【摘要】： 閃光視網(wǎng)膜電圖(flash electroretinogram, f-ERG)反映視網(wǎng)膜對(duì)光刺激綜合反應(yīng),它是一種臨床上評(píng)價(jià)神經(jīng)節(jié)細(xì)胞以前整個(gè)視網(wǎng)膜功能狀態(tài)的檢查方法。它對(duì)廣泛性視網(wǎng)膜病變有較好的診斷意義。早產(chǎn)兒、低出生體重兒出生時(shí)全身臟器功能較差,視網(wǎng)膜功能發(fā)育也不成熟。隨著圍生醫(yī)學(xué)和兒科學(xué)的發(fā)展,早產(chǎn)兒和低出生體重兒的搶救存活率明顯提高,早產(chǎn)兒視網(wǎng)膜病變(retinopathy of prematurity, ROP)在我國的發(fā)病率也呈上升趨勢(shì)。良好的視覺質(zhì)量是嬰兒健康發(fā)育的重要內(nèi)容,早產(chǎn)和ROP病變影響了視網(wǎng)膜功能的成熟,這就迫切需要了解早產(chǎn)兒和ROP患兒視網(wǎng)膜功能發(fā)育情況。嬰兒不能主動(dòng)表達(dá)視覺異常,輕度視功能障礙又不能被普通檢查所發(fā)現(xiàn),f-ERG可在嬰兒睡眠狀態(tài)下進(jìn)行,具有客觀性、無創(chuàng)性和可重復(fù)性等優(yōu)點(diǎn),因此它是客觀評(píng)價(jià)嬰兒視網(wǎng)膜功能的適宜工具。已有研究報(bào)道稱早產(chǎn)兒和ROP患兒生后視網(wǎng)膜功能落后于正常足月兒。但尚未見到既于不同月齡橫向?qū)Ρ萊OP患兒、無眼底病變?cè)绠a(chǎn)兒和正常足月兒的ERG反應(yīng),又隨年齡增長縱向觀察了他們的視網(wǎng)膜ERG的發(fā)育趨勢(shì),并與成年人進(jìn)行對(duì)照的研究報(bào)道。 目的:觀察早產(chǎn)因素和輕度ROP病變對(duì)嬰兒視網(wǎng)膜功能發(fā)育的影響趨勢(shì);對(duì)比觀察ROP患兒、無眼底病變?cè)绠a(chǎn)兒和足月產(chǎn)嬰兒視網(wǎng)膜功能發(fā)育情況。 方法:1眼底檢查:2008年11月至2009年10月來我中心進(jìn)行眼底檢查的新生兒。研究對(duì)象:(1)早產(chǎn)兒為(按照我國衛(wèi)生部2004年規(guī)定)孕齡≤37周,出生體重≤2500g的活產(chǎn)新生兒。(2)足月兒為胎齡滿37周～42周,體重≥2500g,身長47cm以上,無任何畸形和疾病的活產(chǎn)新生兒。(3)成年人為年齡23～44歲,無眼部及全身其它部位病變的健康志愿者。采用直接或間接眼底鏡和美國產(chǎn)RetcamⅡ廣域數(shù)字視網(wǎng)膜檢測系統(tǒng)進(jìn)行眼底檢查。通過眼底檢查進(jìn)行實(shí)驗(yàn)分組:ROP(+)組、ROP(-)組、正常足月兒對(duì)照組和健康成年對(duì)照組。ROP(+)組眼底隨診直至病變消退,周邊視網(wǎng)膜血管化。 2 ERG檢查:ROP(+)組、ROP(-)組和正常足月兒對(duì)照組分別于矯正胎齡40周(相當(dāng)于0個(gè)月)、53周(相當(dāng)于3個(gè)月)和65周(相當(dāng)于6個(gè)月)進(jìn)行f-ERG檢查;健康成年對(duì)照組f-ERG檢查一次。 3記錄檢查結(jié)果并應(yīng)用SPSS13.0系統(tǒng)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。各組均進(jìn)行正態(tài)性檢驗(yàn)和方差齊性檢驗(yàn),屬正態(tài)分布且方差齊。采用方差分析LSD進(jìn)行兩組間比較。 結(jié)果:1眼底檢查結(jié)果:ROP(+)組30例(男20例,女10例)。0個(gè)月時(shí),男嬰中17例雙眼ROP、3例單眼ROP;女嬰中8例雙眼ROP、2例單眼ROP。男女嬰ROP(+)共55眼,其中:34眼為3區(qū)Ⅰ期;21眼為3區(qū)Ⅱ期,病變累計(jì)均小于8個(gè)鐘點(diǎn)范圍。3個(gè)月時(shí),55眼病變均消退,周邊視網(wǎng)膜血管化。ROP(-)組30例60眼(男22例,女8例),未查及眼底病變。正常足月兒對(duì)照組15例30眼(男9例,女6例),未查及眼底病變。成年人對(duì)照組15例30眼(男5例,女10例),未查及眼底病變。 2 ERG檢查結(jié)果 2.1 ROP(+)組與正常足月兒對(duì)照組比較結(jié)果 0個(gè)月:兩組間視錐反應(yīng)a波潛伏期和OPs波數(shù)目無明顯差異,(P值=0.1150.01)無統(tǒng)計(jì)學(xué)意義。視桿反應(yīng)、視錐反應(yīng)a波振幅;視桿反應(yīng)、視錐反應(yīng)b波潛伏期和振幅;最大混合反應(yīng)a、b波潛伏期和振幅;OPs振幅波均存在明顯差異(P值均0.01),具有統(tǒng)計(jì)學(xué)意義; 3個(gè)月:兩組間最大混合反應(yīng)a、b波、視錐反應(yīng)b波潛伏期以及OPs波數(shù)目無明顯差異(P值均0.01),無統(tǒng)計(jì)學(xué)意義。