本文選題：原發(fā)性開(kāi)角型青光眼 + 原發(fā)性閉角型青光眼��； 參考：《河北醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：青光眼是世界上最常見(jiàn)的致盲原因之一，是由多種因素引起的進(jìn)展性視神經(jīng)病變，具體機(jī)制尚不是很清楚。現(xiàn)在較公認(rèn)的是把青光眼按房角開(kāi)放程度分為原發(fā)性開(kāi)角型青光眼（primary open angle glaucoma，POAG）和原發(fā)性閉角型青光眼（primary angle-closure glaucoma，PACG）。人們對(duì)原發(fā)性閉角型青光眼的發(fā)病機(jī)制研究的比較清楚，而原發(fā)性開(kāi)角型青光眼的病因和發(fā)病機(jī)制較為復(fù)雜，一直是青光眼研究領(lǐng)域的重要問(wèn)題，但至今尚不完全清楚，隨著研究的深入，目前傾向于由于小梁細(xì)胞的形態(tài)和功能異常，導(dǎo)致房水流出受阻，眼壓升高所造成的，而青光眼視神經(jīng)損害的多因素綜合理論，包括機(jī)械學(xué)說(shuō)和血管血流學(xué)說(shuō)，并重視細(xì)胞凋亡和線粒體的作用，并且自身免疫反應(yīng)應(yīng)激機(jī)制可能產(chǎn)生直接損害視網(wǎng)膜細(xì)胞的抗體而發(fā)揮作用，隨后一些學(xué)者發(fā)現(xiàn)幽門螺桿菌作為病原體也參與了青光眼發(fā)病的過(guò)程，但其相關(guān)性由于不同學(xué)者的研究方法不同而有不同的結(jié)論，具體作用機(jī)制目前仍不是很清楚，仍需進(jìn)一步研究。幽門螺桿菌為革蘭陰性、微需氧鏈球菌，病理學(xué)和臨床研究均明確了幽門螺桿菌在慢性胃炎和消化道潰瘍的作用機(jī)制以及作為胃癌的危險(xiǎn)因素，幽門螺桿菌感染引起胃部疾病的嚴(yán)重性及最終的臨床結(jié)果由宿主、菌株及細(xì)菌毒力共同決定。除胃部疾病，幽門螺桿菌還與心腦血管疾病、血液系統(tǒng)疾病、和自身免疫性疾病如干燥綜合癥、免疫性血小板減少性紫癜等胃腸道以外疾病相關(guān)聯(lián)。Kountouras等最先報(bào)道在希臘人群中青光眼幽門螺桿菌感染率明顯高于正常對(duì)照組，推測(cè)幽門螺桿菌感染可能與青光眼的發(fā)病機(jī)制相關(guān)聯(lián)。此外，還有多數(shù)學(xué)者通過(guò)不同的研究方法得出相同的結(jié)論，然而，也有學(xué)者通過(guò)研究認(rèn)為它們之間沒(méi)有相關(guān)性。我們的研究在于比較本地區(qū)原發(fā)性開(kāi)角型青光眼、原發(fā)性閉角型青光以及白內(nèi)障患者房水和血清中幽門螺桿菌IgG抗體的水平，以此來(lái)探討幽門螺桿菌感染是否與原發(fā)性開(kāi)角型青光眼有關(guān)聯(lián)，借以探索青光眼的發(fā)病機(jī)制，從而為臨床治療提供指導(dǎo)意見(jiàn)和理論依據(jù)。 方法：本實(shí)驗(yàn)患者來(lái)源于2010年11月到2011年8月在河北醫(yī)大二院眼科及邢臺(tái)眼科醫(yī)院住院治療的原發(fā)性開(kāi)角型青光眼患者，于同期在河北醫(yī)大二院住院治療的原發(fā)性閉角型青光眼和單純白內(nèi)障患者。在青光眼患者小梁切除手術(shù)進(jìn)入前房之前收集25例25眼原發(fā)性開(kāi)角型青光眼（POAG組）、30例30眼原發(fā)性閉角型青光眼（PACG組）；在白內(nèi)障超聲乳化吸除術(shù)行角膜切口之前收集33例33眼單純老年性白內(nèi)障患者（正常對(duì)照組）房水約0.06ml，放入-70°C的冰箱保存，并與手術(shù)同一天采集患者靜脈血3ml，離心，4000轉(zhuǎn)/分，十分鐘，獲得血清放入-70°C的冰箱保存，20-25天之內(nèi)應(yīng)用膠體金標(biāo)記免疫斑點(diǎn)滲濾法測(cè)定88例患者房水和血清幽門螺桿菌IgG抗體的陽(yáng)性率。用SPSS13.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析，三組中計(jì)量資料均數(shù)的比較采用方差分析，幽門螺桿菌陽(yáng)性率用卡方檢驗(yàn)進(jìn)行分析。 結(jié)果：本研究共收集血清和房水各88例，原發(fā)性開(kāi)角型青光眼組病例25例25眼；原發(fā)性閉角型青光眼組病例30例30眼；單純性白內(nèi)障組病例33例33眼，三組之間平均年齡和性別分別應(yīng)用方差分析和卡方檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)分析，，三組人口構(gòu)成比之間差異不顯著，青光眼各組之間平均光敏度缺損差異不顯著，青光眼各組平均眼內(nèi)壓明顯高于正常對(duì)照組，具有統(tǒng)計(jì)學(xué)意義，而青光眼各組之間無(wú)明顯差別。19/25（76%）的原發(fā)性開(kāi)角型青光眼組患者，13/30(43.3%)原發(fā)性閉角型青光眼組患者,10/33(30.3%)單純性白內(nèi)障組患者血清中檢測(cè)到幽門螺桿菌IgG抗體,各組之間應(yīng)用χ2檢驗(yàn)進(jìn)行比較，原發(fā)性開(kāi)角型青光眼組明顯高于原發(fā)性閉角型青光眼組和單純性白內(nèi)障組患者，有統(tǒng)計(jì)學(xué)意義(分別為P=0.014，P=0.001)，而原發(fā)性閉角型青光眼組和單純性白內(nèi)障組患者之間差異不顯著，無(wú)統(tǒng)計(jì)學(xué)意義(P=0.283)。6/25（24%）的原發(fā)性開(kāi)角型青光眼組患者，7/30(23.3%)原發(fā)性閉角型青光眼組患者,7/33(21.2%)單純性白內(nèi)障組患者房水中檢測(cè)到幽門螺桿菌IgG抗體，應(yīng)用χ2檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)分析，認(rèn)為三組房水之間差異不顯著（P=0.964），無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論：雖然原發(fā)性開(kāi)角型青光眼組，原發(fā)性閉角型青光眼組，單純性白內(nèi)障組房水中幽門螺桿菌IgG抗體陽(yáng)性率沒(méi)有明顯差異性，但是原發(fā)性開(kāi)角型青光眼組血清中幽門螺桿菌IgG抗體明顯高于其他兩組，可能由于我們的實(shí)驗(yàn)試劑以及房水中幽門螺桿菌IgG抗體滴度比血清低的原因，因此我們認(rèn)為幽門螺桿菌感染可能是原發(fā)性開(kāi)角型青光眼的危險(xiǎn)因素之一，并且在促進(jìn)原發(fā)性開(kāi)角型青光眼的發(fā)生和進(jìn)展中發(fā)揮一定的作用。同時(shí)我們還需要在大量青光眼人群中根據(jù)臨床表現(xiàn)和客觀檢查進(jìn)一步研究驗(yàn)證幽門螺桿菌的存在是否會(huì)影響青光眼視神經(jīng)病變的發(fā)展。
