非动脉炎性前部缺血性视神经病变患者多焦视网膜电图明视负波反应变化观察  

Changes of photopic negative response of multifocal electroretinogram in patients with Non-arteritic Anterior Ischemia Optic Neuropathy

作　　者：毛胜如[1] 冯超[2] 徐冲[2] 徐昶中 吴建华[2] 

机构地区：[1]中南大学爱尔眼科学院,长沙410000 [2]武汉爱尔眼科医院,武汉430000

出　　处：《中国实用眼科杂志》2016年第3期220-226,共7页Chinese Journal of Practical Ophthalmology

基　　金：湖北省卫生计生委科研立项项目（WJ2015MB258）、爱尔眼科医院集团科研基金项目（AF141D04）

摘　　要：目的记录并观察非动脉炎性前部缺血性视神经病变（non-arteritic anterior ischemic optic neuropathy，NAION）患者多焦视网膜电图（mf-ERG）明视负波（PhNR）的临床特征。方法临床病例对照研究。对2014年10月至2015年5月在武汉爱尔眼科医院选取NAION患者17例17只眼纳入研究，并选取排除相关眼部疾病的正常人14名14只眼作为对照组。所有受检者均进行标准自动视野计（SAP）24-2SITA标准程序测定视野平均缺损（SAP-MD）、光学相干断层扫描仪（OCT）行黄斑神经节细胞复合体（mGCC）厚度测量并进行mf-ERG检查。mf-ERG采用频率为6．25 HZ的低频刺激，采用内环半径为6．8°，外环半径为20°的2环刺激模式，内环为中央区，外环分为鼻侧、鼻上、鼻下、颞侧、顾上、顾下六个区域，记录mf-ERGPhNR振幅及mf-ERG其他参数指标。结果mf-ERGPhNR波是低频刺激下mf-ERG波形中继N1、P1波之后的第2个缓慢负向波。NAION组mf-ERG刺激区域总体PhNR平均振幅及各刺激区域内PhNR平均振幅较正常组降低，差异有统计学意义（P〈0．01），PhNR平均峰时较正常组稍延迟，但差异无统计学意义（P=0．437）。mf-ERG刺激区域PhNR平均振幅的AUC为0．908，灵敏度和特异度分别为92．9％和88．2％。NAION组和对照组mf-ERG刺激区域N1平均振幅、P1平均振幅比较，差异无统计学意义（P〉0．05）。NAION组mGCC平均厚度及SAP-MD平均值较正常组降低，差异有统计学意义（P〈0．01）；mf-ERG刺激区域总体PhNR平均振幅与SAP—MD（，=0．581，P=0．001）及mGCC厚度（，=0．472，P〈0．001）差异有统计学意义；mGCC厚度与SAP-MD（r=0．452，P=0．011）亦差异有统计学意义。视野缺损区域PhNR平均振幅与对应区域SAP-MD差异有统计学意义（r=0．495，P=0．043）。结论mf-ERG的低频刺激可以记录正常人及NAION患者mf-ERGPhNR波形；mf-ERGPhNR振幅受NAION影响，并可以用来Objective To record and detect the clinical alterations of Photopic Negative Re- sponse （PhNR） of Multifocal Electroretinogram （mf-ERG） in patients with Non-arteritic Anterior Isch- emia Optic Neuropathy （NAION）. Methods Seventeen patients （17 eyes） with NAION and 14 nor- mal subjects （14 eyes） were studied. All eyes underwent 24-2 standard antomated perimeter （SAP）, macular imaging using high-definition optical coherence tomography （OCT） and mf-ERG. The mean deficit （SAP-MD） was determined by SAP and macular ganglion cells complex （mGCC） thickness was measured by OCT. The mf-ERG stimulus frequency was a slow stimuli with 6.25HZ, and the mf-ERG used a circle stimulation mode with a 6.8° radius of inner border of the annulus centered on the fovea and with a 20° radius of outer border of the annulus. The inner circle was center ar- ea, and the outer ring composed of six stimulation areas including nasal, superior/nasal, inferior/na- sal, temporal, superior/temporal, inferor/temporal. PhNR amplitude and other parameters of the mf-ERG were recorded. Results mf-ERG PhNR was a following slow negative wave of the mf-ERGs after a negative wave （N1） and a positive wave （P1） elicited by low-frequency stimuli. The average mf-ERG PhNR amplitudes in all-trace and each stimulation areas in NAION group were significantly decreased than those in normal group （P 〈0.01）. The average peak latency of PhNR was delayed slightly in NAION group, but no significant difference was observed between the two groups （P 〉0.05）. The AUC of mf-ERG PhNR amplitude was 0.908; the sensitivity was 92.9% and specificity was 88.2%. There were no significant differences in the average N1 amplitude and average P1 amplitude between normal group and NAION group （P 〉0.05）. The average mGCC thickness was （97.76±14.05）gm in NAION group and （108.78±3.53）gm in normal control group, the difference were statistically significant （F =3.99, P 〈0.01）. The average SAP-MD in NAION group wa

关 键 词：明视负波反应 多焦视网膜电图 前部缺血性视神经病变 

分 类 号：R774.6[医药卫生—眼科]