可攜帶式瞳孔量測儀之研究

Abstract

在日常生活與一般健康檢查中，自律神經病變之症狀並不明顯，容易被忽略。目前自律神經檢測之方法與評估上，因儀器本身昂貴、或量測方法無法以客觀量化其神經病變之狀態，量測方法變異性很大，僅能視為一個簡單的篩檢工具。瞳孔受自律神經支配，瞳孔收縮反應與自律神經之小纖維相關。醫師臨床經驗中發現，長期慢性病如糖尿病、高血壓等其末梢神經容易發生病變，因而本研究藉由瞳孔受光線刺激後之收縮反應，研究是否可以透過瞳孔反應變化早期辨識自律神經病變。 本研究設計一個簡易、可攜帶且重量輕的瞳孔量測儀，透過兩種強度1.2 cd與0.12 cd，四種不同波長白光、紅光(650 nm)、綠光(534 nm)、藍光(470 nm)刺激右眼，觀察光線刺激後瞳孔大小、瞳孔收縮與舒張速度及瞳孔反應時間等參數。研究中利用正常人與糖尿病患作為研究之對象。正常人為近視小於600度之健康成年人，糖尿病患為視力正常之狀態下，且没有網膜病變與神經病變之患者。資料以無母數分析方法來分析與比較，並探討兩個族群在瞳孔反應上之差異性。 實驗結果顯示(1)糖尿病患者原始休息時之瞳孔直徑比正常人小(p=0.02)。(2)糖尿病患者由瞳孔最小值恢復到原始瞳孔直徑的50%所需要之時間比較長，不同強度與不同波長刺激之p值介於0.036到0.001間(p<0.05)。(3)糖尿病患者光線刺激後瞳孔最大收縮速度比較快，p值介於0.038到0.005間(p<0.05)。(4)1.2及0.12 cd的白光刺激後糖尿病患須要比較長時間後瞳孔才開始收縮，p值分別為0.001及0.022(p<0.05)。(5)分別利用0.12 cd 白、紅、綠以及1.2 cd的白、紅、藍光刺激瞳孔後，糖尿病患瞳孔恢復速度比較慢，p值分別為0.004,0.009,0.003,0.0001及0.003都有達到統計上的顯著差異(p<0.05)。

In the daily life, symptoms of autonomic neuropathy are not obvious, it’s easily to ignore. Currently the method and evaluation of the autonomic nervous system, due to the instruments were expensive, or the measurement methods were not objective, measurement errors will be caused by human factors, the existing measurement methods cannot be a golden standard. Pupil response was controlled by small fibers of the autonomic nerve system. Clinical experience showed that the peripheral nerve is prone to damage such as diabetes mellitus and hypertension. Therefore, through the pupil response, it’s expected to identify the early diabetes with autonomic neuropathy. In this research, we design a simple, easy, portable, and small pupillometery to record the pupil response stimulated with different intensity, 1.2 cd and 0.12 cd and different wavelength light, white, red(650 nm), green(534 nm) and blue(470 nm). Ten parameters derived from pupil diameter, pupil response time, and pupil response speed will be evaluated for healthy and diabetic. The healthy subjects are used to be a control group that with low myopia(<-6.0D). The subjects with diabetes are used to be experiment group, their eyesight is normal, without any retinopathy and optic neuropathy. Non-parametric statistics was used for analysis. The experimental results show that resting pupil diameter of diabetic is significantly smaller than those of healthy subjects (p=0.02). Duration between the minimum pupil size restoring to the 50% pupil size and the maximum restoring speed were longer and slower in diabetics (p<0.05). The latency after 0.12 cd and 1.2 cd white light stimulate was significantly longer in diabetics (p<0.05). After 0.12 cd W,R,G and 1.2 cd W,R,B stimulation, the average restoring velocity is slower in diabetics (p<0.05).