本文選題：脈絡(luò)膜　切入點(diǎn)：循環(huán)障礙　出處：《北京協(xié)和醫(yī)學(xué)院》2017年博士論文　論文類型：學(xué)位論文

【摘要】：[背景]厚脈絡(luò)膜疾病是以脈絡(luò)膜結(jié)構(gòu)、功能改變?yōu)楹诵牟±砩頇C(jī)制所致的一系列疾病,其主要特征為脈絡(luò)膜大血管的擴(kuò)張。近來的研究認(rèn)為息肉狀脈絡(luò)膜血管病變等疾病屬于厚脈絡(luò)膜疾病譜,脈絡(luò)膜血管擴(kuò)張與厚脈絡(luò)膜疾病的病理機(jī)制尚不明確,有研究認(rèn)為這些改變可能繼發(fā)于脈絡(luò)膜靜脈充血。渦靜脈是脈絡(luò)膜血液的主要回流靜脈,研究表明,阻斷渦靜脈血流會(huì)導(dǎo)致脈絡(luò)膜循環(huán)障礙,但渦靜脈阻斷后脈絡(luò)膜厚度與結(jié)構(gòu)變化的研究鮮有。脈絡(luò)膜循環(huán)障礙情況下眼內(nèi)炎癥-免疫環(huán)境的變化的研究也處于空白。[目的]通過結(jié)扎食蟹猴渦靜脈,建立脈絡(luò)膜循環(huán)障礙模型,初步探索脈絡(luò)膜循環(huán)障礙情況下脈絡(luò)膜厚度和結(jié)構(gòu)的變化,及其對(duì)眼內(nèi)免疫-炎癥環(huán)境的影響。[方法]1.8只食蟹猴被隨機(jī)平均分為A、B兩組,每只猴隨機(jī)選擇一眼為實(shí)驗(yàn)眼,對(duì)側(cè)眼為對(duì)照眼。通過結(jié)扎顳上與顳下象限渦靜脈(A組)或僅結(jié)扎顳下象限渦靜脈(B組)建立脈絡(luò)膜循環(huán)障礙模型。通過EDI-OCT采集模型猴手術(shù)眼及對(duì)照眼術(shù)前、術(shù)后1天、術(shù)后1周、術(shù)后4周、術(shù)后8周及術(shù)后12周黃斑及視盤顳上、顳下、鼻上、鼻下四象限脈絡(luò)膜圖像。測(cè)量黃斑中心凹下及距離視盤顳上、顥下、鼻上、鼻下四象限3800 μm處脈絡(luò)膜厚度。利用Image J軟件對(duì)圖像進(jìn)行黑白化處理,計(jì)算脈絡(luò)膜血管指數(shù)。2.采集A、B兩組猴雙眼術(shù)前、術(shù)后1周、術(shù)后4周、術(shù)后8周及術(shù)后12周房水,利用LuminexTM xMAPTM檢測(cè)平臺(tái)檢測(cè)房水中炎癥因子、趨化因子、生長因子三類共計(jì)29種細(xì)胞因子濃度。3.采用SPSS22.0統(tǒng)計(jì)軟件包,使用配對(duì)t檢驗(yàn)和單因素方差分析方法對(duì)數(shù)據(jù)進(jìn)行分析,P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。[結(jié)果]1.猴術(shù)前各檢查位置(黃斑中心凹下,視盤顳上、顳下、鼻上、鼻下四象限觀察點(diǎn))手術(shù)眼與對(duì)照眼脈絡(luò)膜厚度、脈絡(luò)膜血管指數(shù)差異無統(tǒng)計(jì)學(xué)意義。結(jié)扎顳上、顳下兩個(gè)象限渦靜脈后,手術(shù)眼顳上象限脈絡(luò)膜在術(shù)后1天(P=0.025)、術(shù)后4周(P=0.013)顯著厚于對(duì)照眼;手術(shù)眼視盤鼻上(P=0.016)、鼻下(P0.045)象限脈絡(luò)膜在術(shù)后12周厚于對(duì)照眼。手術(shù)眼顳上象限脈絡(luò)膜厚度在術(shù)后8周內(nèi)較術(shù)前顯著增加(術(shù)后1天P=0.008;術(shù)后1周P=0.007;術(shù)后4周P=0.032;術(shù)后8周P=0.044),手術(shù)眼黃斑中心凹下脈絡(luò)膜厚度術(shù)后1天較術(shù)前顯著增加(P=0.022)。結(jié)扎顳下象限渦靜脈,手術(shù)眼僅視盤顳上象限脈絡(luò)膜在術(shù)后1周顯著厚于對(duì)照眼(P=0.007)。結(jié)扎顳上、顳下兩個(gè)象限渦靜脈后,手術(shù)眼視盤鼻上象限CVI在術(shù)后8周顯著大于對(duì)照眼(P=0.027)。手術(shù)眼視盤顳上象限CVI術(shù)后4周(P=0.033)、術(shù)后8周(P=0.035)顯著高于術(shù)前。僅結(jié)扎顳下象限渦靜脈,手術(shù)眼與對(duì)照眼各時(shí)期各觀察點(diǎn)CVI無顯著變化。2.結(jié)扎顳上、顳下兩個(gè)象限渦靜脈后,術(shù)后1周實(shí)驗(yàn)眼房水中I-TAC濃度低于對(duì)照眼(P=0.006);術(shù)后4周時(shí)實(shí)驗(yàn)眼房水中1L-2濃度高于對(duì)照眼(P=0.047)。僅結(jié)扎顳下象限渦靜脈,術(shù)后12周時(shí)實(shí)驗(yàn)眼房水中IL-12濃度低于對(duì)照眼(P=0.022)。[結(jié)論]1.猴渦靜脈阻斷可引起相應(yīng)區(qū)域脈絡(luò)膜增厚,慢性期可被逐步代償并引起代償區(qū)域脈絡(luò)膜厚度變化。脈絡(luò)膜血管指數(shù)測(cè)量重復(fù)性好,可作為分析脈絡(luò)膜血管結(jié)構(gòu)的重要參數(shù)。阻斷渦靜脈可導(dǎo)致局部脈絡(luò)膜血管指數(shù)升高。猴眼脈絡(luò)膜渦靜脈系統(tǒng)具有較強(qiáng)自調(diào)節(jié)能力。2.脈絡(luò)膜循環(huán)障礙可引起房水內(nèi)I-TAC、IL-2及IL-12表達(dá)水平變化,眼內(nèi)炎癥-免疫環(huán)境基本處于穩(wěn)定狀態(tài)。
[Abstract]:[background] thick choroidal disease is choroid structure, function change for a series of diseases caused by the core pathophysiologic mechanism, the main features of choroidal vascular expansion. Recent studies suggested that polypoidal choroidal vasculopathy and other diseases are thick choroidal disease spectrum, pathological mechanism of choroidal vascular dilatation and the thickness of choroidal diseases is not clear, studies have suggested that these changes may be secondary to choroidal venous congestion. The vortex vein is the main venous return, choroidal blood studies show that blocking the vortex vein flow may induce choroidal circulation, but few studies of vortex vein occlusion of choroidal thickness and structure changes of context. Study on changes of intraocular circulation barrier membrane inflammation immune environment is also blank. Objective] by ligation of the cynomolgus monkey vortex vein, establish the choroidal circulation model, a preliminary exploration of choroidal circulation 鐜殰紕嶆儏鍐典笅鑴夌粶鑶滃帤搴﹀拰緇撴瀯鐨勫彉鍖，

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