F-ERG监测正常婴儿及ROP患儿视网膜功能发育的应用研究

发布时间：2018-08-07 11:20

【摘要】： 闪光视网膜电图(flash electroretinogram, f-ERG)反映视网膜对光刺激综合反应,它是一种临床上评价神经节细胞以前整个视网膜功能状态的检查方法。它对广泛性视网膜病变有较好的诊断意义。早产儿、低出生体重儿出生时全身脏器功能较差,视网膜功能发育也不成熟。随着围生医学和儿科学的发展,早产儿和低出生体重儿的抢救存活率明显提高,早产儿视网膜病变(retinopathy of prematurity, ROP)在我国的发病率也呈上升趋势。良好的视觉质量是婴儿健康发育的重要内容,早产和ROP病变影响了视网膜功能的成熟,这就迫切需要了解早产儿和ROP患儿视网膜功能发育情况。婴儿不能主动表达视觉异常,轻度视功能障碍又不能被普通检查所发现,f-ERG可在婴儿睡眠状态下进行,具有客观性、无创性和可重复性等优点,因此它是客观评价婴儿视网膜功能的适宜工具。已有研究报道称早产儿和ROP患儿生后视网膜功能落后于正常足月儿。但尚未见到既于不同月龄横向对比ROP患儿、无眼底病变早产儿和正常足月儿的ERG反应,又随年龄增长纵向观察了他们的视网膜ERG的发育趋势,并与成年人进行对照的研究报道。目的:观察早产因素和轻度ROP病变对婴儿视网膜功能发育的影响趋势;对比观察ROP患儿、无眼底病变早产儿和足月产婴儿视网膜功能发育情况。方法:1眼底检查:2008年11月至2009年10月来我中心进行眼底检查的新生儿。研究对象:(1)早产儿为(按照我国卫生部2004年规定)孕龄≤37周,出生体重≤2500g的活产新生儿。(2)足月儿为胎龄满37周～42周,体重≥2500g,身长47cm以上,无任何畸形和疾病的活产新生儿。(3)成年人为年龄23～44岁,无眼部及全身其它部位病变的健康志愿者。采用直接或间接眼底镜和美国产RetcamⅡ广域数字视网膜检测系统进行眼底检查。通过眼底检查进行实验分组:ROP(+)组、ROP(-)组、正常足月儿对照组和健康成年对照组。ROP(+)组眼底随诊直至病变消退,周边视网膜血管化。 2 ERG检查:ROP(+)组、ROP(-)组和正常足月儿对照组分别于矫正胎龄40周(相当于0个月)、53周(相当于3个月)和65周(相当于6个月)进行f-ERG检查;健康成年对照组f-ERG检查一次。 3记录检查结果并应用SPSS13.0系统软件进行统计学分析。各组均进行正态性检验和方差齐性检验,属正态分布且方差齐。采用方差分析LSD进行两组间比较。结果:1眼底检查结果:ROP(+)组30例(男20例,女10例)。0个月时,男婴中17例双眼ROP、3例单眼ROP;女婴中8例双眼ROP、2例单眼ROP。男女婴ROP(+)共55眼,其中:34眼为3区Ⅰ期;21眼为3区Ⅱ期,病变累计均小于8个钟点范围。3个月时,55眼病变均消退,周边视网膜血管化。ROP(-)组30例60眼(男22例,女8例),未查及眼底病变。正常足月儿对照组15例30眼(男9例,女6例),未查及眼底病变。成年人对照组15例30眼(男5例,女10例),未查及眼底病变。 2 ERG检查结果 2.1 ROP(+)组与正常足月儿对照组比较结果 0个月:两组间视锥反应a波潜伏期和OPs波数目无明显差异,(P值=0.1150.01)无统计学意义。视杆反应、视锥反应a波振幅;视杆反应、视锥反应b波潜伏期和振幅;最大混合反应a、b波潜伏期和振幅;OPs振幅波均存在明显差异(P值均0.01),具有统计学意义; 3个月:两组间最大混合反应a、b波、视锥反应b波潜伏期以及OPs波数目无明显差异(P值均0.01),无统计学意义。视杆反应b波、视锥反应a波潜伏期和振幅;最大混合反应a、b波和视锥反应b波振幅;以及OPs波振幅均存在明显差异(P值均0.01),具有统计学意义。 6个月:两组间视杆反应b波、视锥反应a、b波潜伏期和振幅;最大混合反应a、b波振幅以及OPs波数目无明显差异(P值均0.01),没有统计学意义。最大混合反应a、b波潜伏期和OPs波振幅差异较明显(P值均0.01),具有统计学意义。 2.2 ROP(-)组与正常足月儿对照组比较结果 0个月:两组间视锥反应a、b波潜伏期和OPs波数目无明显差异(P值均0.01),无统计学意义。视锥反应a、b波振幅;视杆反应b波、最大混合反应a、b波潜伏期和振幅;以及OPs波振幅差异较明显(P值均0.01),具有统计学意义。 3个月:两组间最大混合反应a波、视锥反应a、b波潜伏期和振幅以及OPs波数目无明显差异(P值均0.01),无统计学意义。视杆反应b波、最大混合反应b波潜伏期和振幅;以及OPs波振幅差异较明显(P值均0.01),具有统计学意义。 6个月:两组间视杆反应b波、最大混合反应和视锥反应a、b波振幅;视锥反应a、b波潜伏期以及OPs波数目均无差异(P值均0.01),没有统计学意义。视杆反应b波、最大混合反应a、b波潜伏期以及OPs波振幅(P值均0.01),具有统计学意义。 2.3 ROP(+)组与ROP(-)组比较结果 0个月:两组间视锥反应a、b波潜伏期、OPs波数目和振幅无明显差异(P值均0.01),无统计学意义。视锥反应a、b波振幅;视杆反应b波、最大混合反应a、b波潜伏期和振幅差异较明显(P值均0.01)。潜伏期延长,振幅降低,具有统计学意义。 3个月:两组间最大混合反应a波潜伏期和b波振幅;视锥反应a、b波潜伏期和振幅以及OPs波数目无明显差异(P值均0.01),无统计学意义。视杆反应b波潜伏期和振幅;最大混合反应a波振幅和b波潜伏期;以及OPs波振幅差异较明显(P值均0.01)。潜伏期延长,振幅降低,具有统计学意义。 6个月:两组间视杆反应b波、最大混合反应和视锥反应a、b波潜伏期和振幅以及OPs波数目均无差异(P值均0.01),没有统计学意义。OPs波振幅差异较明显(P值均0.01)。潜伏期延长,振幅降低,具有统计学意义。 2.4ROP(+)组与成年对照组比较结果两组间0个月、3个月视杆反应b波潜伏期、最大混合反应和视锥反应a、b潜伏期差异较明显(P值均0.01);6个月,各波潜伏期无明显差异(P值均0.01)。