目的：研究基质金属蛋白酶-2（Matrix metalloproteinase-2, MMP-2）、基质金属蛋白酶-9（Matrix metalloproteinase-9, MMP-9）和血管内皮生长因子（Vascular endothelial growth factor, VEGF）在视网膜母细胞瘤（Retinoblastoma, RB）中的表达及其与 RB 分化程度和视神经浸润的关系，探讨它们在 RB 浸润、转移过程中的作用和临床意义。

方法：采用免疫组化方法检测 40 例 RB 中 MMP-2、MMP-9 和 VEGF 的表达。

结果：40 例 RB 中 MMP-2、MMP-9 和 VEGF 的阳性表达率分别为 52.5%、57.5% 和 72.5%。未分化型 RB 中 MMP-2、MMP-9 和 VEGF 的阳性表达均高于分化型（P < 0.05）；有视神经浸润的 RB 中 MMP-2、MMP-9 和 VEGF 的阳性水平均高于无视神经浸润的 RB（P < 0.05）。RB 中 MMP-2、MMP-9 和 VEGF 的表达呈正相关关系（P < 0.05）。

结论：RB 中 MMP-2、MMP-9 和 VEGF 高表达与 RB 的浸润和转移相关，且 MMP-2、MMP-9 表达与 VEGF 表达存在相关性。联合检测 MMP-2、MMP-9 和 VEGF 的表达可作为反映 RB 浸润、转移潜能的生物学指标，有助于筛选转移高危病例及评价患者预后。

Purpose: To study the expression of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9) and vascular endothelial growth factor (VEGF) in retinoblastoma (RB) and its relationship with the differentiation and optic nerve infiltration of RB. And to investigate the role of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9) and VEGF in the infiltration and metastasis of RB and their clinical significance.

Methods: Immunohistochemical technique was used to detect the protein expression of MMP-2, MMP-9 and VEGF in 40 RB cases.

Results: The MMP-2, MMP-9 protein and VEGF protein expression were detected as positive in 52.5%, 57.5% and 72.5% of 40 RB cases respectively. The expression of MMP-2, MMP-9 and VEGF was significantly higher in the undifferentiated pattern than in the rosetted pattern (p < 0.05); and the expression of MMP-2, MMP-9 and VEGF was significantly higher in tumors with optic nerve invasion than in those without optic nerve invasion (p < 0.05). In RB, the expression of MMP-2, MMP-9 had a positive correlation with the expression of VEGF.

Conclusions: In RB, high expression of MMP-2, MMP-9 and VEGF is related to the invasion and metastasis of RB. The expression of MMP-2, MMP-9 is positively correlated with the expression of VEGF. The expression of MMP-2, MMP-9 and VEGF may act as a biological marker for the invasion and metastasis of RB. The method may help screen and identify the cases with high risk for metastasis and to predict the prognosis of patients. 

目的：观察不同程度早期糖尿病视网膜病变（diabetic retinopathy，DR）的多焦视网膜电图（multifocal electroretinograms，mf-ERG）一阶 kernel 反应（first order kernel，FOK）的变化特征，探讨糖尿病患者的视网膜组织形态学改变与功能学检查的关联，及早期DR视功能受损的敏感监测指标。方法：横断面研究，采用多焦视觉电生理检查系统测量分析16例无DR组、15 例轻度非增殖性DR（non-proliferative diabetic retinopathy，NPDR）组和 15 例中度非增殖性 DR（中度 NPDR 组），正常对照组 16 例 FOK 反应，选右眼测量，比较不同程度 DR 的 N1，P1 波潜伏期、振幅密度差异。结果：与正常组相比，无 DR 组、轻度 NPDR 组、中度 NPDR 组的N1，P1波潜伏期延长分别 1.42，1.35，2.75 ms和 0.98，1.01，2.71 ms（P < 0.001），N1，P1波振幅密度差异无统计学意义（P > 0.05）。随DR程度加重，N1，P1波潜伏期逐渐延长。无 DR 组虽尚未出现可见视网膜病变，但FOK 的 N1，P1 波潜伏期已出现异常。结论：糖尿病患者早期眼底尚未出现可见视网膜血管病变，mfERG 的 FOK 的 N1，P1 波潜伏期已出现异常。FOK 的 N1，P1 波的潜伏期的延长与 DR 的血管病变的严重程度呈正相关。FOK 的 N1，P1 波的潜伏期可能是较振幅密度更为敏感视网膜功能异常的观察指标。

Objective: To investigate the change of the first-order kernel (FOK) in multifocal electroretinogram (mf-ERG) in different severity grade of early diabetic retinopathy.

Methods: The FOK of mf-ERG were performed in 16 eyes with no diabetic retinopathy (non-DR group), 15 with mild non-proliferative diabetic retinopathy (mild NPDR group) and 15 with moderate NPDR; 15 age-matched healthy subjects were selected in the control group.

Results: Compared with the control group, N1 and P1 implicit times in the non-DR group, the mild NPDR group and the moderate NPDR group were delayed by 1.42, 1.35, 2.75 ms and 0.98, 1.01, 2.71 ms (all P < 0.001). N1 and P1 amplitudes did not significantly change (both P > 0.05).

Conclusion: Implicit times of N1 and P1 of mf-ERG delay before diabetic patients have no visible retinal vascular lesions. There is a significant correlation between retinopathy severity and the magnitude of the delays of N1 and P1 implicit times. Compared with the amplitude, implicit time of FOK yields high sensitivity in predicting the incidence of abnormal retinal function. Sensitivity to abnormal retinal function