中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2012年
4期
331-335
,共5页
曹亮%宋愈%吴莹%孙志敏%黄黎黎%喻建锋
曹亮%宋愈%吳瑩%孫誌敏%黃黎黎%喻建鋒
조량%송유%오형%손지민%황려려%유건봉
翼状胬肉%纤维蛋白胶%血管内皮生长因子%碱性成纤维细胞生长因子
翼狀胬肉%纖維蛋白膠%血管內皮生長因子%堿性成纖維細胞生長因子
익상노육%섬유단백효%혈관내피생장인자%감성성섬유세포생장인자
Pterygia%Fibrin glue%Vascular endothelial growth factor%Basic fibroblast growth factor
背景 翼状胬肉为临床常见的眼表疾病.为降低其术后复发率,众多学者进行了广泛的研究.近年来,纤维蛋白胶的应用逐渐受到人们的重视. 目的 探讨利用纤维蛋白胶粘合翼状胬肉自体结膜瓣转移对于减少术后刺激的作用机制.方法 取12只清洁级家兔采用角巩膜缘组织切除和质量分数1.25％稀盐酸点眼法制作兔眼翼状胬肉模型并行翼状胬肉自体结膜瓣转移手术,其中左眼利用手术缝线缝合结膜瓣(缝线组),右眼利用纤维蛋白胶封闭结膜瓣(蛋白胶组),比较两组手术的持续时间.分别于术后1周和4周检查两组兔眼的刺激症状,采用免疫组织化学染色和逆转录聚合酶链反应( RT-PCR)法观察血管内皮生长因子(VEGF)和碱性成纤维细胞生长因子(bFGF)蛋白及其mRNA在结膜组织中的表达情况. 结果 缝线组手术持续时间为(21.3±0.2)min,而纤维蛋白胶组为(10.1±0.1)min,纤维蛋白胶组较缝线组手术时间明显缩短(t=102.242,P＜0.05).术后1周及术后4周,纤维蛋白胶组的结膜充血程度为(+)～(++),缝线组为(++)～(+++),纤维蛋白胶组充血程度明显较轻.免疫组织化学染色显示,VEGF和bFGF主要在结膜上皮细胞层表达,棕黄色颗粒沉积于上皮细胞的细胞质.术后1周时,纤维蛋白胶组的VEGF和bFGF表达强度明显弱于缝线组；术后4周时,两组VEGF和bFGF的表达较术后1周时有所减弱,但纤维蛋白胶组仍明显弱于同期缝线组.RT-PCR检测显示,术后纤维蛋白胶组VEGF mRNA在结膜上皮组织中的表达明显低于缝线组,VEGFmRNA表达量随着术后时间的延长而下降,差异均有统计学意义(F组别=174.443,P=0.000；F时间=231.459,P=0.000)；bFGF mRNA的表达遵循同样的模式,差异均有统计学意义(F组别=41.727,P=0.000；F时间=55.417,P=0.000).结论 纤维蛋白胶粘合可以免去缝合环节,节省手术时间,避免缝线的刺激,并可减轻炎症反应.通过减少VEGF和bFGF的表达,可能有助于降低翼状胬肉的复发率.
揹景 翼狀胬肉為臨床常見的眼錶疾病.為降低其術後複髮率,衆多學者進行瞭廣汎的研究.近年來,纖維蛋白膠的應用逐漸受到人們的重視. 目的 探討利用纖維蛋白膠粘閤翼狀胬肉自體結膜瓣轉移對于減少術後刺激的作用機製.方法 取12隻清潔級傢兔採用角鞏膜緣組織切除和質量分數1.25％稀鹽痠點眼法製作兔眼翼狀胬肉模型併行翼狀胬肉自體結膜瓣轉移手術,其中左眼利用手術縫線縫閤結膜瓣(縫線組),右眼利用纖維蛋白膠封閉結膜瓣(蛋白膠組),比較兩組手術的持續時間.分彆于術後1週和4週檢查兩組兔眼的刺激癥狀,採用免疫組織化學染色和逆轉錄聚閤酶鏈反應( RT-PCR)法觀察血管內皮生長因子(VEGF)和堿性成纖維細胞生長因子(bFGF)蛋白及其mRNA在結膜組織中的錶達情況. 結果 縫線組手術持續時間為(21.3±0.2)min,而纖維蛋白膠組為(10.1±0.1)min,纖維蛋白膠組較縫線組手術時間明顯縮短(t=102.242,P＜0.05).術後1週及術後4週,纖維蛋白膠組的結膜充血程度為(+)～(++),縫線組為(++)～(+++),纖維蛋白膠組充血程度明顯較輕.免疫組織化學染色顯示,VEGF和bFGF主要在結膜上皮細胞層錶達,棕黃色顆粒沉積于上皮細胞的細胞質.術後1週時,纖維蛋白膠組的VEGF和bFGF錶達彊度明顯弱于縫線組；術後4週時,兩組VEGF和bFGF的錶達較術後1週時有所減弱,但纖維蛋白膠組仍明顯弱于同期縫線組.RT-PCR檢測顯示,術後纖維蛋白膠組VEGF mRNA在結膜上皮組織中的錶達明顯低于縫線組,VEGFmRNA錶達量隨著術後時間的延長而下降,差異均有統計學意義(F組彆=174.443,P=0.000；F時間=231.459,P=0.000)；bFGF mRNA的錶達遵循同樣的模式,差異均有統計學意義(F組彆=41.727,P=0.000；F時間=55.417,P=0.000).結論 纖維蛋白膠粘閤可以免去縫閤環節,節省手術時間,避免縫線的刺激,併可減輕炎癥反應.通過減少VEGF和bFGF的錶達,可能有助于降低翼狀胬肉的複髮率.
