左旋多巴在弱视治疗中的应用研究

发布时间：2018-01-04 22:22

本文关键词：左旋多巴在弱视治疗中的应用研究　出处：《泸州医学院》2013年硕士论文　论文类型：学位论文

【摘要】：目的：弱视是视觉系统在发育期间未受到有效视觉刺激而导致的视功能的障碍，，其治疗原则是在视觉发育敏感期内消除异常视觉经验，传统的治疗方法是病因治疗，通过屈光矫正、视觉功能训练和双眼相互作用的调整来恢复视功能，但对年龄较大的个体来说疗效具有不确定性。近20年来，学者们致力于弱视药物治疗的相关研究，期望能够得到更好地治疗效果，其中，对左旋多巴的研究已经显示出一定的临床价值，但许多研究结果认为其长期疗效不稳定，临床价值有待讨论，不同研究对其在弱视治疗中的作用各持己见，因此有必要作进一步探讨。目前的弱视治疗原则主要来自于对“视觉发育敏感期”理论的认识，认为弱视的治疗效果与年龄有密切关系，一旦患者年龄超过视觉发育敏感期，视觉系统已发育成熟而不再具备可塑性，这与单独采用传统治疗方法难以治愈大于12岁弱视患者的临床结果相符，以至于年龄超过12岁的弱视患者多放弃治疗，这是我国的成人弱视患者人数超过千万的重要原因之一。近年来大量的基础研究和临床实验证实，在“视觉发育敏感期”后，视觉系统仍然具有一定的可塑性，但大多数临床医师依然对敏感期后的弱视治疗没有信心，此类患者接受治疗的顺应性也很差，如果能够寻找到可以预测弱视治疗愈后的指标，将可能扭转这种情况。前期研究已经发现，弱视患者使用单次剂量的左旋多巴后，能够在短期内检测到弱视眼的图形视觉诱发电位（pattern reversal visual evoked potentioals，PVEP)出现潜伏期的显著缩短和振幅的显著提高，可以设想，如果这些变化反映的是被激发的视觉系统潜在功能，将可能对弱视治疗的愈后提供参考。因此，本实验的目的是：探讨治疗前使用单剂量左旋多巴后的PVEP反应与弱视眼治疗效果的关系，探索PVEP检测方法作为弱视治疗愈后指标的可能性；研究左旋多巴配合传统方法治疗“视觉发育敏感期”内、外弱视患者的效果差异，了解左旋多巴在不同年龄组弱视治疗中的临床价值。方法：1.病例选择：按照中华医学会眼科分会斜弱视组2010年弱视诊断标准，选择弱视患者29例、45眼，年龄6-18岁，所有患者均为远视性屈光不正，屈光参差的弱视类型，且未接受过任何弱视治疗。2.分组：按年龄和治疗方法不同，将患眼分为3个组，每组15只弱视眼，其中：A组：年龄≥12岁，使用左旋多巴和综合疗法；B组：年龄＜12岁，使用左旋多巴和综合疗法，C组：年龄＜12岁，仅使用综合疗法。3.图形视觉诱发电位检查：在配镜矫正屈光不正后进行，在用药前使用角频率为2°、1°、30′的三种棋盘格图形刺激弱视眼，记录PVEP的P100潜伏期和振幅数据；然后所有患者均给予单次剂量的思利巴4mg/kg(每片含左旋多巴有效成分125mg），分别记录在服药后60/75/90/105min时的P100的潜伏期和振幅数据。4.治疗：各组按照设计的治疗方法连续治疗三个月。5.随访方法：每周复查视力，观察药物不良反应，治疗满三个月时复查PVEP的P100潜伏期和振幅。6.疗效判断：进步：视力上升≥2行；无效：视力改善≤1行；退步：视力下降≥1行。7.结果分析：比较有效和无效病例在首次服用单剂量左旋多巴后的PVEP改变有无差异，分析PVEP改变与疗效之间的关系。分别对比A组和B组，B组和C组的视力情况，了解在视功能恢复程度和恢复速度上有无差异，分析左旋多巴对于不同年龄组弱视的治疗意义。结果：1.各组均无视力退步病例，视力进步眼在各组的分布为：A组9只眼，B组11只眼，C组10只眼，其余均为无效眼。将A组与B组，B组与C组的视力进步与无效的情况进行两两比较，其疗效的差异没有统计学意义（P＞0.05），2.分别比较有效组内不同年龄组的起效时间，A组和B组之间，起效时间差异没有统计学意义（P＞0.05）。B组和C组之间，起效时间差异具有统计学意义（P＜0.05），B组的起效时间较C组更为提前；3.首次单剂量服用左旋多巴前后的PVEP检查结果比较，有效病例（共30只眼）与无效病例（共15只眼）在1°空间频率的潜伏期变化的差异具有统计学意义（P0.05），而其振幅变化差异不具有统计学意义（P0.05)，其余空间频率的振幅和潜伏期的变化差异均不具有统计学意义（P0.05)；4.单次用药后的四个时间点上测得的1°空间频率的潜伏期，在不同年龄组之间变化没有统计学差异，各个时间点之间有差异。在最初的时间点即60min时，变化幅度最明显；结论：1.单剂量服用左旋多巴后，1°空间频率刺激物诱发的PVEP潜伏期改变与治疗效果之间的关系具有统计学意义（P＜0.05)，且在用药后60min改变最明显，提示单剂量用药后引起的视觉系统反应性的提高，与视觉系统可塑性的潜能可能有一定相关性。通过进一步深入研究，有可能作为一项评价指标。2.对于年龄＜12岁的弱视患者，使用左旋多巴后视力提高速度更为显著（P＜0.05)，但两组在3个月后两组的视力进步情况、VEP的改善情况差异没有统计学意义（P＞0.05)，提示对于＜12岁的弱视治疗无常规使用左旋多巴的必要，应酌情使用。3.对于年龄≥12岁的弱视患者，使用左旋多巴联合综合治疗依然能够获得良好的治疗效果，分析其原因是由于超过视觉发育敏感期的患者仍然具有可塑性，在左旋多巴的作用下，其视觉系统的潜在功能可以被激活，因此在相同视觉环境刺激下可以获得与＜12岁组相似的治疗效果。提示对≥12岁的患者治疗应当配合使用左旋多巴。由于本实验样本量较小，研究结果的可靠性需要扩大样本量，通过进一步的研究加以证实。
[Abstract]:Objective: amblyopia is the visual system during development has not been effective visual stimulation caused by visual function disorder, the treatment principle is to eliminate the abnormal visual experience in the sensitive period of visual development, the traditional method of treatment is the etiological treatment, by adjusting the refractive correction, visual function training and binocular interaction to restore visual function, but the effect is uncertain for older individuals. In the past 20 years, scholars engaged in research related to drug treatment of amblyopia, expect to be able to get a better treatment effect, the study of levodopa has demonstrated some clinical value, but many studies show that the long-term efficacy of clinical value to be unstable. Discussion of different research on its role in the treatment of amblyopia and therefore it is necessary to make a further each one sticks to his own view, explore. Amblyopia treatment principles at present mainly from "vision Understanding development sensitive period "theory, that is closely related to the