采用多焦图形视网膜电图观察针刺睛明、合谷等穴位对慢性青光眼的影响

目的 评价针刺睛明、合谷等穴位对慢性青光眼患者神经节细胞的影响.方法 对经视野检查和眼光学相干断层扫描确诊为慢性开角型青光眼和正常眼压性青光眼继发视神经萎缩的患者10例20只眼,采用最新国际针灸穴位标准,针刺眼周穴位(睛明、鱼腰、承泣等)和远端穴位(合谷、太冲和足三里)进行治疗(每周3次连续12周为1个疗程,平均2.3个疗程),并采用翻转频率为4 Hz的多焦图形视网膜电图(multifocal pattern electroretinogram,mfPERG)检测针刺前后青光眼患者视网膜后极部约30°范围61个小区的N1、P1波振幅变化,将mfPERG振幅变化与多焦视网膜电图(multifocal electroretinogram,mfERG)一阶kernel反应(first order kernel,FOK)相比较.结果 针刺睛明、合谷等穴位前后,mfPERG N1波振幅密度值分别为(3.49±3.87) nV/deg2、(3.98±3.34) nV/deg2,差异有统计学意义(t=-3.37,P=0.0008)；P1波振幅密度值分别为(7.49±7.70) nV/deg2、(8.32±6.70) nV/deg2,差异也有统计学意义(t=-2.98,P=0.0029)；将mfPERG振幅值采用快速傅里叶变换(fast fourier transform,FFT)后,pattern-4 Hz总合振幅密度值分别为(0.08±0.19) nV/deg2、(0.46±1.11) nV/deg2,差异有统计学意义(t=-9.65,P＜0.0001)；数量积(scalar product,SP)分别为(0.20±1.06)nV/deg2、(0.36±0.87) nV/deg2,差异也有统计学意义(t=-3.36,P=0.0008).与此相反,针刺睛明、合谷等穴位前后,mfERG FOK总合反应中,N1波振幅密度值分别为(7.94±3.11) nV/deg2、(7.26±1.86)nV/deg,差异无统计学意义(t=1.24,P=0.2383)；P1波振幅密度值分别为(20.66±7.73) nV/deg2、(18.98±4.98) nV/deg2,差异也无统计学意义(t=1.52,P=0.1518)；经FFT变换,FOK总合振幅密度值分别为(9.91 ±4.46) nV/deg2、(8.44±2.64) nV/deg2,差异无统计学意义(t=2.00,P=0.0674)；SP值在针刺治疗前后分别为(5.19±1.95) nV/deg2,(4.81±1.14) nV/deg,差异也无统计学意义(t=1.28,P=0.2234).结论 图形视网膜电图(pattern electroretinogram,PERG)主要反映视网膜神经节细胞功能,mfPERG较传统PERG检测后极部视网膜神经节细胞功能变化更为敏感；针刺睛明、合谷等穴位后,青光眼患者mfPERG的振幅明显增高,表明视网膜神经节细胞对光刺激的传导加快、兴奋性增强,提示针刺睛明、合谷等穴位对青光眼继发视神经萎缩患者的视网膜神经节细胞可能有保护作用.

Change of the multifocal pattern electroretinogram in chronic open-angle glaucoma acupunctured LI4,BL1,etc.

OBJECTIVE To analyze the effect on the retinal ganglion cells(RGCs) in chronic open-angle glaucoma patients acupunctured in points of LI4,BL1,etc.METHODS Ten optic atrophy cases(20 eyes) secondary to chronic glaucoma detected by static perimetry(Octopus 101) and optical coherence tomography(Stratus OCT),were acupunctured three times per week(30min each time,the average courses of treatment were 2.3) with proximate points of BL1,EXHN4,ST1 and distal points of LI4,LR3,ST36.And 4Hz-reversed multifocal pattern electroretinogram(mfPERG)was tested in each eye before and after the courses,then 61 plots of N1,P1 waveforms surround the central retina were analyzed,followed by a comparison with their first order kernel of mfERG(FOK).RESULTS The average density of N1,P1 amplitude of mfPERG before and after acupuncture was 3.49±3.87 nv/deg2 vs.3.98±3.34 nv/deg2(t=-3.37,P=0.0008) and 7.49±7.70 nv/deg2 vs.8.32±6.70 nv/deg2(t=-2.98,P=0.0029) respectively.After Fast Fourier Transform(FFT),the sum densities were 0.08±0.19 nv/deg2 vs.0.46±1.11 nv/deg2(t=-9.65,P<0.0001),Scalar Products were 0.20±1.06 nv/deg2 vs.0.36±0.87 nv/deg2(t=-3.36,P=0.0008).All these data showed statistical differences before and after acupuncture.In contrast,the sum densities of N1,P1 amplitude of mfERG FOK before and after acupuncture were 7.94±3.11 nv/deg2 vs.7.26±1.86 nv/deg2(t=1.24,P=0.2383) and 20.66±7.73 nv/deg2 vs.18.98±4.98 nv/deg2(t=1.52,P=0.1518).After FFT,the sum densities were 9.91±4.46 nv/deg2 vs.8.44±2.64 nv/deg2(t=2.00,P=0.0674),Scalar Products were 5.19±1.95 nv/deg2 vs.4.81±1.14 nv/deg2(t=1.28,P=0.2234).These data showed no statistical differences before and after acupuncture.CONCLUSIONS Pattern ERG could mainly reflect the function of the RGCs,and multifocal Pattern ERG should be more sensitive than full-field Pattern ERG.In this study,increased amplitudes in glaucoma eyes following acupuncture in points of LI4,BL1,etc.,indicated that there was an acceleration of the stimulus conduction and enhancement of the excitability in RGCs,and suggested that acupuncture might possess a protection towards RGCs in patients with glaucomatous optic atrophy.