0个月、3个月和6个月,视杆反应b波振幅达成人的13.01%、23.96%和44.71%;最大混合反应a波振幅24.37%、42.20%和72.08%, b波22.13%、42.81%和69.03%;视锥反应a波振幅32.69%、48.50%和67.75%,b波26.00%、42.02%和58.70%;OPs波振幅分别达成人的15.01%、23.66%和30.03%。 2.5 ROP(-)组与成年对照组比较结果两组间0个月、3个月视杆反应b波潜伏期、最大混合反应和视锥反应a、b潜伏期差异较明显(P值均0.01);6个月,各波潜伏期无明显差异(P值均0.01)。0个月、3个月和6个月,视杆反应b波振幅达成人的15.91%、28.35%和44.57%;最大混合反应a波振幅33.05%、49.49%和61.63%,b波30.19%、45.56%和69.66%;视锥反应a波40.67%、52.52%和64.19%,b波31.17%、43.10%和57.78%;OPs波振幅分别达到成人的13.22%、26.13%和35.29%。 2.6正常足月儿组与成年对照组纵向比较结果两组间0个月、3个月视杆反应b波潜伏期、最大混合反应和视锥反应a、b潜伏期差异较明显(P值均0.01);6个月,各波潜伏期无明显差异(P值均0.01)。0个月、3个月和6个月,视杆反应b波振幅达成人的26.80%、33.80%和45.43%;最大混合反应a波振幅达成人的41.90%、53.50%和69.81%,b波为35.90%、54.95%和73.36%;视锥反应a波振幅达成人的53.45%、59.70%和67.26%,b波为37.54%、50.26%和63.90% ;OPs波振幅分别达到成人的17.96%、30.83%和39.08%。结论:1早产和ROP病变均使ERG各反应潜伏期延长、振幅降低,视杆反应及Ops尤为显著。早产和ROP病变对视网膜功能存在影响。 2随ROP病变的消退和早产儿的发育,到6个月时,除Ops外,ERG各反应潜伏期及振幅与足月儿趋于一致。 3足月儿生后ERG与成人也存在较大差异,发育至6个月时,各反应潜伏期接近成人水平,但振幅仍明显低于成人。ERG各反应振幅发育落后于潜伏期。 4 F-ERG是检查婴儿视网膜功能的适宜方法。
[Abstract]:Flash electroretinogram (f-ERG) reflects the comprehensive response of the retina to light stimulation. It is a clinical evaluation of the entire retinal function status of ganglion cells. It has a good diagnostic significance for extensive retinopathy. Premature infants and low birth weight infants are born with systemic organ function. Poor retinal function development is not mature. With the development of perinatal medicine and pediatrics, the survival rate of premature infants and low birth weight infants is obviously improved. The incidence of retinopathy of prematurity (ROP) in premature infants is also rising in China. Good visual quality is an important content of healthy development of infants. Production and ROP lesions affect the maturation of retinal function. It is urgent to understand the development of retina function in premature infants and children with ROP. Infants can not express visual abnormalities actively, and mild visual dysfunction can not be found by common examination. F-ERG can be performed in infants' sleep state, with objectivity, noninvasive, reproducibility and other advantages. Therefore, it is an objective tool for evaluating the function of the retina objectively. It has been reported that retina function in prematurely and ROP children is lagging behind normal foot months. However, there is no ERG response to ROP in children with different months of age, with no fundus lesions and normal feet, and the longitudinal observation of him with age. The developmental trend of retinal ERG is reported in comparison with adults.
