屈光不正對(duì)P-VEP影響及法醫(yī)學(xué)意義
發(fā)布時(shí)間：2018-09-19 14:57
【摘要】： 在臨床法醫(yī)學(xué)鑒定中經(jīng)常涉及到視功能評(píng)定的問(wèn)題，由于被鑒定人常�？浯笠暪δ苷系K程度或偽裝成視功能障礙，因此，在法醫(yī)學(xué)如何準(zhǔn)確客觀評(píng)定視功能障礙程度是法醫(yī)學(xué)所面臨的一個(gè)重要課題。視覺(jué)誘發(fā)電位(visual evoked potential簡(jiǎn)稱VEP)是一種客觀評(píng)定視功能的方法，在法醫(yī)學(xué)上應(yīng)用VEP評(píng)定視功能具有特殊意義。按刺激光的不同可以將視覺(jué)誘發(fā)電位分為閃光視覺(jué)誘發(fā)電位(flash visual evoked potential，F(xiàn)-VEP)和圖形視覺(jué)誘發(fā)電位(pattern visual evoked potential，P-VEP)。P-VEP波群中常用于診斷的是P_(100)(亦稱P_1)，其振幅和潛伏期受諸多因素影響。其中屈光狀態(tài)的影響往往易被忽略，而造成假陽(yáng)性，從而不能正確判斷被檢者真實(shí)的視功能狀態(tài)。目前對(duì)于屈光不正對(duì)VEP的影響的研究主要從其潛伏期、波幅的絕對(duì)值變化方面研究，且常限于同一空間頻率刺激，對(duì)于屈光不正對(duì)不同空間頻率刺激的VEP的波幅變化率的影響無(wú)明確報(bào)導(dǎo)。本次試驗(yàn)對(duì)40人(80只眼)給予不同的屈光負(fù)荷后進(jìn)行不同空間頻率刺激下的VEP檢查，通過(guò)對(duì)其波幅變化率及潛伏期進(jìn)行比較，進(jìn)一步探討屈光不正對(duì)VEP的影響及在法醫(yī)學(xué)鑒定中的應(yīng)用價(jià)值。 試驗(yàn)對(duì)象與方法 試驗(yàn)對(duì)象：來(lái)自于中國(guó)醫(yī)科大學(xué)在校本科生40人(80眼)，均為男性，年齡為20～25歲，眼科常規(guī)檢查正常，除近視外無(wú)其他眼病，所有眼矯正視力均在1.0以上。 方法：讓被檢眼注視屏幕中央，遮蓋另眼，采用三種不同空間頻率(8×8、16×16、32×32)的棋盤格分別刺激，記錄最佳矯正視力(1.0，相對(duì)屈光負(fù)荷為OD)下和分別在此基礎(chǔ)上給予+2.00D、+4.00D、+6.00D和+8.00D屈光負(fù)荷下的P-VEP波形，相對(duì) 屈光負(fù)荷為OD組設(shè)為對(duì)照組，其余屈光負(fù)荷組為實(shí)驗(yàn)組，與對(duì)照 組相比計(jì)算出各實(shí)驗(yàn)組的P；。波幅的變化率及潛伏期變化值。 統(tǒng)計(jì)學(xué)分析：采用 SPSS for indows．0統(tǒng)計(jì)分析軟件，應(yīng)用 L檢驗(yàn)及方差分析方法進(jìn)行統(tǒng)計(jì)分析。 結(jié) 果 1．三種不同空間頻率堆 X 8、16 X 16J2 X 32）刺激誘發(fā)出的 P；。波幅的下降率均隨凸透鏡屈光度的增加而逐漸增加，H者之間 的相關(guān)系數(shù)分別為0．999J．992和0．957，P；。振幅的下降率均與 所加凸透鏡屈光度之間存在正相關(guān)關(guān)系。同時(shí)結(jié)果表明在相同屈 光負(fù)荷下，P；。波幅的下降率隨刺激空間頻率的增加而增加。 2．不同屈光負(fù)荷在不同空間頻率方格刺激下的P－VEP中 Pl。波幅的下降率離散系數(shù)明顯小于絕對(duì)值的變化值離散系數(shù)，經(jīng) 配對(duì)t檢驗(yàn)：t＝＝－15．026，P＜0．001。 3．在 40人 80只受試眼中，除 8 x 8格空間頻率刺激下＋2 ．00 D屈光負(fù)荷組中100潛伏期與對(duì)照組相比無(wú)顯著性差異外K ＞O．05入其余實(shí)驗(yàn)組中在同一空間頻率格刺激中，隨著屈光負(fù)荷 的增加，P；。潛伏期延長(zhǎng)值也明顯增加；在相同屈光負(fù)荷下，隨著刺 激格空間頻率的增高，P；。潛伏期延長(zhǎng)值也明顯增加。 討 論 1．屈光不正對(duì)P－VEP中P；。波幅的影響 本次實(shí)驗(yàn)通過(guò)對(duì)40人80只眼在不同屈光負(fù)荷下的VEP檢 測(cè)，經(jīng)統(tǒng)計(jì)學(xué)分析得出：在同一空間頻率刺激下，P；co波幅隨著凸透 鏡屈光度數(shù)的增加而降低，其下降率隨凸透鏡屈光度數(shù)的增加而 增高，即Pl。振幅的下降率與凸透鏡屈光度之間存在正相關(guān)關(guān)系。 這是由于正屈光負(fù)荷使圖象在視網(wǎng)膜上的成像變得模糊，導(dǎo)致視 敏度下降，且這種視敏度下降程度隨屈光負(fù)荷的增加而增加。 ·2· 對(duì)于同一屈光負(fù)荷下，P；。波幅的下降率隨刺激空間頻率的提 高而增高，這說(shuō)明在不同空間頻率中，屈光負(fù)荷對(duì)小方格刺激所誘 發(fā)出VEP的影響要大于對(duì)大方格刺激的影響。 誘發(fā)電位反應(yīng)波的幅值叩波幅）在健康個(gè)體內(nèi)和個(gè)體間的 變異較大，因此不能簡(jiǎn)單說(shuō)一個(gè)人P；。波幅低，就是神經(jīng)元本身的 病變。本實(shí)驗(yàn)通過(guò)對(duì)不同屈光負(fù)荷在不同空間頻率刺激下誘發(fā)出 Pl。波幅的下降值的離散率及其下降率的離散率進(jìn)行統(tǒng)計(jì)學(xué)分析 卜檢驗(yàn)入P＜0．001，波幅下降率的離散率明顯小于波幅下降值的 離散率，即其個(gè)體差異性較小，，可以用于不同個(gè)體間的比較。 2．屈光不正對(duì)P－VEP中P；。潛伏期的影響 潛伏期主要反映被測(cè)試的感覺(jué)或運(yùn)動(dòng)系統(tǒng)的粗徑有髓纖維的 傳導(dǎo)功能。潛伏期長(zhǎng)，說(shuō)明傳導(dǎo)速度減慢。本實(shí)驗(yàn)結(jié)果證明，隨著 屈光負(fù)荷的增加，P；。潛伏期延長(zhǎng)值也相繼提高，這是由于屈光負(fù) 荷的增加使圖象在視網(wǎng)膜上成像的圖形邊緣變得更加模糊，導(dǎo)致 潛伏期的延長(zhǎng)。本組實(shí)驗(yàn)顯示在同一屈光負(fù)荷下隨著空間頻率的 提高，P；。潛伏期延長(zhǎng)值也相繼增加，說(shuō)明在屈光負(fù)荷對(duì)P；。潛伏 期的影響中，高空間頻率刺激較低空間頻率刺激更為敏感。 3．正確認(rèn)識(shí)屈光不正對(duì)P－VEP的影響在客觀評(píng)價(jià)視功能中 的法醫(yī)學(xué)意義 在眼損傷的法醫(yī)學(xué)鑒定中可以充分利用屈光不正對(duì)P－VEP
[Abstract]:Visual evoked potential (VEP) is an important subject in forensic science, because the appraised often exaggerate the degree of visual impairment or disguise it as visual impairment. VEP is an objective method for evaluating visual function. It has special significance in forensic medicine to use VEP to evaluate visual function. According to the stimulating light, VEP can be divided into flash visual evoked potential (F-VEP) and pattern visual evoked potential (P-VEP). The amplitude and latency of P_ (100) (also called P_1) are influenced by many factors. The influence of refractive state is often neglected, which leads to false positivity, and thus can not correctly judge the true visual state of the examinee. In this study, 40 subjects (80 eyes) were examined for the amplitude change rate and latency progression of VEP after different refractive loads with different spatial frequencies. To compare the effects of ametropia on VEP and its application in forensic identification.
Test subjects and methods
Subjects: 40 undergraduates (80 eyes) from China Medical University, all male, aged 20-25 years, had normal routine ophthalmic examination, no eye diseases except myopia. All eyes had corrected visual acuity above 1.0.