視桿反應(yīng)b波、視錐反應(yīng)a波潛伏期和振幅;最大混合反應(yīng)a、b波和視錐反應(yīng)b波振幅;以及OPs波振幅均存在明顯差異(P值均0.01),具有統(tǒng)計(jì)學(xué)意義。 6個(gè)月:兩組間視桿反應(yīng)b波、視錐反應(yīng)a、b波潛伏期和振幅;最大混合反應(yīng)a、b波振幅以及OPs波數(shù)目無明顯差異(P值均0.01),沒有統(tǒng)計(jì)學(xué)意義。最大混合反應(yīng)a、b波潛伏期和OPs波振幅差異較明顯(P值均0.01),具有統(tǒng)計(jì)學(xué)意義。 2.2 ROP(-)組與正常足月兒對(duì)照組比較結(jié)果 0個(gè)月:兩組間視錐反應(yīng)a、b波潛伏期和OPs波數(shù)目無明顯差異(P值均0.01),無統(tǒng)計(jì)學(xué)意義。視錐反應(yīng)a、b波振幅;視桿反應(yīng)b波、最大混合反應(yīng)a、b波潛伏期和振幅;以及OPs波振幅差異較明顯(P值均0.01),具有統(tǒng)計(jì)學(xué)意義。 3個(gè)月:兩組間最大混合反應(yīng)a波、視錐反應(yīng)a、b波潛伏期和振幅以及OPs波數(shù)目無明顯差異(P值均0.01),無統(tǒng)計(jì)學(xué)意義。視桿反應(yīng)b波、最大混合反應(yīng)b波潛伏期和振幅;以及OPs波振幅差異較明顯(P值均0.01),具有統(tǒng)計(jì)學(xué)意義。 6個(gè)月:兩組間視桿反應(yīng)b波、最大混合反應(yīng)和視錐反應(yīng)a、b波振幅;視錐反應(yīng)a、b波潛伏期以及OPs波數(shù)目均無差異(P值均0.01),沒有統(tǒng)計(jì)學(xué)意義。視桿反應(yīng)b波、最大混合反應(yīng)a、b波潛伏期以及OPs波振幅(P值均0.01),具有統(tǒng)計(jì)學(xué)意義。 2.3 ROP(+)組與ROP(-)組比較結(jié)果 0個(gè)月:兩組間視錐反應(yīng)a、b波潛伏期、OPs波數(shù)目和振幅無明顯差異(P值均0.01),無統(tǒng)計(jì)學(xué)意義。視錐反應(yīng)a、b波振幅;視桿反應(yīng)b波、最大混合反應(yīng)a、b波潛伏期和振幅差異較明顯(P值均0.01)。潛伏期延長,振幅降低,具有統(tǒng)計(jì)學(xué)意義。 3個(gè)月:兩組間最大混合反應(yīng)a波潛伏期和b波振幅;視錐反應(yīng)a、b波潛伏期和振幅以及OPs波數(shù)目無明顯差異(P值均0.01),無統(tǒng)計(jì)學(xué)意義。視桿反應(yīng)b波潛伏期和振幅;最大混合反應(yīng)a波振幅和b波潛伏期;以及OPs波振幅差異較明顯(P值均0.01)。潛伏期延長,振幅降低,具有統(tǒng)計(jì)學(xué)意義。 6個(gè)月:兩組間視桿反應(yīng)b波、最大混合反應(yīng)和視錐反應(yīng)a、b波潛伏期和振幅以及OPs波數(shù)目均無差異(P值均0.01),沒有統(tǒng)計(jì)學(xué)意義。OPs波振幅差異較明顯(P值均0.01)。潛伏期延長,振幅降低,具有統(tǒng)計(jì)學(xué)意義。 2.4ROP(+)組與成年對(duì)照組比較結(jié)果 兩組間0個(gè)月、3個(gè)月視桿反應(yīng)b波潛伏期、最大混合反應(yīng)和視錐反應(yīng)a、b潛伏期差異較明顯(P值均0.01);6個(gè)月,各波潛伏期無明顯差異(P值均0.01)。0個(gè)月、3個(gè)月和6個(gè)月,視桿反應(yīng)b波振幅達(dá)成人的13.01%、23.96%和44.71%;最大混合反應(yīng)a波振幅24.37%、42.20%和72.08%, b波22.13%、42.81%和69.03%;視錐反應(yīng)a波振幅32.69%、48.50%和67.75%,b波26.00%、42.02%和58.70%;OPs波振幅分別達(dá)成人的15.01%、23.66%和30.03%。 2.5 ROP(-)組與成年對(duì)照組比較結(jié)果 兩組間0個(gè)月、3個(gè)月視桿反應(yīng)b波潛伏期、最大混合反應(yīng)和視錐反應(yīng)a、b潛伏期差異較明顯(P值均0.01);6個(gè)月,各波潛伏期無明顯差異(P值均0.01)。0個(gè)月、3個(gè)月和6個(gè)月,視桿反應(yīng)b波振幅達(dá)成人的15.91%、28.35%和44.57%;最大混合反應(yīng)a波振幅33.05%、49.49%和61.63%,b波30.19%、45.56%和69.66%;視錐反應(yīng)a波40.67%、52.52%和64.19%,b波31.17%、43.10%和57.78%;OPs波振幅分別達(dá)到成人的13.22%、26.13%和35.29%。 