屈光不正對P-VEP影響及法醫(yī)學(xué)意義
發(fā)布時間：2018-09-19 14:57
【摘要】： 在臨床法醫(yī)學(xué)鑒定中經(jīng)常涉及到視功能評定的問題，由于被鑒定人常�？浯笠暪δ苷系K程度或偽裝成視功能障礙，因此，在法醫(yī)學(xué)如何準(zhǔn)確客觀評定視功能障礙程度是法醫(yī)學(xué)所面臨的一個重要課題。視覺誘發(fā)電位(visual evoked potential簡稱VEP)是一種客觀評定視功能的方法，在法醫(yī)學(xué)上應(yīng)用VEP評定視功能具有特殊意義。按刺激光的不同可以將視覺誘發(fā)電位分為閃光視覺誘發(fā)電位(flash visual evoked potential，F(xiàn)-VEP)和圖形視覺誘發(fā)電位(pattern visual evoked potential，P-VEP)。P-VEP波群中常用于診斷的是P_(100)(亦稱P_1)，其振幅和潛伏期受諸多因素影響。其中屈光狀態(tài)的影響往往易被忽略，而造成假陽性，從而不能正確判斷被檢者真實的視功能狀態(tài)。目前對于屈光不正對VEP的影響的研究主要從其潛伏期、波幅的絕對值變化方面研究，且常限于同一空間頻率刺激，對于屈光不正對不同空間頻率刺激的VEP的波幅變化率的影響無明確報導(dǎo)。本次試驗對40人(80只眼)給予不同的屈光負荷后進行不同空間頻率刺激下的VEP檢查，通過對其波幅變化率及潛伏期進行比較，進一步探討屈光不正對VEP的影響及在法醫(yī)學(xué)鑒定中的應(yīng)用價值。 試驗對象與方法 試驗對象：來自于中國醫(yī)科大學(xué)在校本科生40人(80眼)，均為男性，年齡為20～25歲，眼科常規(guī)檢查正常，除近視外無其他眼病，所有眼矯正視力均在1.0以上。 方法：讓被檢眼注視屏幕中央，遮蓋另眼，采用三種不同空間頻率(8×8、16×16、32×32)的棋盤格分別刺激，記錄最佳矯正視力(1.0，相對屈光負荷為OD)下和分別在此基礎(chǔ)上給予+2.00D、+4.00D、+6.00D和+8.00D屈光負荷下的P-VEP波形，相對 屈光負荷為OD組設(shè)為對照組，其余屈光負荷組為實驗組，與對照 組相比計算出各實驗組的P；。波幅的變化率及潛伏期變化值。 統(tǒng)計學(xué)分析：采用 SPSS for indows．0統(tǒng)計分析軟件，應(yīng)用 L檢驗及方差分析方法進行統(tǒng)計分析。 結(jié) 果 1．三種不同空間頻率堆 X 8、16 X 16J2 X 32）刺激誘發(fā)出的 P；。波幅的下降率均隨凸透鏡屈光度的增加而逐漸增加，H者之間 的相關(guān)系數(shù)分別為0．999J．992和0．957，P；。振幅的下降率均與 所加凸透鏡屈光度之間存在正相關(guān)關(guān)系。同時結(jié)果表明在相同屈 光負荷下，P；。波幅的下降率隨刺激空間頻率的增加而增加。 2．不同屈光負荷在不同空間頻率方格刺激下的P－VEP中 Pl。波幅的下降率離散系數(shù)明顯小于絕對值的變化值離散系數(shù)，經(jīng) 配對t檢驗：t＝＝－15．026，P＜0．001。 3．在 40人 80只受試眼中，除 8 x 8格空間頻率刺激下＋2 ．00 D屈光負荷組中100潛伏期與對照組相比無顯著性差異外K ＞O．05入其余實驗組中在同一空間頻率格刺激中，隨著屈光負荷 的增加，P；。潛伏期延長值也明顯增加；在相同屈光負荷下，隨著刺 激格空間頻率的增高，P；。潛伏期延長值也明顯增加。 討 論 1．屈光不正對P－VEP中P；。波幅的影響 本次實驗通過對40人80只眼在不同屈光負荷下的VEP檢 測，經(jīng)統(tǒng)計學(xué)分析得出：在同一空間頻率刺激下，P；co波幅隨著凸透 鏡屈光度數(shù)的增加而降低，其下降率隨凸透鏡屈光度數(shù)的增加而 增高，即Pl。振幅的下降率與凸透鏡屈光度之間存在正相關(guān)關(guān)系。 這是由于正屈光負荷使圖象在視網(wǎng)膜上的成像變得模糊，導(dǎo)致視 敏度下降，且這種視敏度下降程度隨屈光負荷的增加而增加。 ·2· 對于同一屈光負荷下，P；。波幅的下降率隨刺激空間頻率的提 高而增高，這說明在不同空間頻率中，屈光負荷對小方格刺激所誘 發(fā)出VEP的影響要大于對大方格刺激的影響。 誘發(fā)電位反應(yīng)波的幅值叩波幅）在健康個體內(nèi)和個體間的 變異較大，因此不能簡單說一個人P；。波幅低，就是神經(jīng)元本身的 病變。本實驗通過對不同屈光負荷在不同空間頻率刺激下誘發(fā)出 Pl。波幅的下降值的離散率及其下降率的離散率進行統(tǒng)計學(xué)分析 卜檢驗入P＜0．001，波幅下降率的離散率明顯小于波幅下降值的 離散率，即其個體差異性較小，，可以用于不同個體間的比較。 2．屈光不正對P－VEP中P；。潛伏期的影響 潛伏期主要反映被測試的感覺或運動系統(tǒng)的粗徑有髓纖維的 傳導(dǎo)功能。潛伏期長，說明傳導(dǎo)速度減慢。本實驗結(jié)果證明，隨著 屈光負荷的增加，P；。潛伏期延長值也相繼提高，這是由于屈光負 荷的增加使圖象在視網(wǎng)膜上成像的圖形邊緣變得更加模糊，導(dǎo)致 潛伏期的延長。本組實驗顯示在同一屈光負荷下隨著空間頻率的 提高，P；。潛伏期延長值也相繼增加，說明在屈光負荷對P；。潛伏 期的影響中，高空間頻率刺激較低空間頻率刺激更為敏感。 3．正確認識屈光不正對P－VEP的影響在客觀評價視功能中 的法醫(yī)學(xué)意義 在眼損傷的法醫(yī)學(xué)鑒定中可以充分利用屈光不正對P－VEP