Methods: Three different spatial frequencies (8 *8, 16 *16, 32 *32) were used to stimulate the examined eye to fix on the center of the screen and cover the other eye. The P-VEP waveforms were recorded under the best corrected visual acuity (1.0, OD) and under the refractive load of + 2.00D, + 4.00D, + 6.00D and + 8.00D respectively.
Refractive load was set as control group in group OD, while in other refractive load group, the experimental group was compared with control group.
The P, amplitude and latency of each experimental group were calculated.
Statistical analysis: SPSS for indows.0 statistical analysis software was applied.
L test and variance analysis were used for statistical analysis.
Result
1. three different spatial frequency reactors X 8,16 X 16J2 X 32) induced by stimulation.
P. The decrease rate of amplitude increases with the increase of the refractive index of the convex lens, and between H.
The correlation coefficients were 0.999J.992 and 0.957, P, respectively.
There is a positive correlation between the refractive index of the convex lens.
Under the light load, the decrease rate of P and amplitude increases with the increase of the spatial frequency of stimulation.
2. the different refraction load under the different space frequency square stimulus of P VEP.
The decrease rate of Pl. amplitude is obviously smaller than that of absolute value.
Paired t test: T = = - 15. 26, P < 0.001.
3. in the eyes of 40 subjects and 80 subjects, except 8 x 8 space frequency stimulus + 2
There was no significant difference in the latency of 100 in.00 D refractive load group compared with the control group, K
> O.05 into the rest of the experimental group in the same spatial frequency stimulus, with refractive load.
The increase of P, latency of the incubation period also increased significantly.
The spatial frequency of excitation increased, P, and latency prolonged significantly.
Discussion
1. the influence of ametropia on P, amplitude of P VEP.
In this experiment, 40 eyes and 80 eyes were examined by VEP under different refractive loads.
Statistical analysis showed that under the same spatial frequency stimulation, the amplitude of P and CO was convex.
The decrease of the refractive index increases with the increase of the refractive index of the convex lens.
There is a positive correlation between the decrease of Pl. amplitude and the refractive index of convex lens.
This is due to the blurring of the image on the retina due to the positive refractive load.
The sensitivity decreased, and the decrease of the visual acuity increased with the increase of refractive load.
2.
For the same refractive load, the decrease rate of P, amplitude decreases with the increase of the spatial frequency of stimulation.
Higher and higher, which indicates that in different spatial frequencies, the refractive load is induced by small square stimuli.
The effect of VEP is greater than that on large square stimuli.
The amplitude of evoked response wave amplitude is between healthy individuals and individuals.
The variation is large, so we can not simply say a person P; the amplitude is low, that is, the neuron itself.
The experiment was induced by stimulation of different diopter loads at different spatial frequencies.
The dispersion rate of the descending value of Pl. amplitude and the dispersion rate of its descending rate were statistically analyzed.
The discretization rate of the amplitude decrease rate is significantly smaller than that of the amplitude decrease in P < 0.001.
Dispersion rate, that is, its individual difference is small, can be used for comparison among different individuals.
2. the influence of ametropia on P. Latency in P VEP.
The incubation period mainly reflects the diameter of the tested sensory or motor system with myelinated fibers.
Conduction function. Long incubation period indicates slow conduction velocity.
The increase in refractive load, P, and latency also increased due to refractive errors.
The increase of load makes the image edge of the image on the retina become more blurred.
Prolongation of latency. This group of experiments showed that with the same refractive load, with the increase of spatial frequency
The increase in P, latency, and latency also showed that the refractive load was P.
High spatial frequency stimulation is more sensitive than low spatial frequency stimulation.
3. correctly understand the effect of ametropia on P VEP and objectively evaluate visual function.
Forensic significance
In the forensic identification of eye injury, we can make full use of ametropia to P VEP.
【學(xué)位授予單位】：中國(guó)醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2003
【分類號(hào)】：D919
[Abstract]:Visual evoked potential (VEP) is an important subject in forensic science, because the appraised often exaggerate the degree of visual impairment or disguise it as visual impairment. VEP is an objective method for evaluating visual function. It has special significance in forensic medicine to use VEP to evaluate visual function. According to the stimulating light, VEP can be divided into flash visual evoked potential (F-VEP) and pattern visual evoked potential (P-VEP). The amplitude and latency of P_ (100) (also called P_1) are influenced by many factors. The influence of refractive state is often neglected, which leads to false positivity, and thus can not correctly judge the true visual state of the examinee. In this study, 40 subjects (80 eyes) were examined for the amplitude change rate and latency progression of VEP after different refractive loads with different spatial frequencies. To compare the effects of ametropia on VEP and its application in forensic identification.