treatment of amblyopia with age, once patients older than the sensitive period of visual development, the visual system has been mature and no longer have plasticity, and this alone using the traditional treatment methods difficult to cure more than 12 patients with clinical results of amblyopia are consistent with that of amblyopia patients older than the 12 year old more than to give up treatment, this is one of the important reasons for the number of adult patients with amblyopia in China more than 10 million. That a lot of basic research and clinical trials in recent years, in the sensitive period of visual development", the visual system still has certain plasticity, but most clinicians still on the treatment of amblyopia after the sensitive period of no such confidence, medication compliance is poor, if we can find the treatment of amblyopia can predict the prognosis, may reverse this situation before. Research has found that patients with amblyopia using a single dose of levodopa, to visual evoked potential detection of amblyopia in the short term (pattern reversal visual evoked potentioals, PVEP) significantly increased the latency and amplitude appear significantly shortened, can be envisaged, if these changes reflect the potential function of visual system is excited that may provide a reference for the treatment of amblyopia after healing. Therefore, the purpose of this study is: To explore the relationship between the use of PVEP reaction and amblyopia treatment effect after a single dose of levodopa before treatment, the PVEP method is explored as amblyopia treatment after the index of the possibility of levodopa with traditional therapy; "the sensitive period of visual development" in between amblyopic patients, to understand the clinical value of levodopa in the treatment of amblyopia in different age groups. Methods: 1. cases According to the Chinese Medical Association of Ophthalmology oblique amblyopia group 2010 amblyopia diagnostic criteria, select 29 cases of patients with amblyopia, 45 eyes, 6-18 years of age, all patients were hypermetropia, anisometropic amblyopia type, and did not receive any treatment of amblyopia.2. group: according to the age and the different treatment methods, the patients were divided into the 3 group, 15 rats in each group: A group of amblyopic eyes, the age of more than 12 years, the use of levodopa and comprehensive therapy; group B: age less than 12 years, the use of levodopa and comprehensive therapy, group C: age < 12 years, using only the comprehensive therapy.3. graphic visual evoked potential examination: in the use of eyeglasses after the use of angular frequency in ametropia, before the medication is 2 degrees, 1 degrees, three kinds of pattern 30 'the amblyopic eye records PVEP P100 latency and amplitude data; then all patients were given a single dose of levodopa (each containing either 4mg/kg Pakistan), effective components of 125mg latency were recorded in the P100 60/75/90/105min after treatment and.4. treatment groups: amplitude data according to the treatment methods of design of continuous treatment for three months follow-up.5. methods: Weekly Review of visual acuity, observation of adverse drug reactions, treatment with PVEP three months later the latency and amplitude of P100.6. curative effect judgment: progress: the visual acuity increased more than 2 lines of vision improvement; invalid: less than 1; more than 1 step backwards: decreased visual