[Abstract]:Visual evoked potential (VEP) is an important subject in forensic science, because the appraised often exaggerate the degree of visual impairment or disguise it as visual impairment. VEP is an objective method for evaluating visual function. It has special significance in forensic medicine to use VEP to evaluate visual function. According to the stimulating light, VEP can be divided into flash visual evoked potential (F-VEP) and pattern visual evoked potential (P-VEP). The amplitude and latency of P_ (100) (also called P_1) are influenced by many factors. The influence of refractive state is often neglected, which leads to false positivity, and thus can not correctly judge the true visual state of the examinee. In this study, 40 subjects (80 eyes) were examined for the amplitude change rate and latency progression of VEP after different refractive loads with different spatial frequencies. To compare the effects of ametropia on VEP and its application in forensic identification.
Test subjects and methods
Subjects: 40 undergraduates (80 eyes) from China Medical University, all male, aged 20-25 years, had normal routine ophthalmic examination, no eye diseases except myopia. All eyes had corrected visual acuity above 1.0.
Methods: Three different spatial frequencies (8 *8, 16 *16, 32 *32) were used to stimulate the examined eye to fix on the center of the screen and cover the other eye. The P-VEP waveforms were recorded under the best corrected visual acuity (1.0, OD) and under the refractive load of + 2.00D, + 4.00D, + 6.00D and + 8.00D respectively.
Refractive load was set as control group in group OD, while in other refractive load group, the experimental group was compared with control group.
The P, amplitude and latency of each experimental group were calculated.
Statistical analysis: SPSS for indows.0 statistical analysis software was applied.