Objective: To observe the influence of preterm birth factors and mild ROP lesions on retinal functional development in infants and to compare the retinal function development in children with ROP, prematurely prematurely and full-term infants.
Methods: 1 fundus examination: from November 2008 to October 2009, the newborns of the fundus examination were conducted in our center. (1) the birth weight of the newborn was less than 2500g (2) the birth weight was 37 weeks to 42 weeks, the body weight was more than 2500g, and the length of the body was more than 47cm. There was no malformation and no malformation. Living born newborns of the disease (3) adults aged 23~44 years old and healthy volunteers without ocular and other parts of the body. Direct or indirect ophthalmoscope and Retcam II wide area digital retina detection system were used to carry out fundus examination. Through fundus examination, the experimental group was divided into ROP (+) group, ROP (-) group, normal foot month control group and In healthy adult control group, the fundus of.ROP (+) group was followed up until the lesion subsided and peripheral retina vascularization.
2 ERG examination: the ROP (+) group, the ROP (-) group and the normal foot month control group were corrected for 40 weeks (equivalent to 0 months), 53 weeks (equivalent to 3 months) and 65 weeks (equivalent to 6 months) for f-ERG examination, and the healthy adult control group was examined once by f-ERG.
3 the results of the examination were recorded and the SPSS13.0 system software was used for statistical analysis. All groups were tested for normality and variance homogeneity, which were normal distribution and homogeneity of variance, and the two groups were compared by variance analysis LSD.
Results: 1 fundus examination results: in ROP (+) group, 30 cases (male 20, female 10), 17 cases of binocular ROP and 3 case of single eye ROP, 8 cases of ROP in the female baby, 2 cases of ROP. and ROP (+) in 55 eyes, among which 34 eyes were 3 zone I, 21 eyes were 3 District II, and all the diseases were less than.3 months in the range of 20. In the.ROP (-) group, 30 cases (male 22, female 8) were not detected in the group of 60 eyes. 15 cases in the normal foot moon control group were 30 eyes (9 men and 6 women). The adult control group had 30 eyes (5 and 10 cases) in the adult control group, and the eye fundus lesions were not found.
2 ERG examination results
Comparison of 2.1 ROP (+) group with normal term infant control group
0 months: there was no significant difference between the a wave latency and the OPs wave number of the cone reaction between the two groups. There was no statistical significance (P value =0.1150.01). The rod reaction, the a wave amplitude of the cone reaction, the visual pole reaction, the b wave latency and amplitude of the cone reaction, the maximum mixing reaction a, the b wave latency and amplitude, and the OPs amplitude waves were obviously different (P values were 0.01), and were statistically significant. Significance;
3 months: the maximum mixing reaction a, b wave, the b wave latency of the cone reaction and the number of OPs wave numbers have no significant difference (P value is 0.01), and there is no statistical significance. The b wave of the optic rod reaction, the a wave latency and amplitude of the cone reaction, the maximum mixing reaction a, the b wave and the cone reaction b wave amplitude, and the OPs wave amplitude are obviously different (all P values are 0.01), having series The significance of learning.
6 months: two groups of rod reaction b wave, cone reaction a, b wave latency and amplitude, the maximum mixing reaction a, b wave amplitude and OPs wave number, no significant difference (P value is 0.01), no statistical significance. The maximum mixed reaction a, b wave latency and OPs wave amplitude difference is more obvious (P value is 0.01), with statistical significance.
Comparison of 2.2 ROP (-) group with normal term infant control group
0 months: there was no significant difference between the two groups of cones a, the latency of B wave and the number of OPs wave numbers (the P value was 0.01). There was no statistical significance. The cone reaction a, the amplitude of B wave, the b wave of the optic rod reaction, the maximum mixing reaction a, the b wave latency and amplitude, and the significant difference of the OPs wave amplitude (P 0.01), had statistical significance.
3 months: the maximum mixed reaction a wave between the two groups, the cone reaction a, the latency and amplitude of the b wave and the number of OPs wave numbers (P value is 0.01), no statistical significance. The b wave of the optic rod reaction, the maximum mixing reaction b wave latency and amplitude, and the amplitude difference of OPs wave are obvious (P values are 0.01), and have statistical significance.
