左旋多巴对弱视患者色觉的影响

doi:DOI:10.3760/cma.j.issn.1674-845X.2016.08.003

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摘要

目的初步探讨左旋多巴对弱视患者色觉的影响，揭示其可能存在的色觉恢复机制。方法前瞻性随机对照研究。选取2014年1月至2015年2月中山大学中山眼科中心门诊常规配镜后符合单眼弱视的初诊患者55例（110眼），年龄5~12周岁。按随机数字表法分为对照组27例（54眼）和左旋多巴组28例（56眼），对照组予配镜+遮盖健眼治疗，左旋多巴组予配镜+遮盖健眼+口服左旋多巴治疗，连续治疗3个月后分别检查2组患者的双眼视力、屈光状态、颜色图形视觉诱发电位（CP-VEP）。视力与FM-100 Hue色觉测试相关性采用Spearman等级相关性分析，治疗前后CP-VEP的波幅及潜伏期变化采用独立样本t检验。结果完成研究46例，其中对照组21例，治疗组25例：①优势眼视力与总错误分值平方根不相关（r=-0.015，P＞0.05），弱视眼视力与总错误分值平方根呈负相关（r=-0.298，P＜0.05）。②左旋多巴组和对照组在红/灰棋盘格的刺激下，治疗前后P100潜伏期缩短时间的差异有统计学意义（t=2.258，P＜0.05）；在黑/白（t=2.642，P＜0.05）、红/灰（t=2.861，P＜0.01）、绿/灰（t=2.526，P＜0.05）、红/绿（t=2.281，P＜0.05）4种颜色棋盘格刺激下，治疗前后N75-P100波幅增加幅度的差异具有统计学意义。③2组视力评价为治疗无效的弱视眼，在红/灰（t=2.113，P＜0.05）、绿/灰（t=2.085，P＜0.05）颜色棋盘格刺激下，治疗前后P100潜伏期缩短时间的差异有统计学意义。在黑/白（t=2.531，P＜0.05）、绿/灰（t=2.229，P＜0.05）、红/绿（t=2.374，P＜0.05）3种颜色棋盘格的刺激下，2组治疗无效的弱视眼N75-P100波幅增加幅度的差异有统计学意义。结论服用左旋多巴后，CP-VEP出现潜伏期和波幅的改变与治疗效果之间有密切关系。左旋多巴能改善部分色觉功能，但具体机制尚未明确。

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关键词 ：左旋多巴,弱视,色觉,诱发电位, 视觉

Abstract：

Objective To study the effect of levodopa (L-dopa) on monocular amblyopic children using chromatic pattern visual evoked potentials and FM 100-hue tests; to assess the role of levadopa on possible color vision recovery. Methods This was a prospective randomized controlled study. Fifty-five research candidates (110 eyes), ranging in age from 5 to 12 years, who were diagnosed with monocular amblyopia were randomly selected for the project from January 2014 to February 2015 at the Zhongshan Ophthalmic Center. The children were randomly divided into a control group of 27 cases (54 eyes) and a treatment group of 28 cases (56 eyes). The healthy eye of both groups was covered. The control group was treated with spectacles and the treatment group was treated with levodopa. Binocular visual acuity, refractive state, FM 100-hue color sorting and chromatic pattern visual evoked potentials (CP-VEP) were used for testing. The data was analyzed with SPSS 19.0 software, including an independent-samples t test and Spearman rank correlation. Results ①There was a negative correlation between the visual acuity of the amblyopic eye and (r=-0.298, P＜0.05). The confusion axis in the amblyopic patients distributed mainly in the blue and yellow sectors. ②There were no significant differences in the narrow time frame of P100 latencies between the L-dopa treatment group and the control group, except for the test based on red-gray (t=2.258, P＜0.05). There were no significant differences between the two groups in the increase of N75-P100 amplitudes, except for the tests based on black-white (t=2.642, P＜0.05), red-gray (t=2.861, P＜0.01), green-gray (t=2.526, P＜0.05), and red-green (t=2.281, P＜0.05). ③Excluding the effect of visual acuity on the CP-VEP, there were no significant differences in the narrow time frame of P100 latencies between the L-dopa treatment group and control group, except for the tests based on red-gray (t=2.113, P＜0.05) and green-gray (t=2.085, P＜0.05). There were no significant differences in the increase of N75-P100 amplitudes between the two groups, except for the tests based on black-white (t=2.531, P＜0.05), green-gray (t=2.229, P＜0.05) and red-green (t=2.374, P＜0.05). Conclusion There is a close relationship between CP-VEP latency and the amplitude of the change and the therapeutic effect when taking levodopa. Levodopa can improve partial color vision, but the specific mechanism is not clear.

收稿日期: 2016-05-18

通信作者: 林小铭，Email：linxiaom@mail.sysu.edu.cn

引用本文:

李蓓,刘俐,吴淑端,等. 左旋多巴对弱视患者色觉的影响. 中华眼视光学与视觉科学杂志, 2016, 18(8):459-464. DOI:DOI:10.3760/cma.j.issn.1674-845X.2016.08.003.
Li Bei,Liu Li,Wu Shuduan,et al. The influence of levodopa on color vision in patients with amblyopia . Chinese Journal of Optometry Ophthalmology and Visual science, 2016, 18(8):459-464.

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http://www.cjoovs.com/CN/DOI:10.3760/cma.j.issn.1674-845X.2016.08.003 或 http://www.cjoovs.com/CN/Y2016/V18/I8/459

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