[Abstract]:Objective: glaucoma is one of the most common causes of blindness in the world. It is a progressive optic neuropathy caused by a variety of factors. The specific mechanism is not yet clear. It is now recognized that glaucoma is divided into primary open angle glaucoma (primary open angle glaucoma, POAG) and primary angle closure glaucoma (PRI). Mary angle-closure glaucoma, PACG). People are quite clear about the pathogenesis of primary angle closure glaucoma, and the etiology and pathogenesis of primary open angle glaucoma are more complex. It has been an important problem in the field of glaucoma research. But it is not completely clear now. With the further research, it is inclined to be the trabecula. The morphological and functional abnormalities of the cells, resulting in the obstruction of the aqueous humor and the increase of intraocular pressure, and the multifactor theory of glaucomatous optic nerve damage, including the theory of mechanical and vascular blood flow, and the importance of apoptosis and the role of mitochondria, and the mechanism of autoimmune reaction may produce direct damage to retinal cells. Some scholars have found that Helicobacter pylori has also been involved in the pathogenesis of glaucoma, but its relevance has different conclusions due to different research methods of different scholars. The specific mechanism is still not very clear and still needs further research. Helicobacter pylori is a gram negative, microaerobic chain ball. The mechanism of Helicobacter pylori in chronic gastritis and alimentary tract ulcers and the risk factors of gastric cancer, the severity of Helicobacter pylori infection caused by Helicobacter pylori infection and the final clinical results are determined by the host, strain and bacterial virulence. Vascular disease, blood system disease, and autoimmune diseases such as Sjogren syndrome, immune thrombocytopenic purpura, and other gastrointestinal diseases associated with.Kountouras, the first reported in the Greek population of Helicobacter pylori infection rate is significantly higher than the normal control group, it is presumed that Helicobacter pylori infection may be associated with the hair of glaucoma. In addition, many mathematicians come to the same conclusion by different methods of study. However, some scholars have also found that there is no correlation between them. Our study is to compare the primary open angle glaucoma in the region, the primary angle closure, and the aqueous and serum pyloric screw in the patients with cataract. The level of IgG antibody is used to investigate whether Helicobacter pylori infection is associated with primary open angle glaucoma, to explore the pathogenesis of glaucoma and to provide guidance and theoretical basis for clinical treatment.
Methods: primary open angle glaucoma patients were hospitalized in the second hospital of Hebei Medical University and Xingtai ophthalmology hospital from November 2010 to August 2011. Primary angle closure glaucoma and simple cataract patients were hospitalized in the second hospital of Hebei Medical University. Before trabeculectomy in glaucoma patients, the patients were treated with trabeculectomy. Before the room, 25 cases of 25 eyes primary open angle glaucoma (group POAG), 30 cases of 30 eyes with primary angle closure glaucoma (group PACG) were collected. Before the cataract phacoemulsification, 33 cases of 33 eyes of simple senile cataract patients (normal control