acuity.7. results analysis: effective and ineffective cases in the first administration of a single dose of levodopa after the PVEP changes the difference, analyze the relationship between PVEP changes and the curative effect were compared. A group and B group, visual acuity B group and C group, understand the visual function in the recovery and the recovery speed difference, analysis of different age groups for amblyopia levodopa treatment. Results: the 1. groups had no vision back Cases in each eye visual acuity distribution: 9 eyes in group A and group B in 11 eyes, 10 eyes in group C, the rest are invalid eyes. A group and B group, B group and C group were 22 and the visual acuity is the difference of the curative effect, no statistical significance (P > 0.05), the onset time of 2. groups were compared effectively in different age groups, between A group and B group, the onset time difference was not statistically significant (P > 0.05) between.B group and C group, with significant differences in the onset time (P < 0.05), the onset time of group B is more than group C the first time in advance; 3. single doses of levodopa compared before and after PVEP examination results, effective cases (30 eyes) and invalid cases (15 eyes) with statistically significant difference in the latency changes of 1 degrees of spatial frequency (P0.05), and the amplitude of the difference was not statistically significant (P0.05), the spatial frequency the amplitude and Differences in latency changes were not statistically significant (P0.05); four of the 4. time points after a single dose on the measured 1 degrees of spatial frequency latency between different age groups was not statistically difference, the difference between each time point. At the initial time point is 60min, the most obvious change conclusion: 1.; single doses of levodopa, statistically significant relationship between the PVEP latency and changes in effect induced by 1 degrees of spatial frequency stimuli (P < 0.05), and the most obvious changes in 60min after administration, suggesting that a single dose of drug caused after the vision system for the enhancement of the reactivity, and visual plasticity the full potential of the system may have a certain relevance. Through further research, may serve as an index of.2. for age < 12 years amblyopia, levodopa use visual acuity improved speed is more significant (P < 0 5), but the two groups after 3 months in the two groups of vision improvement, improve the situation of the difference of VEP was not statistically significant (P > 0.05), the 12 year old "necessary amblyopia treatment without routine use of levodopa, as appropriate, the use of.3. for amblyopia patients 12 years of age or older, with levodopa combined with comprehensive treatment can obtain good therapeutic effect, the reason is because over the sensitive period of visual development of patients still have plasticity in levodopa under the action of the potential function of the visual system can be activated, so it can be obtained with less than 12 year old group of similar treatment in the same visual environment to stimulate. With the use of levodopa on more than 12 year old patient treatment should be due to the small sample size, the reliability of the results need to expand the sample size, to be confirmed by further research.

【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R777.44

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