L test and variance analysis were used for statistical analysis.
Result
1. three different spatial frequency reactors X 8,16 X 16J2 X 32) induced by stimulation.
P. The decrease rate of amplitude increases with the increase of the refractive index of the convex lens, and between H.
The correlation coefficients were 0.999J.992 and 0.957, P, respectively.
There is a positive correlation between the refractive index of the convex lens.
Under the light load, the decrease rate of P and amplitude increases with the increase of the spatial frequency of stimulation.
2. the different refraction load under the different space frequency square stimulus of P VEP.
The decrease rate of Pl. amplitude is obviously smaller than that of absolute value.
Paired t test: T = = - 15. 26, P < 0.001.
3. in the eyes of 40 subjects and 80 subjects, except 8 x 8 space frequency stimulus + 2
There was no significant difference in the latency of 100 in.00 D refractive load group compared with the control group, K
> O.05 into the rest of the experimental group in the same spatial frequency stimulus, with refractive load.
The increase of P, latency of the incubation period also increased significantly.
The spatial frequency of excitation increased, P, and latency prolonged significantly.
Discussion
1. the influence of ametropia on P, amplitude of P VEP.
In this experiment, 40 eyes and 80 eyes were examined by VEP under different refractive loads.
Statistical analysis showed that under the same spatial frequency stimulation, the amplitude of P and CO was convex.
The decrease of the refractive index increases with the increase of the refractive index of the convex lens.
There is a positive correlation between the decrease of Pl. amplitude and the refractive index of convex lens.
This is due to the blurring of the image on the retina due to the positive refractive load.
The sensitivity decreased, and the decrease of the visual acuity increased with the increase of refractive load.
2.
For the same refractive load, the decrease rate of P, amplitude decreases with the increase of the spatial frequency of stimulation.
Higher and higher, which indicates that in different spatial frequencies, the refractive load is induced by small square stimuli.
The effect of VEP is greater than that on large square stimuli.
The amplitude of evoked response wave amplitude is between healthy individuals and individuals.
The variation is large, so we can not simply say a person P; the amplitude is low, that is, the neuron itself.
The experiment was induced by stimulation of different diopter loads at different spatial frequencies.
The dispersion rate of the descending value of Pl. amplitude and the dispersion rate of its descending rate were statistically analyzed.
The discretization rate of the amplitude decrease rate is significantly smaller than that of the amplitude decrease in P < 0.001.
Dispersion rate, that is, its individual difference is small, can be used for comparison among different individuals.
2. the influence of ametropia on P. Latency in P VEP.
The incubation period mainly reflects the diameter of the tested sensory or motor system with myelinated fibers.
Conduction function. Long incubation period indicates slow conduction velocity.
The increase in refractive load, P, and latency also increased due to refractive errors.
The increase of load makes the image edge of the image on the retina become more blurred.
Prolongation of latency. This group of experiments showed that with the same refractive load, with the increase of spatial frequency
The increase in P, latency, and latency also showed that the refractive load was P.
High spatial frequency stimulation is more sensitive than low spatial frequency stimulation.
3. correctly understand the effect of ametropia on P VEP and objectively evaluate visual function.
Forensic significance
In the forensic identification of eye injury, we can make full use of ametropia to P VEP.
【學(xué)位授予單位】：中國醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2003
【分類號】：D919
[Abstract]:Visual evoked potential (VEP) is an important subject in forensic science, because the appraised often exaggerate the degree of visual impairment or disguise it as visual impairment. VEP is an objective method for evaluating visual function. It has special significance in forensic medicine to use VEP to evaluate visual function. According to the stimulating light, VEP can be divided into flash visual evoked potential (F-VEP) and pattern visual evoked potential (P-VEP). The amplitude and latency of P_ (100) (also called P_1) are influenced by many factors. The influence of refractive state is often neglected, which leads to false positivity, and thus can not correctly judge the true visual state of the examinee. In this study, 40 subjects (80 eyes) were examined for the amplitude change rate and latency progression of VEP after different refractive loads with different spatial frequencies. To compare the effects of ametropia on VEP and its application in forensic identification.