2.6正常足月兒組與成年對(duì)照組縱向比較結(jié)果 兩組間0個(gè)月、3個(gè)月視桿反應(yīng)b波潛伏期、最大混合反應(yīng)和視錐反應(yīng)a、b潛伏期差異較明顯(P值均0.01);6個(gè)月,各波潛伏期無明顯差異(P值均0.01)。0個(gè)月、3個(gè)月和6個(gè)月,視桿反應(yīng)b波振幅達(dá)成人的26.80%、33.80%和45.43%;最大混合反應(yīng)a波振幅達(dá)成人的41.90%、53.50%和69.81%,b波為35.90%、54.95%和73.36%;視錐反應(yīng)a波振幅達(dá)成人的53.45%、59.70%和67.26%,b波為37.54%、50.26%和63.90% ;OPs波振幅分別達(dá)到成人的17.96%、30.83%和39.08%。 結(jié)論:1早產(chǎn)和ROP病變均使ERG各反應(yīng)潛伏期延長、振幅降低,視桿反應(yīng)及Ops尤為顯著。早產(chǎn)和ROP病變對(duì)視網(wǎng)膜功能存在影響。 2隨ROP病變的消退和早產(chǎn)兒的發(fā)育,到6個(gè)月時(shí),除Ops外,ERG各反應(yīng)潛伏期及振幅與足月兒趨于一致。 3足月兒生后ERG與成人也存在較大差異,發(fā)育至6個(gè)月時(shí),各反應(yīng)潛伏期接近成人水平,但振幅仍明顯低于成人。ERG各反應(yīng)振幅發(fā)育落后于潛伏期。 4 F-ERG是檢查嬰兒視網(wǎng)膜功能的適宜方法。
[Abstract]:Flash electroretinogram (f-ERG) reflects the comprehensive response of the retina to light stimulation. It is a clinical evaluation of the entire retinal function status of ganglion cells. It has a good diagnostic significance for extensive retinopathy. Premature infants and low birth weight infants are born with systemic organ function. Poor retinal function development is not mature. With the development of perinatal medicine and pediatrics, the survival rate of premature infants and low birth weight infants is obviously improved. The incidence of retinopathy of prematurity (ROP) in premature infants is also rising in China. Good visual quality is an important content of healthy development of infants. Production and ROP lesions affect the maturation of retinal function. It is urgent to understand the development of retina function in premature infants and children with ROP. Infants can not express visual abnormalities actively, and mild visual dysfunction can not be found by common examination. F-ERG can be performed in infants' sleep state, with objectivity, noninvasive, reproducibility and other advantages. Therefore, it is an objective tool for evaluating the function of the retina objectively. It has been reported that retina function in prematurely and ROP children is lagging behind normal foot months. However, there is no ERG response to ROP in children with different months of age, with no fundus lesions and normal feet, and the longitudinal observation of him with age. The developmental trend of retinal ERG is reported in comparison with adults.