배경 익상노육위림상상견적안표질병.위강저기술후복발솔,음다학자진행료엄범적연구.근년래,섬유단백효적응용축점수도인문적중시. 목적 탐토이용섬유단백효점합익상노육자체결막판전이대우감소술후자격적작용궤제.방법 취12지청길급가토채용각공막연조직절제화질량분수1.25％희염산점안법제작토안익상노육모형병행익상노육자체결막판전이수술,기중좌안이용수술봉선봉합결막판(봉선조),우안이용섬유단백효봉폐결막판(단백효조),비교량조수술적지속시간.분별우술후1주화4주검사량조토안적자격증상,채용면역조직화학염색화역전록취합매련반응( RT-PCR)법관찰혈관내피생장인자(VEGF)화감성성섬유세포생장인자(bFGF)단백급기mRNA재결막조직중적표체정황. 결과 봉선조수술지속시간위(21.3±0.2)min,이섬유단백효조위(10.1±0.1)min,섬유단백효조교봉선조수술시간명현축단(t=102.242,P＜0.05).술후1주급술후4주,섬유단백효조적결막충혈정도위(+)～(++),봉선조위(++)～(+++),섬유단백효조충혈정도명현교경.면역조직화학염색현시,VEGF화bFGF주요재결막상피세포층표체,종황색과립침적우상피세포적세포질.술후1주시,섬유단백효조적VEGF화bFGF표체강도명현약우봉선조；술후4주시,량조VEGF화bFGF적표체교술후1주시유소감약,단섬유단백효조잉명현약우동기봉선조.RT-PCR검측현시,술후섬유단백효조VEGF mRNA재결막상피조직중적표체명현저우봉선조,VEGFmRNA표체량수착술후시간적연장이하강,차이균유통계학의의(F조별=174.443,P=0.000；F시간=231.459,P=0.000)；bFGF mRNA적표체준순동양적모식,차이균유통계학의의(F조별=41.727,P=0.000；F시간=55.417,P=0.000).결론 섬유단백효점합가이면거봉합배절,절성수술시간,피면봉선적자격,병가감경염증반응.통과감소VEGF화bFGF적표체,가능유조우강저익상노육적복발솔.
Background Pterygia is a clinical common disease.A lot of surgical methods are developed to decrease the recurrence rate.Resent years,the application of fibrin glue is receiving more and more attention.Objective This study was to explore the effects of fibrin glue in decreasing inflammatory irritation and its mechanism. Methods Pterygia models were created in 12 clean rabbits by exsection of limbal tissue and topical administration of 1.25％ diluted hydrochloric acid,and then the conjunctival autograft surgery was performed in the experimental rabbits.The conjunctival flap was sutured in the left eyes,and the conjunctival wound was closed using fibrin glue in the right eyes.The operation duration for each group was documented and compared.The irritation sign was examined under the slit lamp in all the rabbits 1 week and 4 weeks respectively.The expressions of vascular endothelial growth factor (VFGF) and basic fibroblast growth factor (bFGF) proteins in the conjunctiva tissue were detected by immunochemistry,and the expressions of VFGF mRNA and bFGF mRNA in the conjunctival tissue were determined by reverse transcription polymerase chain reaction (RT-PCR). Results The operative duration was (21.3±0.2) minutes in suture group and( 10.1 ±0.1 )minutes in the fibrin glue group with a significant difference between two groups( t =102.242,P＜0.05 ).From 1 week through 4 weeks,the hyperemiain degree was obviously slight in fibrin glue group compared with suture group.Immunochemistry showed that VEGF and bFGF proteins were expressed mainly in the cytoplasm of conjunctival epithelium layer.The positive response intensity was weaker in the fibrin glue group than in suture group 1 week and 4 weeks after operation.RT-PCR revealed that the expression level of VEGF mRNA was significantly lower in fibrin glue group than in suture group,and the VEGF mRNA was gradually decreased with the time lapse ( Fgroup =174.443,P =0.000 ; Ftime =231.459,P =0.000 ).The similar outcomes were found in the expression of bFGF mRNA(Fgroup=41.727,P=0.000;Ftime=55.417,P=0.000). Conclusions The use of fibrin glue can shorten the operation duration and reduce postoperation inflammatory reaction.The downregulation of VEGF and bFGF in tissue is the possible mechanism of remitting irritation sign,which allows a reduce of the recurrence rate of pterygia.