6 months: the rod reaction b wave, the maximum mixing reaction and the cone reaction a, the amplitude of the b wave, the cone reaction a, the b wave latency and the OPs wave number are not different (P value is 0.01), and there is no statistical significance. The b wave of the rod reaction, the maximum mixing reaction a, the b wave latency and OPs wave amplitude (P values are 0.01), have statistical significance.
Comparison between the 2.3 ROP (+) group and the ROP (-) group
0 months: two groups of cones a, b wave incubation period, OPs wave number and amplitude no significant difference (P value is 0.01), no statistical significance. Cone reaction a, b wave amplitude; the rod reaction b wave, the maximum mixed reaction a, b wave latency and amplitude difference is more obvious (P value is 0.01). Latent period extension, amplitude decrease, with statistical significance.
3 months: the a wave incubation period and b wave amplitude of the maximum mixing reaction between the two groups; the cone reaction a, the latency and amplitude of the b wave and the OPs wave number (P value 0.01) are not statistically significant. The b wave latency and amplitude of the optic rod reaction, the A wave amplitude and the b wave latent period of the maximum mixing reaction, and the amplitude difference of the OPs wave are more obvious (P 0.01). The period is prolonged and the amplitude is reduced, with statistical significance.
6 months: the b wave of the two groups, the maximum mixing reaction and the cone reaction a, the latency and amplitude of B wave and the number of OPs wave numbers were not different (P values were both 0.01). There was no statistically significant difference in amplitude of.OPs wave (P value 0.01). The latency period was prolonged, and the amplitude was reduced, with statistical significance.
Comparison between the 2.4ROP (+) group and the adult control group
Two groups of 0 months, 3 months b wave latency of rod reaction, maximum mixed reaction and cone reaction a, B latency difference is obvious (P value is 0.01); 6 months, there is no significant difference (P value 0.01).0 months, 3 months and 6 months, the pole reaction b wave amplitude of 13.01%, 23.96% and 44.71% of adults, a wave amplitude 24.37%, 42.20, 42.20, 42.20, 42.20, 42.20 % and 72.08%, B waves 22.13%, 42.81% and 69.03%; cone reaction a wave amplitude 32.69%, 48.50% and 67.75%, B waves 26%, 42.02% and 58.70%; OPs wave amplitude, respectively, to adults 15.01%, 23.66% and 30.03%., respectively.
Comparison between the 2.5 ROP (-) group and the adult control group
Two groups of 0 months, 3 months b wave latency of rod reaction, maximum mixed reaction and cone reaction a, B latency difference is obvious (P value is 0.01); 6 months, there is no significant difference (P value 0.01).0 months, 3 months and 6 months, the pole reaction b wave amplitude of 15.91%, 28.35% and 44.57% of adults, a wave amplitude 33.05%, 49.49, 49.49, 49.49, 49.49, 49.49 % and 61.63%, B waves 30.19%, 45.56% and 69.66%; cone reaction a waves 40.67%, 52.52% and 64.19%, B waves 31.17%, 43.10% and 57.78%; OPs wave amplitude reached 13.22%, 26.13%, and 35.29%. in adults, respectively.
2.6 longitudinal comparison of normal term group and adult control group
In the two groups, the latency of B wave in 0 months and 3 months, the maximum mixed reaction and the cone reaction a, the difference in the latency of B was obvious (P value was 0.01); 6 months, there was no obvious difference in the latency of each wave (all P values were 0.01).0 months, 3 months and 6 months, and the amplitude of the b wave of the rod reaction reached 26.80%, 33.80% and 45.43% in adults and the amplitude of a wave of the maximum mixing reaction reached adult. 41.90%, 53.50% and 69.81%, B waves 35.90%, 54.95% and 73.36%; the a wave amplitude of the cone reaction reaches 53.45%, 59.70% and 67.26% in adults, and the B waves are 37.54%, 50.26% and 63.90%; the amplitude of the OPs wave reaches the 17.96%, 30.83%, and 39.08%. of the adult, respectively.
Conclusion: 1 preterm delivery and ROP lesions all prolong the latency of ERG reaction, decrease the amplitude, especially the rod response and Ops. Preterm and ROP lesions have an effect on the retinal function.
With the regression of ROP lesion and the development of premature infants, the latency and amplitude of ERG were similar to those of full-term infants except Ops at 6 months.
There is a great difference between the ERG and the adult after the birth of 3 feet, and the latency of each reaction is close to the adult level at 6 months, but the amplitude of the amplitude is still lower than that of the adult.ERG, and the amplitude of the amplitude is still lagging behind the incubation period.
4 F-ERG is an appropriate method to examine the function of the retina in infants.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R774.1

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