不同类型糖尿病性黄斑水肿的多焦视网膜电图分析  

Multifocal electroretinogram findings of different types of diabetic macular edema

作　　者：康皓[1] 徐延山[1] 张红[1] 

机构地区：[1]天津医科大学眼科中心,300070

出　　处：《中华实验眼科杂志》2011年第2期139-144,共6页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景了解糖尿病患者的视网膜功能变化对于指导临床治疗非常重要。目前对糖尿病性黄斑水肿（DME）患者的研究包括荧光素眼底血管造影（FFA）、多焦视网膜电图（mfERG）等，但对不同类型DME患者mfERG特征的研究较少。目的探讨不同类型DME患者的mfERG改变。方法病例对照研究。对确诊糖尿病视网膜病变（DR）合并临床显著黄斑水肿的40例57眼进行mfERG和FFA检查，同时对年龄和性别相匹配的正常对照组35例35眼行mfERG检查，并进行比较。依照FFA表现将DME分为局限型DME13例16眼、弥漫型DME17例22眼和囊样型DME12例17眼，分析各类型DME患者mfERG的特征。结果与正常对照组比较，局限型DME组患者mfERG1环的P．波反应密度显著下降，P。波4环、5环隐含时明显延迟，差异均有统计学意义（t=2．170，P=0．038；t=2．519，P=0．017；t=2．451，P=0．020）；4环N1波隐含时明显延迟，差异有统计学意义（t=2．858，P=0．008）。弥漫型DME组患者1、3、5环P。波反应密度显著下降，1、3、4、5环N1波反应密度显著下降，差异均有统计学意义（P〈0．05）；3环、4环P，波隐含时明显延迟，差异均有统计学意义（t=2．446，P=0．019；t=2．759，P=0．009）。与正常对照组比较，囊样型DME组患者1～5环P，波反应密度显著下降，1、3、4、5环N．波反应密度显著下降，差异均有统计学意义（P〈0．05）；3、4、5环P。波隐含时明显延迟，4环N，波隐含时明显延迟，差异均有统计学意义（P〈0．05）。黄斑区功能在中心凹处严重受损，外环功能虽有不同程度下降，但均较中心凹功能下降程度轻。结论不同类型DME的局部视网膜功能改变程度与FFA的形态学表现结果一致，各型DME患者中黄斑中心凹功能受累程度由重至轻依次为囊样型DME、弥漫型DME及局限型DME。FFA与mfERG联合诊断可以全面、多角度地反映糖尿病患�Background It is very important for us to understand retinal function change in the patient with diabetic mellitus in clinic. At present,the study about diabetic mellitus associated with macular edema includes fundus fluorescense angiography （FFA） and multifocal electroretinogram （mfERG） etc.. However, seldom research is performed in the mfERG findings for different types of diabetic macular edema. Objective This study aimed to investigate the mfERG change in different types of diabetic macular edema compared with normal population. Methods Fifty-seven eyes with diabetic macular edema from 40 patients and 35 eyes from age-and gender-matched normal subjects were enrolled in this study. The eyes with diabetic macular edema were assigned to local macular edema group （n= 16）, diffuse macular edema group （ n = 22） and cystoid macular edema （ n = 17 ） based on the manifestation of FFA. MfERG was recorded in all the individuals. The informed consent was obtained from each subject prior to any the medical examination. Results In focal diabetic macular edema group,the response density of Pl wave was significantly attenuated in ring 1, showing a statistical difference in comparison with controls （t = 2. 170,P = 0. 038）, and the latencies of P1 and N1 waves showed obvious prolong in ring 4 and 5 （t = 2. 519, P = 0. 017 ; t = 2. 451, P = 0. 020）. In diffuse diabetic macular edema group, the response densities of P1 and N1 waves were declined in ring 1,3,5 and ring 1,3,4,5 respectively, and the latencies of P1 in ring 3,4 were significantly delayed respectively in comparison with controls （ all P 〈 0.05 ）. In cystoid diabetic macular edema group, the response densities of P1 and N1 waves were lowed from ring 1 through 5 respectively,and the latencies of P1 and N1 waves were significantly longer from ring 3 through 5 and ring 4 respectively with the statistically significant difference from controls （ all P〈0. 05）. The visual function of fovea was badly damaged. Conclusion These studies

关 键 词：糖尿病 黄斑水肿 多焦视网膜电图 荧光素眼底血管造影 

分 类 号：R77[医药卫生—眼科] R587[医药卫生—临床医学]