【摘要】：目的：激光角膜切削術(shù)在全世界已有三十余年的發(fā)展歷程，準(zhǔn)分子激光原位角膜磨鑲術(shù)(LASIK)在我國(guó)也有近二十年的發(fā)展，LASIK手術(shù)由于手術(shù)時(shí)間短、恢復(fù)時(shí)間快、術(shù)后疼痛輕、術(shù)后反應(yīng)少、術(shù)后安全及穩(wěn)定性強(qiáng)等優(yōu)點(diǎn)，在眼科醫(yī)師中被公認(rèn)為矯正各種屈光不正理想的，在臨床工作中應(yīng)用前景最廣的一種手術(shù)。而LASIK手術(shù)后角膜創(chuàng)傷愈合反應(yīng)機(jī)制是研究預(yù)測(cè)術(shù)后臨床效果的重要環(huán)節(jié)。角膜創(chuàng)傷修復(fù)是一個(gè)極其復(fù)雜而又高度協(xié)調(diào)的過程，此過程基本上可以分為局部的炎癥反應(yīng)、細(xì)胞的增殖分化和組織的修復(fù)重建三個(gè)互不相同而又相互交錯(cuò)的階段。在這一過程中涉及了多種生長(zhǎng)因子和細(xì)胞因子之間的相互作用及相互影響，它們共同參與調(diào)控細(xì)胞的遷移、增生、分化、基質(zhì)沉積以及組織塑形等多個(gè)反應(yīng)。各種細(xì)胞因子與生長(zhǎng)因子的作用貫穿了整個(gè)角膜的創(chuàng)傷愈合的全過程形成一個(gè)有機(jī)的網(wǎng)絡(luò)體系。深入探討了解各種細(xì)胞因子和生長(zhǎng)因子在LASIK術(shù)后角膜傷口愈合中的作用，對(duì)于理解LASIK術(shù)后角膜傷口愈合反應(yīng)的調(diào)控機(jī)制，獲得LASIK術(shù)后更好的臨床預(yù)后效果具有重大的指導(dǎo)意義。 本試驗(yàn)通過對(duì)LASIK手術(shù)前后淚液中與角膜關(guān)系密切的肝細(xì)胞生長(zhǎng)因子（HGF）含量的定量分析，，探討肝細(xì)胞生長(zhǎng)因子在LASIK手術(shù)前后患者淚液中短期內(nèi)濃度變化規(guī)律及它在LASIK術(shù)后角膜傷口愈合中的作用。 方法：隨機(jī)收集2011年4月至2011年7月于我院行LASIK手術(shù)患者30人60眼(男：女比例1：1)的淚液標(biāo)本，用雙抗體夾心酶聯(lián)免疫吸附法（ELISA法）檢測(cè)LASIK術(shù)前、術(shù)后1天、3天、1周、2周、1個(gè)月患者淚液標(biāo)本中HGF表達(dá)量的變化，用統(tǒng)計(jì)學(xué)方法對(duì)不同時(shí)間淚液中細(xì)胞因子平均濃度進(jìn)行相關(guān)性分析。 結(jié)果：所有患者60只眼在LASIK手術(shù)術(shù)前至術(shù)后1個(gè)月的隨訪期間，術(shù)后1天（775.42±96.96）pg/ml、3天（612.38±80.72）pg/ml、1周（390.25±121.68）pg/ml、2周（253.52±45.69）pg/ml淚液中的HGF表達(dá)量均較術(shù)前HGF表達(dá)量（199.12±25.46）pg/ml明顯提高(P0．05），特別是術(shù)后1天和3天較術(shù)前提高顯著（P0．01）。但術(shù)后1個(gè)月（200.75±31.46）pg/ml與術(shù)前比較無統(tǒng)計(jì)學(xué)差異(P0．05）。 結(jié)論：LASIK術(shù)后淚液中HGF含量存在著一個(gè)由升高到降至術(shù)前水平的短期動(dòng)態(tài)變化過程，這一結(jié)果提示在LASIK術(shù)后淚液中由淚腺和角膜成纖維細(xì)胞分泌的HGF含量增加，可能發(fā)揮了對(duì)角膜損傷反應(yīng)中的上調(diào)作用，促進(jìn)細(xì)胞分裂增殖及遷移等生物學(xué)效應(yīng)作用，參與了LASIK術(shù)后角膜傷口愈合的早期過程。
[Abstract]:Objective: laser keratectomy has been developed for more than 30 years in the world. Excimer laser in situ keratomileusis (LASIK) has been developed in China for nearly 20 years. It has the advantages of less reaction, better safety and stability after operation. It is recognized as the most widely used surgery in clinical work for the correction of all kinds of ametropia among ophthalmologists. The mechanism of corneal wound healing after LASIK is an important link in predicting the clinical effect. Corneal wound repair is an extremely complex and highly coordinated process, which can be divided into three stages: local inflammatory response, cell proliferation and differentiation, and tissue repair and reconstruction. The interaction and interaction of various growth factors and cytokines are involved in this process, and they are involved in the regulation of cell migration, proliferation, differentiation, matrix deposition and tissue remodeling. The effects of cytokines and growth factors throughout the corneal wound healing process form an organic network system. To understand the role of cytokines and growth factors in corneal wound healing after LASIK is of great significance in understanding the mechanism of corneal wound healing response after LASIK and obtaining a better clinical prognosis after LASIK. The content of hepatocyte growth factor (HGF), which is closely related to cornea, was determined by quantitative analysis before and after LASIK operation. Objective: to investigate the changes of hepatocyte growth factor (HGF) concentration in tear before and after LASIK operation and its role in corneal wound healing after LASIK. Methods: from April 2011 to July 2011, 60 eyes (60 eyes) of 30 patients undergoing LASIK operation in our hospital were randomly collected. Double antibody sandwich enzyme linked immunosorbent assay (ELISA) was used to detect LASIK before operation. The changes of HGF expression in tear samples were analyzed by statistical method. The mean concentrations of cytokines in tears at different times were analyzed by statistical method. Results: 60 eyes of all patients were followed up for 1 month after LASIK operation. The expression of HGF in tears of (775.42 鹵96.96) PG / ml (612.38 鹵80.72) PG / ml for 1 week (390.25 鹵121.68) PG / ml for 2 weeks (253.52 鹵45.69) pg/ml was significantly higher than that for preoperative (199.12 鹵25.46) pg/ml (P0.05), especially on the 1st and 3rd day after operation (P0.01). But 1 month after operation (200.75 鹵31.46) pg/ml had no statistical difference compared with preoperative (P0.05). Conclusion there is a short period of dynamic change of HGF content in tear after W1 LASIK, which indicates that the content of HGF secreted by lacrimal gland and corneal fibroblasts in tear after LASIK is increased. It may play a role in the up-regulation of corneal injury response, promote cell division, proliferation and migration, and participate in the early process of corneal wound healing after LASIK.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R779.63

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