CAJ | 학술논문

目的多焦视网膜电图(mfERG)检测糖尿病(DM)患者视网膜功能异常变化,探讨光学相干断层扫描(OCT)测得的DM患者黄斑区视网膜厚度(CRT)与mfERG变化的相关性.方法临床病例对照研究.对2013年4月至2014年4月在天津市眼科医院门诊收治的DM患者37例72只眼和正常对照组20例32只眼纳入研究.依据检查结果按照糖尿病视网膜病变(DR)国际分期标准分为DM无视网膜病变(NDR,Ⅰ级)组17只眼,中、重度非增殖型DR(NPDR,Ⅲ-Ⅳ级)34只眼及增殖型DR (PDR,V级)组21只眼.mfERG评价DM对视网膜功能的影响,OCT和mfERG联合评价DM患者形态学和功能学的相关性.结果 NDR组较对照组,mfERG后极部二阶反应(SOK)总反应的P1波潜伏期延长差异有统计学意义(t =-2.147,P=0.036,P＜0.05),而振幅密度下降差异有统计学意义(f =3.608,P=0.000,P＜0.05).一阶反应(FOK)仅有P1波潜伏期延长差异有统计学意义(f =-4.350,P=0.000,P＜0.05).NPDR、PDR组较对照组,仅NPDR组FOK的N1波振幅密度较对照组差异无统计学意义(f =-1.830,P=0.072,P＞0.05),其余各指标较对照组差异均有统计学意义(P＜0.05).OCT检查CRT与黄斑区水肿程度成正相关,mfERG的潜伏期和CRT有直接相关性差异有统计学意义(R=0.550,P＜0.05).结论 mfERG能早期发现DM患者亚临床视网膜局部功能异常,潜伏期延长程度和DR病情程度呈正相关.OCT和mfERG联合使用,测定黄斑区域形态及电活动改变,在疾病早期观察、随访和进一步治疗的选择上具有很高的应用价值.
목적 다초시망막전도(mfERG)검측당뇨병(DM)환자시망막공능이상변화,탐토광학상간단층소묘(OCT)측득적DM환자황반구시망막후도(CRT)여mfERG변화적상관성.방법 림상병례대조연구.대2013년4월지2014년4월재천진시안과의원문진수치적DM환자37례72지안화정상대조조20례32지안납입연구.의거검사결과안조당뇨병시망막병변(DR)국제분기표준분위DM무시망막병변(NDR,Ⅰ급)조17지안,중、중도비증식형DR(NPDR,Ⅲ-Ⅳ급)34지안급증식형DR (PDR,V급)조21지안.mfERG평개DM대시망막공능적영향,OCT화mfERG연합평개DM환자형태학화공능학적상관성.결과 NDR조교대조조,mfERG후겁부이계반응(SOK)총반응적P1파잠복기연장차이유통계학의의(t =-2.147,P=0.036,P＜0.05),이진폭밀도하강차이유통계학의의(f =3.608,P=0.000,P＜0.05).일계반응(FOK)부유P1파잠복기연장차이유통계학의의(f =-4.350,P=0.000,P＜0.05).NPDR、PDR조교대조조,부NPDR조FOK적N1파진폭밀도교대조조차이무통계학의의(f =-1.830,P=0.072,P＞0.05),기여각지표교대조조차이균유통계학의의(P＜0.05).OCT검사CRT여황반구수종정도성정상관,mfERG적잠복기화CRT유직접상관성차이유통계학의의(R=0.550,P＜0.05).결론 mfERG능조기발현DM환자아림상시망막국부공능이상,잠복기연장정도화DR병정정도정정상관.OCT화mfERG연합사용,측정황반구역형태급전활동개변,재질병조기관찰、수방화진일보치료적선택상구유흔고적응용개치.
Objective To identify local retinal abnormalities of retinal dysfunction in diabetes mellitus (DM) using multifocal electroretinogram (mfERG) and to determine the correlation between the central retinal thickness (CRT) detected by optical coherence tomography (OCT) and mfERG.Methods Thirty-seven patients (72 eyes) with diabetes mellitus and twenty normal subjects (control group; 32 eyes) were evaluated.According to the inspection results in accordance with the diabetic retinopathy international staging divided into the diabetic mellitus but without diabetic retinopathy (NDR,gradel) group,early and late non proliferative diabetic retinopathy (NPDR,grade 3,4) group and proliferative diabetic retinopathy (PDR,grade 5) group,mfERG was used to assess the effects of DM on retinal function,OCT and mfERG were used to assess and compare morphological changes with functional changes in DM patients.Results In NDR group,the implicit time of the second order kernel (SOK) of P1 wave was delayed (t =-2.147,P =0.036,P ＜0.05) and amplitude density was reduced (t =3.608,P =0.000,P ＜0.05),while only implicit time of first order kernel (FOK) was delayed (t =-4.350,P =0.000,P ＜0.05).In NPDR and PDR group,the overall amplitude density was reduced and implicit time increased in the FOK and SOK (P ＜0.05),except for the amplitude density of FOK of NI in NPDR group (t =-1.830,P =0.072,P ＞0.05).OCT of the DM patient showed the CRT was correlated with the degree of the macular edema and the implicit time of mfERG was directly correlated with CRT (R =0.550,P ＜0.05).Conclusions MfERG can detect subclinical local retinal dysfunction in diabetic patients.The delay of mfERG implicit time reflects the degree of local clinical abnormalities in eyes with retinopathy.Determining the morphological and electrical activity changes of the macular area with OCT combine with mfERG,both means has a high application value in the early observation,follow up and further treatment options of the disease.