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  本文關(guān)鍵詞：左旋多巴在弱視治療中的應(yīng)用研究　出處：《瀘州醫(yī)學(xué)院》2013年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 弱視 敏感期 左旋多巴

【摘要】：目的：弱視是視覺系統(tǒng)在發(fā)育期間未受到有效視覺刺激而導(dǎo)致的視功能的障礙，，其治療原則是在視覺發(fā)育敏感期內(nèi)消除異常視覺經(jīng)驗(yàn)，傳統(tǒng)的治療方法是病因治療，通過屈光矯正、視覺功能訓(xùn)練和雙眼相互作用的調(diào)整來恢復(fù)視功能，但對年齡較大的個體來說療效具有不確定性。近20年來，學(xué)者們致力于弱視藥物治療的相關(guān)研究，期望能夠得到更好地治療效果，其中，對左旋多巴的研究已經(jīng)顯示出一定的臨床價值，但許多研究結(jié)果認(rèn)為其長期療效不穩(wěn)定，臨床價值有待討論，不同研究對其在弱視治療中的作用各持己見，因此有必要作進(jìn)一步探討。目前的弱視治療原則主要來自于對“視覺發(fā)育敏感期”理論的認(rèn)識，認(rèn)為弱視的治療效果與年齡有密切關(guān)系，一旦患者年齡超過視覺發(fā)育敏感期，視覺系統(tǒng)已發(fā)育成熟而不再具備可塑性，這與單獨(dú)采用傳統(tǒng)治療方法難以治愈大于12歲弱視患者的臨床結(jié)果相符，以至于年齡超過12歲的弱視患者多放棄治療，這是我國的成人弱視患者人數(shù)超過千萬的重要原因之一。近年來大量的基礎(chǔ)研究和臨床實(shí)驗(yàn)證實(shí)，在“視覺發(fā)育敏感期”后，視覺系統(tǒng)仍然具有一定的可塑性，但大多數(shù)臨床醫(yī)師依然對敏感期后的弱視治療沒有信心，此類患者接受治療的順應(yīng)性也很差，如果能夠?qū)ふ业娇梢灶A(yù)測弱視治療愈后的指標(biāo)，將可能扭轉(zhuǎn)這種情況。前期研究已經(jīng)發(fā)現(xiàn)，弱視患者使用單次劑量的左旋多巴后，能夠在短期內(nèi)檢測到弱視眼的圖形視覺誘發(fā)電位（pattern reversal visual evoked potentioals，PVEP)出現(xiàn)潛伏期的顯著縮短和振幅的顯著提高，可以設(shè)想，如果這些變化反映的是被激發(fā)的視覺系統(tǒng)潛在功能，將可能對弱視治療的愈后提供參考。因此，本實(shí)驗(yàn)的目的是：探討治療前使用單劑量左旋多巴后的PVEP反應(yīng)與弱視眼治療效果的關(guān)系，探索PVEP檢測方法作為弱視治療愈后指標(biāo)的可能性；研究左旋多巴配合傳統(tǒng)方法治療“視覺發(fā)育敏感期”內(nèi)、外弱視患者的效果差異，了解左旋多巴在不同年齡組弱視治療中的臨床價值。方法：1.病例選擇：按照中華醫(yī)學(xué)會眼科分會斜弱視組2010年弱視診斷標(biāo)準(zhǔn)，選擇弱視患者29例、45眼，年齡6-18歲，所有患者均為遠(yuǎn)視性屈光不正，屈光參差的弱視類型，且未接受過任何弱視治療。2.分組：按年齡和治療方法不同，將患眼分為3個組，每組15只弱視眼，其中：A組：年齡≥12歲，使用左旋多巴和綜合療法；B組：年齡＜12歲，使用左旋多巴和綜合療法，C組：年齡＜12歲，僅使用綜合療法。3.圖形視覺誘發(fā)電位檢查：在配鏡矯正屈光不正后進(jìn)行，在用藥前使用角頻率為2°、1°、30′的三種棋盤格圖形刺激弱視眼，記錄PVEP的P100潛伏期和振幅數(shù)據(jù)；然后所有患者均給予單次劑量的思利巴4mg/kg(每片含左旋多巴有效成分125mg），分別記錄在服藥后60/75/90/105min時的P100的潛伏期和振幅數(shù)據(jù)。4.治療：各組按照設(shè)計的治療方法連續(xù)治療三個月。5.隨訪方法：每周復(fù)查視力，觀察藥物不良反應(yīng)，治療滿三個月時復(fù)查PVEP的P100潛伏期和振幅。6.療效判斷：進(jìn)步：視力上升≥2行；無效：視力改善≤1行；退步：視力下降≥1行。7.結(jié)果分析：比較有效和無效病例在首次服用單劑量左旋多巴后的PVEP改變有無差異，分析PVEP改變與療效之間的關(guān)系。分別對比A組和B組，B組和C組的視力情況，了解在視功能恢復(fù)程度和恢復(fù)速度上有無差異，分析左旋多巴對于不同年齡組弱視的治療意義。結(jié)果：1.各組均無視力退步病例，視力進(jìn)步眼在各組的分布為：A組9只眼，B組11只眼，C組10只眼，其余均為無效眼。將A組與B組，B組與C組的視力進(jìn)步與無效的情況進(jìn)行兩兩比較，其療效的差異沒有統(tǒng)計學(xué)意義（P＞0.05），2.分別比較有效組內(nèi)不同年齡組的起效時間，A組和B組之間，起效時間差異沒有統(tǒng)計學(xué)意義（P＞0.05）。B組和C組之間，起效時間差異具有統(tǒng)計學(xué)意義（P＜0.05），B組的起效時間較C組更為提前；3.首次單劑量服用左旋多巴前后的PVEP檢查結(jié)果比較，有效病例（共30只眼）與無效病例（共15只眼）在1°空間頻率的潛伏期變化的差異具有統(tǒng)計學(xué)意義（P0.05），而其振幅變化差異不具有統(tǒng)計學(xué)意義（P0.05)，其余空間頻率的振幅和潛伏期的變化差異均不具有統(tǒng)計學(xué)意義（P0.05)；4.單次用藥后的四個時間點(diǎn)上測得的1°空間頻率的潛伏期，在不同年齡組之間變化沒有統(tǒng)計學(xué)差異，各個時間點(diǎn)之間有差異。在最初的時間點(diǎn)即60min時，變化幅度最明顯；結(jié)論：1.單劑量服用左旋多巴后，1°空間頻率刺激物誘發(fā)的PVEP潛伏期改變與治療效果之間的關(guān)系具有統(tǒng)計學(xué)意義（P＜0.05)，且在用藥后60min改變最明顯，提示單劑量用藥后引起的視覺系統(tǒng)反應(yīng)性的提高，與視覺系統(tǒng)可塑性的潛能可能有一定相關(guān)性。通過進(jìn)一步深入研究，有可能作為一項評價指標(biāo)。2.對于年齡＜12歲的弱視患者，使用左旋多巴后視力提高速度更為顯著（P＜0.05)，但兩組在3個月后兩組的視力進(jìn)步情況、VEP的改善情況差異沒有統(tǒng)計學(xué)意義（P＞0.05)，提示對于＜12歲的弱視治療無常規(guī)使用左旋多巴的必要，應(yīng)酌情使用。3.對于年齡≥12歲的弱視患者，使用左旋多巴聯(lián)合綜合治療依然能夠獲得良好的治療效果，分析其原因是由于超過視覺發(fā)育敏感期的患者仍然具有可塑性，在左旋多巴的作用下，其視覺系統(tǒng)的潛在功能可以被激活，因此在相同視覺環(huán)境刺激下可以獲得與＜12歲組相似的治療效果。提示對≥12歲的患者治療應(yīng)當(dāng)配合使用左旋多巴。由于本實(shí)驗(yàn)樣本量較小，研究結(jié)果的可靠性需要擴(kuò)大樣本量，通過進(jìn)一步的研究加以證實(shí)。
[Abstract]:Objective: amblyopia is the visual system during development has not been effective visual stimulation caused by visual function disorder, the treatment principle is to eliminate the abnormal visual experience in the sensitive period of visual development, the traditional method of treatment is the etiological treatment, by adjusting the refractive correction, visual function training and binocular interaction to restore visual function, but the effect is uncertain for older individuals. In the past 20 years, scholars engaged in research related to drug treatment of amblyopia, expect