Test subjects and methods
Subjects: 40 undergraduates (80 eyes) from China Medical University, all male, aged 20-25 years, had normal routine ophthalmic examination, no eye diseases except myopia. All eyes had corrected visual acuity above 1.0.
Methods: Three different spatial frequencies (8 *8, 16 *16, 32 *32) were used to stimulate the examined eye to fix on the center of the screen and cover the other eye. The P-VEP waveforms were recorded under the best corrected visual acuity (1.0, OD) and under the refractive load of + 2.00D, + 4.00D, + 6.00D and + 8.00D respectively.
Refractive load was set as control group in group OD, while in other refractive load group, the experimental group was compared with control group.
The P, amplitude and latency of each experimental group were calculated.
Statistical analysis: SPSS for indows.0 statistical analysis software was applied.
L test and variance analysis were used for statistical analysis.
Result
1. three different spatial frequency reactors X 8,16 X 16J2 X 32) induced by stimulation.
P. The decrease rate of amplitude increases with the increase of the refractive index of the convex lens, and between H.
The correlation coefficients were 0.999J.992 and 0.957, P, respectively.
There is a positive correlation between the refractive index of the convex lens.
Under the light load, the decrease rate of P and amplitude increases with the increase of the spatial frequency of stimulation.
2. the different refraction load under the different space frequency square stimulus of P VEP.
The decrease rate of Pl. amplitude is obviously smaller than that of absolute value.
Paired t test: T = = - 15. 26, P < 0.001.
3. in the eyes of 40 subjects and 80 subjects, except 8 x 8 space frequency stimulus + 2
There was no significant difference in the latency of 100 in.00 D refractive load group compared with the control group, K
> O.05 into the rest of the experimental group in the same spatial frequency stimulus, with refractive load.
The increase of P, latency of the incubation period also increased significantly.
The spatial frequency of excitation increased, P, and latency prolonged significantly.
Discussion
1. the influence of ametropia on P, amplitude of P VEP.
In this experiment, 40 eyes and 80 eyes were examined by VEP under different refractive loads.
Statistical analysis showed that under the same spatial frequency stimulation, the amplitude of P and CO was convex.
The decrease of the refractive index increases with the increase of the refractive index of the convex lens.
There is a positive correlation between the decrease of Pl. amplitude and the refractive index of convex lens.
This is due to the blurring of the image on the retina due to the positive refractive load.
The sensitivity decreased, and the decrease of the visual acuity increased with the increase of refractive load.
2.
For the same refractive load, the decrease rate of P, amplitude decreases with the increase of the spatial frequency of stimulation.
Higher and higher, which indicates that in different spatial frequencies, the refractive load is induced by small square stimuli.
The effect of VEP is greater than that on large square stimuli.
The amplitude of evoked response wave amplitude is between healthy individuals and individuals.
The variation is large, so we can not simply say a person P; the amplitude is low, that is, the neuron itself.
The experiment was induced by stimulation of different diopter loads at different spatial frequencies.
The dispersion rate of the descending value of Pl. amplitude and the dispersion rate of its descending rate were statistically analyzed.
The discretization rate of the amplitude decrease rate is significantly smaller than that of the amplitude decrease in P < 0.001.
Dispersion rate, that is, its individual difference is small, can be used for comparison among different individuals.
2. the influence of ametropia on P. Latency in P VEP.
The incubation period mainly reflects the diameter of the tested sensory or motor system with myelinated fibers.
Conduction function. Long incubation period indicates slow conduction velocity.
The increase in refractive load, P, and latency also increased due to refractive errors.
The increase of load makes the image edge of the image on the retina become more blurred.
Prolongation of latency. This group of experiments showed that with the same refractive load, with the increase of spatial frequency
The increase in P, latency, and latency also showed that the refractive load was P.
High spatial frequency stimulation is more sensitive than low spatial frequency stimulation.
3. correctly understand the effect of ametropia on P VEP and objectively evaluate visual function.
Forensic significance
In the forensic identification of eye injury, we can make full use of ametropia to P VEP.
【學(xué)位授予單位】：中國醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2003
【分類號】：D919
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