group) were collected before the corneal incision, and the aqueous humor of the normal control group was about 0.06ml, and -70 degree C was stored in the refrigerator, and the day was collected on the same day with the operation. The patient's venous blood was 3ml, centrifuge, 4000 turns / minutes, ten minutes, and the serum was stored in the refrigerator of -70 C. The positive rate of IgG antibody in aqueous humor and sera Helicobacter pylori was measured by colloidal gold labeling immuno filtration method within 20-25 days. The statistical analysis was carried out by SPSS13.0 software, and the comparison of the data in the three groups was compared. The positive rate of Helicobacter pylori was analyzed by chi square test.
Results: 88 cases of serum and aqueous humor were collected, 25 cases of primary open angle glaucoma group were 25 eyes, 30 cases were 30 eyes of primary angle closure glaucoma group, 33 cases of simple cataract group were 33 eyes, and the average age and sex between three groups were analyzed statistically by variance analysis and chi square test, and the three groups were composed of population. There was no significant difference in the average light sensitivity difference between each group. The average intraocular pressure in each group was significantly higher than that of the normal control group. There was no significant difference between the groups of glaucoma groups and.19/25 (76%) of primary open angle glaucoma group, and 13/30 (43.3%) primary angle closure glaucoma group. The IgG antibody of Helicobacter pylori was detected in the serum of 10/33 (30.3%) simple cataract group. The x 2 test was used for comparison among the groups. The primary open angle glaucoma group was significantly higher than the primary angle closure glaucoma group and the simple cataract group. It was statistically significant (P=0.014, P=0.001, respectively). There was no significant difference between the patients in the light eye group and the simple cataract group. There was no statistical significance (P=0.283).6/25 (24%) primary open angle glaucoma group, 7/30 (23.3%) primary angle closure glaucoma group, and 7/33 (21.2%) simple cataract group with IgG antibody of Helicobacter pylori detected by Fang Shuizhong, and the x 2 test was used to make statistics Analysis showed that there was no significant difference between the three groups (P=0.964).
Conclusion: Although there is no significant difference in the positive rate of Helicobacter pylori IgG antibody in primary angle closure glaucoma group, primary angle closure glaucoma group and simple cataract group, the IgG antibody of Helicobacter pylori in serum of primary open angle glaucoma group is significantly higher than that of other two groups, which may be due to our experimental reagent and room. We think that Helicobacter pylori infection may be one of the risk factors for primary open angle glaucoma, and it may play a role in the development and progression of primary open angle glaucoma, and we also need to be in the presence of a large number of glaucoma people. We also need to be on the basis of a large number of glaucoma people in the water. Further studies on bed performance and objective examination confirm whether the presence of Helicobacter pylori affects the development of glaucomatous optic neuropathy.

