目的:观察Heidelberg共焦扫描激光多普勒视网膜血流仪(HRF)和视网膜电图震荡电位(OPs)OS2在糖尿病视网膜病变(DR)早期各参数的变化特点,寻找反映早期DR的敏感指标。方法:采用前瞻性实验研究,对正常对照组21例42眼和糖尿病患者104例208眼进行HRF和OPsOS2幅值检测,将糖尿病患者分为无视网膜病变的糖尿病患者(NDR组)和单纯性糖尿病视网膜病变(非增殖性视网膜病变,NPDR组),其中NPDR组又分为I,II,III期组。观察HRF检查鼻、颞侧视乳头旁视网膜,视网膜无可见血管区的血流量、血流速度、红细胞移动速率和OPsOS2幅值的变化,对各组数据进行统计学分析。结果:NDR组、NPDRI,II,III期组患者鼻、颞侧视盘旁视网膜,视网膜无可见血管区的血流参数均低于正常对照组,差异有统计学意义(P<0.05)。NPDRII期组的鼻、颞侧视盘旁视网膜,视网膜无可见血管区的血流量、血流速度均高于其他3组,差异有统计学意义(P<0.05);NPDRII期组的鼻、颞视盘旁视网膜,视网膜无可见血管区的红细胞移动速率高于NPDRI期组、NDR组,差异有统计学意义(P<0.05);NPDRIII期组的鼻、颞侧视盘旁视网膜,视网膜无可见血管区的血流速度、红细胞移动速率均高于NDR组,差异有统计学意义(P<0.05)。糖化血红蛋白值与糖尿病视网膜病变程度呈显著正相关关系。NDR组和NPDR组视觉电生理OPs波OS2波幅均降低,与正常对照组比较,差异均有统计学意义(P<0.05);NPDRIII期组和NPDRII期组与NPDRI期组、NDR组Ops波OS2波幅比较差异具有统计学意义(P<0.05)。结论:HRF作为非侵入性的血流测量技术,联合OPs检测可作为诊断糖尿病视网膜病变早期诊断的敏感指标,能较早、准确地反映视网膜微循环机能的变化,对于揭示糖尿病视网膜病变的发生机制、病变的程度及治疗的选择具有重要的临床应用价值。

·AIM:To observe the effect of laser-Doppler retinal blood flowmeter and oscillatory potentials(OPs)OS2 of the electroretinogram in diabetic retinopathy(DR).·METHODS:The average blood flow volume(VOL),the blood flow velocity(FLW)and the erythrocyte flow velocity of the vesse(VEL)in the temporal and nasal juxtapapillary retina and the avascular area of temporal and nasal retina were measured with the non-invasive Heidelberg retinal flowmeter(HRF),and OPs OS2 were measured with the ROLAND RETIport electroretinogram in 104 patients 208 eyes with diabetes and 21 patients 42 eyes in normal control group.The patients with diabetes were divided into non-diabetic retinopathy(NDR)group(22 patients,44 eyes)and non-proliferative diabetic retinopathy(NPDR)group(82 patients,164 eyes).NPDR group were svbdivided into 3 groups:phase I,II,III group.The data in each group were statistically analyzed.·RESULTS:The parameter of retinal blood flow of temporal and nasal juxtapapillary retina and the avascular area of temporal and nasal retina in NDR and NPDR group was significantly lower than that in the normal control group(P<0.05).The VOL and FLW of temporal and nasal juxtapapillary retina and the avascular area of temporal and nasal retina in NPDR phase II group was obviously higher than that in the other groups(P<0.05).The VEL of temporal and nasal juxtapapillary retina and the avascular area of temporal and nasal retina in NPDR phase II group were significantly higher than that in NPDR phase I and NDR group(P<0.05).The FLW and the VEL of nasal and temporal juxtapapillary retina and the avascular area of temporal and nasal retina in NPDR phase III group were obviously higher than that in NDR group(P<0.05).Hemoglobin Alc value was positively correlated with degree of diabetic retinopathy(r=0.433,P=0.000).The OPs OS2 in NDR and NPDR group was significantly lower than that in the normal control group(P<0.05),the OPs OS2 of the NPDR phase III and phase II group were significantly lower than that in NPDR phase I and NDR group(P<0.05).·CONCLUSION:As a non-invasive method for mea-surement of retinal blood flow,HRF and OPs OS2 has important value in revealing the mechanism and degree of pathological changes and choice of treatment for DR.·

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