建立实验室图形视网膜电图(PERG)各项测量参数的医学参考值范围。采用PERG对黄斑部疾病患者的黄斑部功能改变情况进行评价。

收集2013年1月至2014年3月于广州爱尔眼科医院就诊的21例(29只眼)黄斑病变患者及68例(68只眼)无其他眼部疾病的正常人的临床资料，进行前瞻性对照研究。将纳入研究的全部正常人作为对照组。将对照组正常人按照年龄和裸眼视力分为两个亚组。其中，裸眼视力≥1.0且年龄≥45岁者为对照A组；裸眼视力≥0.8且年龄<45岁者为对照B组。将全部黄斑部疾病患者作为黄斑部疾病组。将黄斑部疾病组患者按照年龄和最佳矫正视力分为两个亚组。其中，最佳矫正视力≥0.1且年龄<45岁者为黄斑A组；最佳矫正视力≥0.1且年龄≥45岁者为黄斑B组。对照组正常人和黄斑部疾病组患者均行相同的PERG检测，记录全部受检者N₃₅波、P₅₀波及N₉₅波潜伏期和P₅₀波及N₉₅波振幅等PERG测量参数。分别将对照组正常人的2个年龄组各项PERG测量参数的2.5%～97.5%百分位数作为本实验室的医学参考值范围。计算黄斑部疾病组患者各项PERG测量参数的异常率。对照组和黄斑部疾病组患者PERG各项测量参数采用中位数和2.5%～97.5%百分位数进行描述。对照组和黄斑部疾病组对应年龄组PERG各项测量参数的组间比较采用Mann－Whitney检验。

经检验，本实验室PERG各项测量参数的医学参考值范围如下。对照A组的N₃₅波、P₅₀波及N₉₅波的潜伏期分别为29.00～32.50 ms、50.00～58.40 ms及93.50～112.90 ms，P₅₀波及N₉₅波的振幅分别为1.14～3.30 μV及3.41～9.61 μV；对照B组的N₃₅波、P₅₀波及N₉₅波的潜伏期分别为25.10～31.90 ms、48.10～56.00 ms及90.30～110.00 ms，P₅₀波及N₉₅波的振幅分别为3.86～8.77 μV及4.93～11.78 μV。黄斑A组患者N₃₅波、P₅₀波及N₉₅波的潜伏期和P₅₀波及N₉₅波的振幅的异常率分别为85%、10%、25%、85%及95%；黄斑B组患者N₃₅波、P₅₀波及N₉₅波的潜伏期和P₅₀波及N₉₅波的振幅的异常率分别为89%、56%、56%、89%及78%。将两组受检者N₃₅波、P₅₀波及N₉₅波的潜伏期进行比较。发现黄斑部疾病组各反应波的潜伏期均大于对照组。其中，在<45岁的受检者中，黄斑A组N₃₅波、P₅₀波及N₉₅波与对照B组比较，差异有统计学意义(Z＝2.45，2.96，3.10；P<0.05)；在≥45岁的受检者中，黄斑B组N₃₅波、P₅₀波及N₉₅波与对照A组比较，差异无统计学意义(Z＝1.52，0.96，1.25；P>0.05)。将黄斑部疾病组患者P₅₀波及N₉₅波的振幅与对照组比较，黄斑部疾病组患者P₅₀波及N₉₅波的振幅均低于对照组，差异均有统计学意义[<45岁组为(Z＝10.46，8.28；P<0.05)，>45岁组为(Z＝8.17，5.88；P<0.05)]。

PERG可客观反映黄斑部疾病患者的黄斑部功能改变情况，具有简单、快速及安全的特点，尤其适用于老年人及儿童等患者，值得推广使用。

To establish the medical reference range of pattern electroretinogram (PERG) measurement parameters in our laboratory. To evaluate the changes of macular function in patients with macular diseases by PERG.

The clinical data of 21 cases (29 eyes) with maculopathy who have visited Guang zhou Aier Eye Hospital and 68 cases (68 eyes) with normal eyes and no other ocular diseases were collected from January 2013 to March 2014 for our prospective controlled study. All normal subjects were included in the control group. The control group was divided into two subgroups according to age and naked vision. The naked vision ≥1 and 45 years of age or older subjects were divided into ≥45 years old group; the naked vision ≥0.8 and younger than 45 years subjects were divided into <45 years old group. All patients with maculopathy were treated as macular disease group. Patients with maculopathy were divided into two subgroups according to age and best corrected visual acuity. Among them, the best corrected visual ≥0.1 and younger than 45 years patients were divided into <45 years old group; the best corrected visual ≥0.1 and 45 years of age or older subjects were divided into ≥45 years old group. Normal subjects in the control group and the patients with maculopathy were detected with the same PERG. The PERG measurement parameters of peak latency of N₃₅ wave, P₅₀ wave and N₉₅ wave and the peak amplitude of P₅₀ wave and N₉₅ wave were recorded for all subjects. The 2.5%~97.5% percentile of each measurement parameters of 2 age groups in the control group were used as the medical reference range of PERG in our laboratory. Abnormal rate of PERG measurement parameters in patients with maculopathy were calculated. PERG measurement parameters of normal subjects in the control group and patients in the macular disease group were described by median and 2.5%~97.5% percentile. PERG measurement parameters between control group and macular disease group in corresponding age group were compared using Mann-Whitney test.

The PERG measurement parameters in our laboratory are following. For ≥45 years old people, peak latency of N₃₅ wave, P₅₀ wave and N₉₅ wave were 29.00~32.50 ms, 50.00~58.40 ms and 93.50~112.90 ms respectively, and the peak amplitude of P₅₀ wave and N₉₅ wave were 1.14~3.30 μV and 3.41~9.61 μV; for <45 years old people, peak latency of N₃₅ wave, P₅₀ wave and N₉₅ wave were 25.10~31.90 ms, 48.10~56.00 ms and 90.30~110.00 ms respectively. The peak amplitude of P₅₀ wave and N₉₅ wave were 3.86~8.77 μV and 4.93~11.78 μV. For macular disease group patients, the abnormal rate of peak latency of N₃₅ wave, P₅₀ wave and N₉₅ wave and peak amplitude of P₅₀ wave and N₉₅ wave were 85%, 10%, 25%, 85% and 95% in <45 years old group; the abnormal rate of peak latency of N₃₅ wave, P₅₀ wave and N₉₅ wave and peak amplitude of P₅₀ wave and N₉₅ wave were 89%, 56%, 56%, 89% and 78% in ≥45 years old group. The peak latency of N₃₅ wave, P₅₀ wave and N₉₅ wave of the two groups were compared. It was found that the peak latency of each wave in the macular disease group were higher than that in the control group. Among them, in the <45 age group, comparing N₃₅ wave, P₅₀ wave and N₉₅ wave of macular disease group with the control group, the differences were statistically significant (Z=2.45, 2.96, 3.10; P<0.05); in ≥45 years old group, comparing N₃₅ wave, P₅₀ wave and N₉₅ wave of macular disease group with the control group, the differences were not statistically significant (Z=1.52, 0.96, 1.25; P>0.05). Comparing the peak amplitude of P₅₀ wave and N₉₅ of macular disease group with the control group, the peak amplitude of P₅₀ wave and N₉₅ of macular disease group in each age were lower than the normal group, the differences were statistically significant [<45 years group (Z=10.46, 8.28; P<0.05), >45 years old group (Z=8.17, 5.88; P<0.05)].

PERG can objectively reflect the changes of macular function in patients with maculopathy, which is simple, fast and safe, especially suitable for the elderly and children.