不同部位损伤致视力障碍的视觉诱发电位特征  

Characteristics of Visual Evoked Potential in Different Parts of Visual Impairment

作　　者：戴定坤 杨丽[2] 孟欢欢[2,3] 陈溪萍 陶陆阳[2] DAI Ding-kun;YANG Li;MENG Huan-huan;CHEN Xi-ping;TAO Lu-yang(Judicial Appraisal Institute of Northern Jiangsu People's Hospital,Yangzhou 225001,Jiangsu Province,China;Department of Forensic Medicine(Institute of Forensic Sciences),Soochow University,Suzhou 215123,China;Department of Forensic Medicine,Institute of Forensic Medicine and Laboratory Medicine,Jining Medical University,Jining 272000,Shandong Province,China)

机构地区：[1]苏北人民医院司法鉴定所,江苏扬州225001 [2]苏州大学法医学系(司法鉴定中心),江苏苏州215123 [3]济宁医学院法医学与医学检验学院法医系,山东济宁272000

出　　处：《法医学杂志》2021年第5期632-638,共7页Journal of Forensic Medicine

基　　金：国家自然科学基金面上资助项目(81971800,81871536);济宁医学院教师科研扶持基金资助项目(JY2017FY005)。

摘　　要：目的研究视觉传导通路不同部位损伤后单眼视力障碍的视觉诱发电位(visual evoked potential,VEP)定量及定性差异。方法选取外伤致单眼视力损害受试者91名,根据损伤原因和解剖节段分为眼内屈光介质-视网膜损伤组(简称“眼球损伤组”)、视神经损伤组、中枢脑损伤组和颅内合并损伤组,分别记录受试者图形翻转视觉诱发电位(pattern-reversal visual evoked potential,PR-VEP)P100和闪光视觉诱发电位(flash visual evoked potential,F-VEP)P2波的峰时及波幅,采用SPSS 26.0统计软件分析4组受试者定量(峰时及波幅)及定性(阈值VEP频数、异常波形类别及频数)指标的差异性。结果眼球损伤组PR-VEP P100波及视神经损伤组F-VEP P2波呈现伤眼较健眼峰时延长、波幅降低的特征性差异(P<0.05),中枢脑损伤组和颅内合并损伤组健眼PR-VEP波幅在多个空间频率下较眼球损伤组健眼波幅降低(P<0.05)。眼球损伤组和视神经损伤组与颅内合并损伤组达到阈值的VEP P波频数之间差异均有统计学意义(P<0.0083)、与中枢脑损伤组在波幅异常降低频数上差异有统计学意义(P<0.0083)。结论VEP可区分中枢损伤与外周损伤、外周损伤中的眼球损伤与神经损伤,但无法区分颅内单纯损伤与复杂损伤,为定位视力障碍损伤部位的进一步研究提供了基础数据和依据。Objective To study the quantitative and qualitative differences of visual evoked potential(VEP)in monocular visual impairment after different parts of visual pathway injury.Methods A total of 91 subjects with monocular visual impairment caused by trauma were selected and divided into in-traocular refractive media-injury group(eyeball injury group for short),optic nerve injury group,cen-tral nervous system injury and intracranial combined injury group according to the injury cause and anatomical segment.Pattern Reversal visual evoked potential(PR-VEP)P100 peak time and ampli-tude,Flash visual evoked potential(F-VEP)P2 peak time and amplitude were recorded respectively.SPSS 26.0 software was used to analyze the differences of quantitative(peak time and amplitude)and qualitative indexes(spatial frequency sweep-VEP acuity threshold,and abnormal waveform cat-egory and frequency)of the four groups.Results Compared with healthy eyes,the PR-VEP P100 waveforms of the intraocular eyeball injury group and the F-VEP P2 waveforms of the optic nerve group showed significant differences in prolonged peak time and decreased amplitude in injured eyes(P<0.05).The PR-VEP amplitudes of healthy eyes were lower than those of injured eyes at multiple spatial frequencies in central nervous system injury group and intracranial combined injury group(P<0.05).The amplitude of PR-VEP in patients with visual impairment involving central injury was lower than that in patients with eye injury at multiple spatial frequencies.The frequency of VEP P wave-forms reaching the threshold of the intraocular injury group and the optic nerve injury group were sigi-nificantly different from the intracranial combined injury group,respectively(P<0.0083),and the fre-quency of abnormal reduction of VEP amplitude of threshold were significantly different from the cen-tral nervous system injury group,respectively(P<0.0083).Conclusion VEP can distinguish central in-jury from peripheral injury,eyeball injury from nerve injury in peripheral injury,but cannot distin

关 键 词：法医学 眼球损伤 视神经损伤 脑损伤 颅内合并伤 视力障碍 视觉诱发电位 

分 类 号：D919.4[医药卫生—法医学]