結膜瓣遮蓋治療角膜堿燒傷中PMNs浸潤的變化

宋東宇，高明宏，崔珊珊

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·實驗研究·

結膜瓣遮蓋治療角膜堿燒傷中PMNs浸潤的變化

宋東宇1，高明宏2，崔珊珊1

1Department of Ophthalmology,Chaoyang Central Hospital,Chaoyang 110016,Liaoning Province,China;2Department of Ophthalmology,the General Hospital of Shenyang Military Command,Shenyang 110016,Liaoning Province,China

Abstract

?AIM: To study the infiltration of polymorphonuclear neutrophils (PMNs) after conjunctival flap covering in alkali-burned cornea.

?METHODS: Rabbit cornea alkali-burned model was made,then 50 rabbits were randomly divided into the experimental group (n=25) and the control group (n=25).At the same time the surgery of conjunctival flap covering was given to rabbits of the experimental group.The condition developing of alkali-burned cornea was observed by slit lamp biomicroscopy,and took photos in two groups.The infiltration of PMNs was identified by hematoxylin eosin (HE) staining in different periods.

?RESULTS:The quantity of PMNs increased on the 3d,reached the lower level on 7d,shown a peak on the 14d,then decreased gradually.PMNs level of the experimental group was significantly lower than that in the control group,and the difference of 3,14 and 21d was significant (P<0.05).

?CONCLUSION: During the wound healing process,alkali-burned cornea has close relation with the infiltration of PMNs.The treatment of conjunctival flap covering for the severe alkali-burned cornea was found to have good effect.

目的：研究結膜瓣遮蓋術治療角膜堿燒傷的療效及損傷修復中多形核中性白細胞(polymorphonuclear neutrophils，PMNs)的浸潤情況。

方法：選取50只兔，隨機分為兩組，每組25只，即實驗組和對照組，并建立兔角膜堿燒傷模型。實驗組在角膜堿燒傷后當天行結膜瓣遮蓋術。裂隙燈下觀察兩組角膜病損恢復情況并照相。采用蘇木素-伊紅(HE)染色切片后測定兩組角膜堿燒傷后不同時間點PMNs的浸潤量值。

結果：PMNs在角膜堿燒傷后的3d開始升高，大量浸潤角膜，7d略有下降，14d上升達到最大峰值，之后逐漸降低，早期分布在燒傷部位角膜基質內，后期則與潰瘍浸潤面積相一致。實驗組PMNs的計數均明顯低于對照組，且角膜堿燒傷后的3、14和21d的差異有統計學意義(P<0.05)。結論：結膜瓣遮蓋治療重度角膜堿燒傷的療效確切，角膜的病理損傷和修復與PMNs的浸潤密切相關。

結膜瓣；角膜堿燒傷；多形核中性白細胞

引用：宋東宇，高明宏，崔珊珊.結膜瓣遮蓋治療角膜堿燒傷中PMNs浸潤的變化.國際眼科雜志2016;16(10):1824-1827

0　引言

角膜堿燒傷是一種病損較重且難以治療的化學性眼外傷，由于堿能溶解脂肪和蛋白質，易于浸潤至角膜深層，造成嚴重的角膜潰瘍溶解，期間發生了復雜的炎性反應，導致大量多形核中性白細胞(polymorphonuclear neutrophils，PMNs)浸潤，進而導致眾多損傷因子、蛋白酶類破壞角膜組織。在治療中，角膜堿燒傷后損傷修復的機制復雜，如何抑制炎癥反應，如何認識炎癥反應在角膜損傷中的分子機制，尚需研究。本實驗通過在體動物角膜模型的建立，探究結膜瓣遮蓋治療角膜堿燒傷的手術療效及 PMNs在損傷修復過程中的浸潤時相，為臨床治療提供理論基礎。……