mfERG对原发性青光眼的诊断价值及其与视野视盘的相关性

目的评价应用多焦视网膜电图（multiple-focus clectroretinogram,mfERG）二阶kernel反应（second order kernel,SOK）对原发性青光艰视功能损害的诊断价值并研究其与视野视盘的相关性。方法检查原发性青光眼42眼。其中早期青光眼15眼，中期16眼，晚期11眼，高眼压症16眼，并检测33眼正常眼作为正常对照组。记录各组SOK成分参数P1波振幅和峰时，N1波振幅和峰时；同时检测平均视野缺损（MD）和杯盘比（CD）应用SPSS 10.0软件进行ANOVE和多元逐步回归统计学处理。结果P1波振幅和峰时在正常对照组与中、晚期青光眼组间有显著性差异；N1波振幅在正常对照组与中、晚期和高眼压症组间有显著性差异；P1波振幅和峰时、N1波振幅在晚期青光眼组与其他各组间均有显著性差异。正常对照组与早期青光眼组鼻上象限P1波峰时有显著性差异；与高眼压症组鼻上象限P1波振幅，鼻下、颞下象限N1波振幅有显著性差异，高眼压症组、早期、中期、晚期青光眼组P1波振幅的异常检出率为50．0％、66．7％、56.3％、100.0％；N1波振幅为：62．5％、53．3％、50．0％、81．8％；P1波峰时为：31．3%、60．0%、100．0％、90．9％；N1波峰时为：50．0％、53．3％、31．3％、45．5％．MD值的大小对P1波振幅、峰时和N1波振幅大小的影响。统计学上有显著性意义（P=0．003，P=0．018，P=0．002）。结论mfERG提供了评价青光眼视功能损害的一种敏感性的方法，但尚未发现具有典型特征性的mfERG改变。因而在临床上应该是多种指标联合检测，以提高诊断的敏感性、准确性。

Diagnosis value of mfERG in the primary glaucoma and its correlation with the visual field and optical papilla

Objective To study the diagnostic value of multiple-focus electroretinogram (mfERG) second order kernel (SOK)'s in glaucoma with vision function damage and its correlation with visual field and optical papilla.Methods Ninety-one eyes were collected in this study in which 42 with primary glaucoma were divided into early stage group (15 eyes),intermediate stage group (16 eyes) and advanced stage group (11 eyes),16 eyes were set as occular hyperfension and 33 eyes were as controls.The SOK parameters of P_1 were amplifude and lafency,N_1 ware amplitude and lafency in each group were recorded,simultaneously the mean visual field defects(MD) and optic cup/disc(C/D) in each group were monifored.All results were analyzed between each group by ANOVA and multinomial logistic regression with Spss10.0 software.Results The amplitude P_1 and latency P_1 were significantly differente between normal eyes and intermediate-stage,advanced-stage glaucoma eyes.The amplitude N_1 was significantly differente between normal eyes and intermediate-stage,advanced-stage glaucoma and ocular hypertension eyes.The latency P_1 in nose above quadrant was significantly differente between normal and early-stage glaucoma;The amplitude P_1 in nose above quadrant and latency N_1 in nose below and temple below quadrant were significantly differente between normal and ocular hypertension eyes.In the ocular hypertension,early-stage,intermediate-stage and advanced-stage glaucoma eyes,the sensitivity of SOK amplitude P_1 was 50.0%,66.7%,56.3% and 100.0% respectively;amplitude N_1 was 62.5%,53.3%,50.0% and 81.8% respectively;latency P_1 was 31.3%,60.0%,100.0% and 90.9% respectively;N_1 was 50.0%,53.3%,31.3% and 45.5% respectively.The MD size affected amplitude P_1,latency P_1 and amplitude N_1 number;With significant difference(P=0.003,P=0.018,P=0.002).Conclusion mfERG provide us an sensitive method for evaluafe glaucoma vision function damage,the characteristic change by mfERG has not been found yet.So clinically multicriteria measurement should be adopted in order to increase the sensitivity and accuracy of diagnosis.