CAJ | 학술논문

目的研究纤溶酶联合透明质酸酶诱导药物性玻璃体切割术的发生机制.方法新西兰白兔24只,分为6组,采用玻璃体腔内注射药物0.1mL.A、B、C组分别注射纤溶酶4、2、1μmol/L;D组:纤溶酶1μmol/L+透明质酸酶20μmol/L;E组:透明质酸酶20μmol/L;F组:BSS溶液0.1mL为对照组.7d后免疫胶体金电镜技术检测玻璃体视网膜界面层粘连蛋白(LN)、纤维连接蛋白(FN)抗体分布.另取7只白兔(14只眼)进行纤溶酶活性测定,组1:一侧眼玻璃体腔内注射纤溶酶1μmol/L+透明质酸酶20μmol/L;组2:对侧眼玻璃体腔内注射纤溶酶1μmol/L.结果免疫胶体金电镜检测视网膜内界膜表面LN、FN显示,A、B、C、D组与对照组比较LN数量减少,差异均有统计学意义(P＜0.01),E组与对照组比较LN数量减少,差异无统计学意义(P＞0.05).FN免疫胶体金电镜结果与LN相似.纤溶酶1μmol/L组在药物注射后1h内维持最大纤溶酶活性,此后酶活性逐渐下降,12h后酶活性消失,D组纤溶酶活性曲线和C组走向基本一致.结论药物性玻璃体切割术的实质是溶解玻璃体视网膜界面的LN、FN等分子胶而发生玻璃体后脱离(PVD),透明质酸酶联合纤溶酶可显著提高PVD的效果,提示合理诱发PVD的药物应既能解除玻璃体视网膜界面之间的粘连,又能液化玻璃体.
목적 연구섬용매연합투명질산매유도약물성파리체절할술적발생궤제.방법 신서란백토24지,분위6조,채용파리체강내주사약물0.1mL.A、B、C조분별주사섬용매4、2、1μmol/L;D조:섬용매1μmol/L+투명질산매20μmol/L;E조:투명질산매20μmol/L;F조:BSS용액0.1mL위대조조.7d후면역효체금전경기술검측파리체시망막계면층점련단백(LN)、섬유련접단백(FN)항체분포.령취7지백토(14지안)진행섬용매활성측정,조1:일측안파리체강내주사섬용매1μmol/L+투명질산매20μmol/L;조2:대측안파리체강내주사섬용매1μmol/L.결과 면역효체금전경검측시망막내계막표면LN、FN현시,A、B、C、D조여대조조비교LN수량감소,차이균유통계학의의(P＜0.01),E조여대조조비교LN수량감소,차이무통계학의의(P＞0.05).FN면역효체금전경결과 여LN상사.섬용매1μmol/L조재약물주사후1h내유지최대섬용매활성,차후매활성축점하강,12h후매활성소실,D조섬용매활성곡선화C조주향기본일치.결론 약물성파리체절할술적실질시용해파리체시망막계면적LN、FN등분자효이발생파리체후탈리(PVD),투명질산매연합섬용매가현저제고PVD적효과,제시합리유발PVD적약물응기능해제파리체시망막계면지간적점련,우능액화파리체.
Background Many ophthalmologists have proved that the intravitreal injection of plasmin can safely induce posterior vitreous detachment(PVD),but if it can generate the complete PVD need further to seek confirmation.Researches showed that the safe dose and toxicity dose of dispase are very near,so its application is limited.Whether hyaluronidase can induce PVD is still in controversy.Objective This study is to clarity the mechanism of pharmacological vitreolysis with plasmin and hyaluronidase.Methods Plasmin 4μmol/L,2μmol/L and 1μmol/L,plasmin 1μmol/L+ hyaluronidase 20μmol/L,hyaluronidase alone were intravitreally injected in lateral eye of 4 clean New Zealand white rabbits respectively,and 0.1mL BSS was injected as control group.Electron immunocytochemical technique was used to detect the laminin and fibronectin of interface between vitreous and retina in 7 days after intravitreal injection.Other 14 eyes of 7 clean New Zealand white rabbits were used in this study.Plasmin 1μmol/L + hyaluronidase 20μmol/L was intravitreally injected in the lateral eyes,and only plasmin 1μmol/L was injected in the fellow eyes.Plasmin activity in vitreous was evaluated in 15 and 30 minutes,1 hour,2,3,6,12 hours after intravitreal injection.The use of animals followed the Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission.Results The amounts of laminin and fibronectin in the vitreoretinal interface were decreased in 4μmol/L plasmin group,2μmol/L plasmin group,1μmol/L plasmin group,1μmol/L plasmin+20μmol/L hyaluronidase group compared with control group(P＜0.01).No significant difference was seen in the density of gold particles of anti FN between 20μmol/L hyaluronidase group and control group (P＞0.05).The change of amounts of fibronectin in the vitreoretinal interface was similar to that of laminin.Plasmin activity remained the highest level 1 hour after injection and thereafter gradually decreased and extincted in 12 hours and presented the same trend between plasmin 1μmol/L+hyaluronidase 20μmol/L group and only plasmin 1μmol/L group.Conclusion The mechanism of pharmacological vitreolysis is to dissolve laminin and fibronectin in the interface between vitreous and retina and therefore induce PVD.Combination of plasmin with hyaluronidase can increase the efficiency of pharmacological vitreolysis.The optimum selection of drug in inducing PVD should consider not only its role of lysis laminin and fibronectin but also the role of liquefying the vitreous.