to be able to get a better treatment effect, the study of levodopa has demonstrated some clinical value, but many studies show that the long-term efficacy of clinical value to be unstable. Discussion of different research on its role in the treatment of amblyopia and therefore it is necessary to make a further each one sticks to his own view, explore. Amblyopia treatment principles at present mainly from "vision Understanding development sensitive period "theory, that is closely related to the treatment of amblyopia with age, once patients older than the sensitive period of visual development, the visual system has been mature and no longer have plasticity, and this alone using the traditional treatment methods difficult to cure more than 12 patients with clinical results of amblyopia are consistent with that of amblyopia patients older than the 12 year old more than to give up treatment, this is one of the important reasons for the number of adult patients with amblyopia in China more than 10 million. That a lot of basic research and clinical trials in recent years, in the sensitive period of visual development", the visual system still has certain plasticity, but most clinicians still on the treatment of amblyopia after the sensitive period of no such confidence, medication compliance is poor, if we can find the treatment of amblyopia can predict the prognosis, may reverse this situation before. Research has found that patients with amblyopia using a single dose of levodopa, to visual evoked potential detection of amblyopia in the short term (pattern reversal visual evoked potentioals, PVEP) significantly increased the latency and amplitude appear significantly shortened, can be envisaged, if these changes reflect the potential function of visual system is excited that may provide a reference for the treatment of amblyopia after healing. Therefore, the purpose of this study is: To explore the relationship between the use of PVEP reaction and amblyopia treatment effect after a single dose of levodopa before treatment, the PVEP method is explored as amblyopia treatment after the index of the possibility of levodopa with traditional therapy; "the sensitive period of visual development" in between amblyopic patients, to understand the clinical value of levodopa in the treatment of amblyopia in different age groups. Methods: 1. cases According to the Chinese Medical Association of Ophthalmology oblique amblyopia group 2010 amblyopia diagnostic criteria, select 29 cases of patients with amblyopia, 45 eyes, 6-18 years of age, all patients were hypermetropia, anisometropic amblyopia type, and did not receive any treatment of amblyopia.2. group: according to the age and the different treatment methods, the patients were divided into the 3 group, 15 rats in each group: A group of amblyopic eyes, the age of more than 12 years, the use of levodopa and comprehensive therapy; group B: age less than 12 years, the use of levodopa and comprehensive therapy, group C: age < 12 years, using only the comprehensive therapy.3. graphic visual evoked potential examination: in the use of eyeglasses after the use of angular frequency in ametropia, before the medication is 2 degrees, 1 degrees, three kinds of pattern 30 'the amblyopic eye records PVEP P100 latency and amplitude data; then all patients were given a single dose of levodopa (each containing either 4mg/kg Pakistan), effective components of 125mg latency were recorded in the P100 60/75/90/105min after treatment and.4. treatment groups: amplitude data according to the treatment methods of design of continuous treatment for three months follow-up.5. methods: Weekly Review of visual acuity, observation of adverse drug