PDF(Pubmed)
Abstract：
Aim and objectives: Visual dysfunction in diabetes mellitus (DM) is multifactorial and can be due to vascular disease, and metabolic abnormalities that can affect the retina, optic nerve, and visual pathways. Visual evoked potential (VEP) is an electrophysiological test that can quantify the functional integrity of the visual pathways from the retina via the optic nerves, and optic tracts to the visual cortices. In this study, we aimed to investigate the visual pathway dysfunction among diabetics without retinopathy compared with healthy controls and to look for any correlation with diabetic neuropathy, duration of diabetes, or HbA1c level. Methods: The study included 75 diabetic patients and 75 age and sex-matched controls. VEPs were recorded using the pattern reversal stimulation method on the Medtronic EMG EP machine, and P100 latency and N75-P100 amplitude were recorded in both diabetic patients and healthy controls. Results: Mean P100 latency was significantly prolonged and N75-P100 amplitude significantly reduced among diabetic cases compared to healthy controls (p < 0.001). Among diabetics with peripheral neuropathy, P100 latency was significantly prolonged and N75-P100 amplitude was significantly reduced compared to diabetics without peripheral neuropathy. A significant positive correlation of VEP P100 latency (p < 0.001) and a negative correlation with N75-P100 amplitude (p < 0.001) with duration of disease were also found. Conclusion: VEP changes are observed in diabetics before the development of retinopathy or peripheral neuropathy indicating optic pathway dysfunction, which precedes the development of these complications. Early preclinical visual pathway dysfunction can warrant taking the necessary measures to reduce diabetic complications. Abbreviations: DM = Diabetes Mellitus, VEP = Visual Evoked Potential, HbA1c = Hemoglobin A1 c, MRI = Magnetic Resonance Imaging, EEG = Electroencephalography, P100 = Positive wave peak at latency 100 ms (millisecond), N75 = Negative wave peak at latency 75 ms (millisecond), N145 = Negative wave peak at latency 145 ms (millisecond), OCT = Optical coherence tomography, PRVEP = Pattern Reversal Visual Evoked Potential, NCS = Nerve Conduction Study, SSR = Sympathetic Skin Response, IL1 = Interleukin-1, LIF = Leukemia inhibitory factor, CNTF = Ciliary neurotrophic factor, TNF alpha = Tumor necrosis factor-alpha, TGF-beta = Transforming growth factor-beta.
摘要：
目的和目标：糖尿病（DM）的视觉功能障碍是多因素的，可能是由于血管疾病，和代谢异常会影响视网膜，视神经,和视觉路径。视觉诱发电位（VEP）是一种电生理测试，可以量化从视网膜通过视神经的视觉通路的功能完整性，和视觉皮层的视束。在这项研究中,我们旨在调查无视网膜病变的糖尿病患者与健康对照组的视觉通路功能障碍，并寻找与糖尿病神经病变的相关性。糖尿病的持续时间，或HbA1c水平。方法：该研究包括75例糖尿病患者和75例年龄和性别匹配的对照。在MedtronicEMGEP机上使用模式反转刺激方法记录VEP，在糖尿病患者和健康对照中记录P100潜伏期和N75-P100振幅。结果：与健康对照组相比，糖尿病患者的平均P100潜伏期显着延长，N75-P100振幅显着降低（p<0.001）。在患有周围神经病变的糖尿病患者中，与没有周围神经病变的糖尿病患者相比，P100潜伏期显着延长，N75-P100振幅显着降低。还发现VEPP100潜伏期（p<0.001）与N75-P100振幅（p<0.001）与疾病持续时间呈显着正相关。结论:糖尿病患者在发生视网膜病变或周围神经病变前观察到VEP变化,提示视路功能异常,先于这些并发症的发展。早期临床前视觉通路功能障碍可以采取必要措施减少糖尿病并发症。缩写：DM=糖尿病，VEP=视觉诱发电位,HbA1c=血红蛋白A1c,MRI=磁共振成像,EEG=脑电图，P100=延迟100ms（毫秒）时的正波峰值，N75=延迟75ms（毫秒）时的负波峰值，N145=延迟145ms（毫秒）时的负波峰值，OCT=光学相干断层扫描，PRVEP=模式反转视觉诱发电位,NCS=神经传导研究，SSR=交感皮肤反应，IL1=白细胞介素-1，LIF=白血病抑制因子，CNTF=睫状神经营养因子，TNFα=肿瘤坏死因子-α，TGF-β=转化生长因子-β。