Test subjects and methods
Subjects: 40 undergraduates (80 eyes) from China Medical University, all male, aged 20-25 years, had normal routine ophthalmic examination, no eye diseases except myopia. All eyes had corrected visual acuity above 1.0.
Methods: Three different spatial frequencies (8 *8, 16 *16, 32 *32) were used to stimulate the examined eye to fix on the center of the screen and cover the other eye. The P-VEP waveforms were recorded under the best corrected visual acuity (1.0, OD) and under the refractive load of + 2.00D, + 4.00D, + 6.00D and + 8.00D respectively.
Refractive load was set as control group in group OD, while in other refractive load group, the experimental group was compared with control group.
The P, amplitude and latency of each experimental group were calculated.
Statistical analysis: SPSS for indows.0 statistical analysis software was applied.
L test and variance analysis were used for statistical analysis.
Result
1. three different spatial frequency reactors X 8,16 X 16J2 X 32) induced by stimulation.
P. The decrease rate of amplitude increases with the increase of the refractive index of the convex lens, and between H.
The correlation coefficients were 0.999J.992 and 0.957, P, respectively.
There is a positive correlation between the refractive index of the convex lens.
Under the light load, the decrease rate of P and amplitude increases with the increase of the spatial frequency of stimulation.
2. the different refraction load under the different space frequency square stimulus of P VEP.
The decrease rate of Pl. amplitude is obviously smaller than that of absolute value.
Paired t test: T = = - 15. 26, P < 0.001.
3. in the eyes of 40 subjects and 80 subjects, except 8 x 8 space frequency stimulus + 2
There was no significant difference in the latency of 100 in.00 D refractive load group compared with the control group, K
> O.05 into the rest of the experimental group in the same spatial frequency stimulus, with refractive load.
The increase of P, latency of the incubation period also increased significantly.
The spatial frequency of excitation increased, P, and latency prolonged significantly.
Discussion
1. the influence of ametropia on P, amplitude of P VEP.
In this experiment, 40 eyes and 80 eyes were examined by VEP under different refractive loads.
Statistical analysis showed that under the same spatial frequency stimulation, the amplitude of P and CO was convex.
The decrease of the refractive index increases with the increase of the refractive index of the convex lens.
There is a positive correlation between the decrease of Pl. amplitude and the refractive index of convex lens.
This is due to the blurring of the image on the retina due to the positive refractive load.
The sensitivity decreased, and the decrease of the visual acuity increased with the increase of refractive load.
2.
For the same refractive load, the decrease rate of P, amplitude decreases with the increase of the spatial frequency of stimulation.
Higher and higher, which indicates that in different spatial frequencies, the refractive load is induced by small square stimuli.
The effect of VEP is greater than that on large square stimuli.
The amplitude of evoked response wave amplitude is between healthy individuals and individuals.
The variation is large, so we can not simply say a person P; the amplitude is low, that is, the neuron itself.
The experiment was induced by stimulation of different diopter loads at different spatial frequencies.
The dispersion rate of the descending value of Pl. amplitude and the dispersion rate of its descending rate were statistically analyzed.
The discretization rate of the amplitude decrease rate is significantly smaller than that of the amplitude decrease in P < 0.001.
Dispersion rate, that is, its individual difference is small, can be used for comparison among different individuals.
2. the influence of ametropia on P. Latency in P VEP.
The incubation period mainly reflects the diameter of the tested sensory or motor system with myelinated fibers.
Conduction function. Long incubation period indicates slow conduction velocity.
The increase in refractive load, P, and latency also increased due to refractive errors.
The increase of load makes the image edge of the image on the retina become more blurred.
Prolongation of latency. This group of experiments showed that with the same refractive load, with the increase of spatial frequency
The increase in P, latency, and latency also showed that the refractive load was P.
High spatial frequency stimulation is more sensitive than low spatial frequency stimulation.
3. correctly understand the effect of ametropia on P VEP and objectively evaluate visual function.
Forensic significance
In the forensic identification of eye injury, we can make full use of ametropia to P VEP.
【學(xué)位授予單位】：中國(guó)醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2003
【分類號(hào)】：D919
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