reactions, treatment with PVEP three months later the latency and amplitude of P100.6. curative effect judgment: progress: the visual acuity increased more than 2 lines of vision improvement; invalid: less than 1; more than 1 step backwards: decreased visual acuity.7. results analysis: effective and ineffective cases in the first administration of a single dose of levodopa after the PVEP changes the difference, analyze the relationship between PVEP changes and the curative effect were compared. A group and B group, visual acuity B group and C group, understand the visual function in the recovery and the recovery speed difference, analysis of different age groups for amblyopia levodopa treatment. Results: the 1. groups had no vision back Cases in each eye visual acuity distribution: 9 eyes in group A and group B in 11 eyes, 10 eyes in group C, the rest are invalid eyes. A group and B group, B group and C group were 22 and the visual acuity is the difference of the curative effect, no statistical significance (P > 0.05), the onset time of 2. groups were compared effectively in different age groups, between A group and B group, the onset time difference was not statistically significant (P > 0.05) between.B group and C group, with significant differences in the onset time (P < 0.05), the onset time of group B is more than group C the first time in advance; 3. single doses of levodopa compared before and after PVEP examination results, effective cases (30 eyes) and invalid cases (15 eyes) with statistically significant difference in the latency changes of 1 degrees of spatial frequency (P0.05), and the amplitude of the difference was not statistically significant (P0.05), the spatial frequency the amplitude and Differences in latency changes were not statistically significant (P0.05); four of the 4. time points after a single dose on the measured 1 degrees of spatial frequency latency between different age groups was not statistically difference, the difference between each time point. At the initial time point is 60min, the most obvious change conclusion: 1.; single doses of levodopa, statistically significant relationship between the PVEP latency and changes in effect induced by 1 degrees of spatial frequency stimuli (P < 0.05), and the most obvious changes in 60min after administration, suggesting that a single dose of drug caused after the vision system for the enhancement of the reactivity, and visual plasticity the full potential of the system may have a certain relevance. Through further research, may serve as an index of.2. for age < 12 years amblyopia, levodopa use visual acuity improved speed is more significant (P < 0 5), but the two groups after 3 months in the two groups of vision improvement, improve the situation of the difference of VEP was not statistically significant (P > 0.05), the 12 year old "necessary amblyopia treatment without routine use of levodopa, as appropriate, the use of.3. for amblyopia patients 12 years of age or older, with levodopa combined with comprehensive treatment can obtain good therapeutic effect, the reason is because over the sensitive period of visual development of patients still have plasticity in levodopa under the action of the potential function of the visual system can be activated, so it can be obtained with less than 12 year old group of similar treatment in the same visual environment to stimulate. With the use of levodopa on more than 12 year old patient treatment should be due to the small sample size, the reliability of the results need to expand the sample size, to be confirmed by further research.

【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R777.44

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