Objective: To observe the influence of preterm birth factors and mild ROP lesions on retinal functional development in infants and to compare the retinal function development in children with ROP, prematurely prematurely and full-term infants.
Methods: 1 fundus examination: from November 2008 to October 2009, the newborns of the fundus examination were conducted in our center. (1) the birth weight of the newborn was less than 2500g (2) the birth weight was 37 weeks to 42 weeks, the body weight was more than 2500g, and the length of the body was more than 47cm. There was no malformation and no malformation. Living born newborns of the disease (3) adults aged 23~44 years old and healthy volunteers without ocular and other parts of the body. Direct or indirect ophthalmoscope and Retcam II wide area digital retina detection system were used to carry out fundus examination. Through fundus examination, the experimental group was divided into ROP (+) group, ROP (-) group, normal foot month control group and In healthy adult control group, the fundus of.ROP (+) group was followed up until the lesion subsided and peripheral retina vascularization.
2 ERG examination: the ROP (+) group, the ROP (-) group and the normal foot month control group were corrected for 40 weeks (equivalent to 0 months), 53 weeks (equivalent to 3 months) and 65 weeks (equivalent to 6 months) for f-ERG examination, and the healthy adult control group was examined once by f-ERG.
3 the results of the examination were recorded and the SPSS13.0 system software was used for statistical analysis. All groups were tested for normality and variance homogeneity, which were normal distribution and homogeneity of variance, and the two groups were compared by variance analysis LSD.
Results: 1 fundus examination results: in ROP (+) group, 30 cases (male 20, female 10), 17 cases of binocular ROP and 3 case of single eye ROP, 8 cases of ROP in the female baby, 2 cases of ROP. and ROP (+) in 55 eyes, among which 34 eyes were 3 zone I, 21 eyes were 3 District II, and all the diseases were less than.3 months in the range of 20. In the.ROP (-) group, 30 cases (male 22, female 8) were not detected in the group of 60 eyes. 15 cases in the normal foot moon control group were 30 eyes (9 men and 6 women). The adult control group had 30 eyes (5 and 10 cases) in the adult control group, and the eye fundus lesions were not found.
2 ERG examination results
Comparison of 2.1 ROP (+) group with normal term infant control group
0 months: there was no significant difference between the a wave latency and the OPs wave number of the cone reaction between the two groups. There was no statistical significance (P value =0.1150.01). The rod reaction, the a wave amplitude of the cone reaction, the visual pole reaction, the b wave latency and amplitude of the cone reaction, the maximum mixing reaction a, the b wave latency and amplitude, and the OPs amplitude waves were obviously different (P values were 0.01), and were statistically significant. Significance;
3 months: the maximum mixing reaction a, b wave, the b wave latency of the cone reaction and the number of OPs wave numbers have no significant difference (P value is 0.01), and there is no statistical significance. The b wave of the optic rod reaction, the a wave latency and amplitude of the cone reaction, the maximum mixing reaction a, the b wave and the cone reaction b wave amplitude, and the OPs wave amplitude are obviously different (all P values are 0.01), having series The significance of learning.
6 months: two groups of rod reaction b wave, cone reaction a, b wave latency and amplitude, the maximum mixing reaction a, b wave amplitude and OPs wave number, no significant difference (P value is 0.01), no statistical significance. The maximum mixed reaction a, b wave latency and OPs wave amplitude difference is more obvious (P value is 0.01), with statistical significance.
Comparison of 2.2 ROP (-) group with normal term infant control group
0 months: there was no significant difference between the two groups of cones a, the latency of B wave and the number of OPs wave numbers (the P value was 0.01). There was no statistical significance. The cone reaction a, the amplitude of B wave, the b wave of the optic rod reaction, the maximum mixing reaction a, the b wave latency and amplitude, and the significant difference of the OPs wave amplitude (P 0.01), had statistical significance.
3 months: the maximum mixed reaction a wave between the two groups, the cone reaction a, the latency and amplitude of the b wave and the number of OPs wave numbers (P value is 0.01), no statistical significance. The b wave of the optic rod reaction, the maximum mixing reaction b wave latency and amplitude, and the amplitude difference of OPs wave are obvious (P values are 0.01), and have statistical significance.
