糖尿病无视网膜病变（no diabetic retinopathy,NDR）组（23例46眼）,非增生性糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)组（16例32眼），另纳入年龄匹配的15例健康体检者为对照组（30眼）。按ISCEV标准行全视野闪光视网膜电图（flash Electroretinogram，f-ERG）检查。滤波去除振荡电位（oscillatory potentials，OPs）对a-、b-波的影响后，测量暗适应0.01、暗适应和明适应3.0ERG的a-、b-波隐含期、振幅、b/a振幅比值。确定视杆和视锥系统OPs的频谱范围后，用快速傅里叶转换分别提取视杆细胞系统和视锥细胞系统OPs并测量峰频率、振幅、隐含期和振幅能量。用ANOVA辅以Bonferroni后矫正行统计分析。P0.05表示有统计学意义。结果：暗适应反应变化明显的是0.01反应中b-波的隐含期延长及振幅下降（P＜0.05）；暗适应3.0反应中NPDR组a-波及b-波振幅较NDR组下降（P＜0.05）；明适应反应中,与对照组相比, NDR组及NPDR组a-波隐含期延长（P＜0.01和P＜0.001）；与对照组相比，NDR组及NPDR组视锥细胞系统Ops隐含期延长有统计学意义（P＜0.05），而视杆细胞系统Ops各项指标改变无统计学意义。NPDR组与对照组、NDR组比较，视锥细胞系统Ops峰频率增高有统计学意义（P＜0.05和P＜0.01）。结论： 1、暗适应0.01ERG b-波隐含期及振幅、明适应3.0ERGa-波隐含期及视锥细胞系统Ops隐含期可作为早期了解糖尿病视网膜功能的稳定客观指标。 2、随着NPDR症状加重，，功能障碍同时累及视锥和视杆系统,并且视杆系统功能的受损程度大于视锥系统。 3、NPDR对视网膜的功能损害可能源自光感受器的损害,视细胞层及视网膜内层均出现功能障碍。 4、ERG各指标中隐含期变异系数较小，振幅能量变异系数较大。 5、DR的视网膜神经元功能改变早于临床可见的视网膜血管病变。
[Abstract]:Objective: to investigate the characteristics and clinical value of electroretinogram in non-proliferative diabetic retinopathy. Methods: from September 2010 to March 2011, 39 consecutive patients with type 2 diabetes mellitus were selected. According to the results of ophthalmologic examination, the patients were divided into 23 cases (46 eyes) with no diabetic retinopathy, 16 cases (32 eyes) with non-proliferative diabetic retinopathy (NPDR) with non-proliferative diabetic retinopathy, and 30 eyes (30 eyes) with age matched 15 healthy controls. Flash electroretinogram (flash Electroretinogramgramma f-ERG) was performed according to ISCEV standard. After removing the effect of oscillatory potentials on a-b- wave, the dark adaptation (0.01), dark adaptation (dark adaptation) and bright adaptation (3.0ERG) are measured, and the amplitude ratio of b / a is measured. After determining the spectrum range of OPs in rod and cone system, the OPs of rod cell system and cone cell system were extracted by fast Fourier transform, and the peak frequency, amplitude, implicit period and amplitude energy were measured. Statistical analysis with ANOVA plus Bonferroni after correction. P05 indicated that there was statistical significance. Results: the obvious change of dark adaptation response was the prolongation of the implicit period and the decrease of the amplitude of b- wave in 0.01 response (P < 0.05), the amplitude of a- wave and b- wave in NPDR group was lower than that in NDR group (P < 0.05), and in the light adaptation reaction, the amplitude of a-wave and b-wave in NPDR group was lower than that in NDR group (P < 0.05). Compared with the control group, the a- wave implicit period was prolonged in NDR group and NPDR group (P < 0. 01 and P < 0. 001), and the prolongation of Ops implicit period in NDR group and NPDR group was statistically significant (P < 0. 05), but there was no significant change in Ops index of rod cell system. Significance: the NPDR group was compared with the control group in NDR group, The frequency of Ops peak in cone cell system increased significantly (P < 0. 05) and P < 0. 01 (P < 0. 01). Conclusion: 1. Dark adaptation to 0.01ERG b-wave implicit period and amplitude, explicit adaptation to 3.0 ERGa-wave implicit period and cone-cell system Ops implicit period can be used as an objective and stable index for early understanding of diabetic retinal function. 2. With the exacerbation of NPDR symptoms, the dysfunction involved both the visual cone and the rod system, and the damage degree of the rod system was greater than that of the cone system. 3The functional damage of retina caused by NPDR may be due to the damage of photoreceptor, and both the optic cell layer and the inner layer of retina have dysfunction. (4) the coefficient of variation of implied period and the coefficient of variation of amplitude energy are smaller in each index of ERG. The changes of retinal neuron function in Dr group were earlier than that in clinical retinopathy.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R774.1

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