【學(xué)位授予單位】：河北醫(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)】：R775

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2 記者 于菲;三招除幽門螺桿菌[N];醫(yī)藥養(yǎng)生保健報(bào);2009年

3 李鑫;幽門螺桿菌——胃內(nèi)的隱形殺手[N];中國(guó)醫(yī)藥報(bào);2010年

4 任海軍;西藍(lán)花嫩芽抑制幽門螺桿菌[N];中國(guó)中醫(yī)藥報(bào);2009年

5 文/徐天景（副主任醫(yī)師）;可惡的幽門螺桿菌[N];上海中醫(yī)藥報(bào);2002年

6 武和平;幽門螺桿菌是如何傳播的[N];文匯報(bào);2003年

7 香港麥迪信醫(yī)學(xué)出版有限公司供稿;拯救幽門螺桿菌！[N];醫(yī)藥經(jīng)濟(jì)報(bào);2003年

8 李增烈;幽門螺桿菌劣跡斑斑[N];大眾衛(wèi)生報(bào);2004年

9 記者 盧文潔 通訊員 朱素穎 王薇;大人嬰兒同睡 易感染幽門螺桿菌[N];廣州日?qǐng)?bào);2004年

10 山西中醫(yī)學(xué)院教授 李殊響;幽門螺桿菌不僅害胃還傷身[N];健康報(bào);2001年

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1 劉爽;幽門螺桿菌σ~（54）調(diào)節(jié)穩(wěn)定期細(xì)菌存活及硫代蒜素抗菌的機(jī)制研究[D];山東大學(xué);2010年

2 衣常紅;異常糖基化修飾IgG的實(shí)驗(yàn)診斷價(jià)值和病理意義研究[D];第二軍醫(yī)大學(xué);2012年

3 趙英會(huì);IFN-γ對(duì)幽門螺桿菌和胃黏膜細(xì)胞作用及其機(jī)制的初步探討[D];山東大學(xué);2011年

4 王廣;幽門螺桿菌熱休克蛋白60與冠狀動(dòng)脈粥樣硬化關(guān)系的研究[D];吉林大學(xué);2010年

5 袁文臻;抗幽門螺桿菌治療對(duì)糾正H.pylori陽(yáng)性患者缺鐵性貧血的系統(tǒng)評(píng)價(jià)[D];蘭州大學(xué);2010年

6 宋春芳;幽門螺桿菌相關(guān)性胃疾病凋亡特性及其調(diào)控機(jī)制的研究[D];中國(guó)醫(yī)科大學(xué);2003年

7 張新;幽門螺桿菌干擾胃黏膜上皮核轉(zhuǎn)錄因子SOX2/Hath1表達(dá)機(jī)制的初步研究[D];第三軍醫(yī)大學(xué);2011年

8 胡小艷;貫葉連翹中二蒽酮類化合物免疫活性研究及其白蛋白-IgG抗體偶聯(lián)物的研制[D];中國(guó)農(nóng)業(yè)科學(xué)院;2012年

9 郝慶;幽門螺桿菌對(duì)克拉霉素耐藥的分子基礎(chǔ)[D];中國(guó)醫(yī)科大學(xué);2002年

10 邵春紅;幽門螺桿菌響應(yīng)環(huán)境脅迫的蛋白質(zhì)組學(xué)研究[D];山東大學(xué);2008年

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1 閆曉偉;本地區(qū)原發(fā)性青光眼患者房水與血清幽門螺桿菌IgG抗體的研究[D];河北醫(yī)科大學(xué);2012年

2 江月萍;PCR-RFLP方法鑒定慢性胃炎、胃癌幽門螺桿菌基因分型[D];青島大學(xué);2001年

3 李惠影;抗幽門螺桿菌治療消化性潰瘍的臨床研究[D];吉林大學(xué);2005年

4 邵春紅;幽門螺桿菌適應(yīng)性蛋白的初步研究[D];山東大學(xué);2005年

5 萬(wàn)榮;幽門螺桿菌耐藥性及其臨床意義[D];江西醫(yī)學(xué)院;2000年

6 王寧;表達(dá)幽門螺桿菌鞭毛粘附素的重組大腸桿菌ghost型疫苗的制備及鑒定[D];第三軍醫(yī)大學(xué);2005年

7 陸志瑛;1500例上消化道疾病患者幽門螺桿菌耐藥率分析[D];浙江大學(xué);2008年

8 劉淼;幽門螺桿菌vacA基因毒性片段與hpaA基因的原核表達(dá)及初步應(yīng)用[D];重慶醫(yī)科大學(xué);2003年

9 江花;潰寧口服液抑殺幽門螺桿菌的實(shí)驗(yàn)研究[D];成都中醫(yī)藥大學(xué);2003年

10 吳小茜;幽門螺桿菌oipA DNA疫苗的免疫保護(hù)作用研究[D];福建醫(yī)科大學(xué);2005年

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