6 months: the rod reaction b wave, the maximum mixing reaction and the cone reaction a, the amplitude of the b wave, the cone reaction a, the b wave latency and the OPs wave number are not different (P value is 0.01), and there is no statistical significance. The b wave of the rod reaction, the maximum mixing reaction a, the b wave latency and OPs wave amplitude (P values are 0.01), have statistical significance.
Comparison between the 2.3 ROP (+) group and the ROP (-) group
0 months: two groups of cones a, b wave incubation period, OPs wave number and amplitude no significant difference (P value is 0.01), no statistical significance. Cone reaction a, b wave amplitude; the rod reaction b wave, the maximum mixed reaction a, b wave latency and amplitude difference is more obvious (P value is 0.01). Latent period extension, amplitude decrease, with statistical significance.
3 months: the a wave incubation period and b wave amplitude of the maximum mixing reaction between the two groups; the cone reaction a, the latency and amplitude of the b wave and the OPs wave number (P value 0.01) are not statistically significant. The b wave latency and amplitude of the optic rod reaction, the A wave amplitude and the b wave latent period of the maximum mixing reaction, and the amplitude difference of the OPs wave are more obvious (P 0.01). The period is prolonged and the amplitude is reduced, with statistical significance.
6 months: the b wave of the two groups, the maximum mixing reaction and the cone reaction a, the latency and amplitude of B wave and the number of OPs wave numbers were not different (P values were both 0.01). There was no statistically significant difference in amplitude of.OPs wave (P value 0.01). The latency period was prolonged, and the amplitude was reduced, with statistical significance.
Comparison between the 2.4ROP (+) group and the adult control group
Two groups of 0 months, 3 months b wave latency of rod reaction, maximum mixed reaction and cone reaction a, B latency difference is obvious (P value is 0.01); 6 months, there is no significant difference (P value 0.01).0 months, 3 months and 6 months, the pole reaction b wave amplitude of 13.01%, 23.96% and 44.71% of adults, a wave amplitude 24.37%, 42.20, 42.20, 42.20, 42.20, 42.20 % and 72.08%, B waves 22.13%, 42.81% and 69.03%; cone reaction a wave amplitude 32.69%, 48.50% and 67.75%, B waves 26%, 42.02% and 58.70%; OPs wave amplitude, respectively, to adults 15.01%, 23.66% and 30.03%., respectively.
Comparison between the 2.5 ROP (-) group and the adult control group
Two groups of 0 months, 3 months b wave latency of rod reaction, maximum mixed reaction and cone reaction a, B latency difference is obvious (P value is 0.01); 6 months, there is no significant difference (P value 0.01).0 months, 3 months and 6 months, the pole reaction b wave amplitude of 15.91%, 28.35% and 44.57% of adults, a wave amplitude 33.05%, 49.49, 49.49, 49.49, 49.49, 49.49 % and 61.63%, B waves 30.19%, 45.56% and 69.66%; cone reaction a waves 40.67%, 52.52% and 64.19%, B waves 31.17%, 43.10% and 57.78%; OPs wave amplitude reached 13.22%, 26.13%, and 35.29%. in adults, respectively.
2.6 longitudinal comparison of normal term group and adult control group
In the two groups, the latency of B wave in 0 months and 3 months, the maximum mixed reaction and the cone reaction a, the difference in the latency of B was obvious (P value was 0.01); 6 months, there was no obvious difference in the latency of each wave (all P values were 0.01).0 months, 3 months and 6 months, and the amplitude of the b wave of the rod reaction reached 26.80%, 33.80% and 45.43% in adults and the amplitude of a wave of the maximum mixing reaction reached adult. 41.90%, 53.50% and 69.81%, B waves 35.90%, 54.95% and 73.36%; the a wave amplitude of the cone reaction reaches 53.45%, 59.70% and 67.26% in adults, and the B waves are 37.54%, 50.26% and 63.90%; the amplitude of the OPs wave reaches the 17.96%, 30.83%, and 39.08%. of the adult, respectively.
Conclusion: 1 preterm delivery and ROP lesions all prolong the latency of ERG reaction, decrease the amplitude, especially the rod response and Ops. Preterm and ROP lesions have an effect on the retinal function.
With the regression of ROP lesion and the development of premature infants, the latency and amplitude of ERG were similar to those of full-term infants except Ops at 6 months.
There is a great difference between the ERG and the adult after the birth of 3 feet, and the latency of each reaction is close to the adult level at 6 months, but the amplitude of the amplitude is still lower than that of the adult.ERG, and the amplitude of the amplitude is still lagging behind the incubation period.
4 F-ERG is an appropriate method to examine the function of the retina in infants.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R774.1

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