本文選題：新生血管性青光眼 + 色素上皮衍生因子　； 參考：《大連醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：新生血管性青光眼（nonvascular glaucoma, NVG）系虹膜表面及房角有新生血管,合并纖維血管膜形成,導(dǎo)致房角關(guān)閉進(jìn)而產(chǎn)生的一種繼發(fā)性青光眼。缺血和缺氧共同作用導(dǎo)致虹膜及房角新生血管的產(chǎn)生,其中包含了一系列的復(fù)雜病理過程。缺血缺氧既會引起新生血管促進(jìn)因子的釋放,同時也會引起血管生成抑制因子的產(chǎn)生,當(dāng)前者作用大于后者時,便會產(chǎn)生新生血管[1]。色素上皮衍生因子（pigment epithelium derived factor, PEDF）和血管內(nèi)皮生長因子(vascularendothelial growth factor, VEGF)被認(rèn)為是血管形成抑制因子和誘導(dǎo)因子的一對典型代表，本實驗通過檢測NVG患者血清與房水中PEDF和VEGF的水平，進(jìn)一步探索PEDF和VEGF對眼部新生血管的作用機制，為眼部新生血管的預(yù)防和治療提供新的思路；通過血清與房水中血管因子的相關(guān)性研究，試圖找到血清中能夠反應(yīng)房水中相關(guān)因子水平的指標(biāo)，進(jìn)而研究和建立能夠正確預(yù)測NVG發(fā)病及病情進(jìn)展情況的客觀指標(biāo)，為臨床的早期預(yù)測、評估病情和判斷預(yù)后提供相關(guān)的理論依據(jù)。 方法：選取NVG患者20例作為實驗組（A組），原發(fā)性慢性閉角型青光眼患者（B組）作為高眼壓對照組20例、老年性白內(nèi)障患者（C組）作為正常對照組20例。采集患者血清及房水標(biāo)本，通過雙抗體夾心酶聯(lián)免疫吸附試驗(enzyme-linked immuno sorbent assay, ELISA法)分別檢測血清與房水中PEDF、VEGF的水平。應(yīng)用SPSS18.0統(tǒng)計軟件處理數(shù)據(jù)，同組內(nèi)同一因子在血清及房水間的數(shù)據(jù)比較用獨立樣本t檢驗；不同組間的相同因子的比較用單因素方差分析（ANOVA）。相關(guān)性分析采用Pearson相關(guān)系數(shù)檢驗。 P＜0.05表示差異具有統(tǒng)計學(xué)意義。 結(jié)果：1.一般情況 A組：收集2011年3月至2012年3月在大連醫(yī)科大學(xué)附屬第二醫(yī)院眼科住院的NVG患者20例（20眼），其中男性11例（11眼），女9例（9眼）；右眼12例，左眼8例；年齡36.0歲-85.0歲，平均年齡66.16±15.12歲。術(shù)前眼壓范圍21-94mmHg，平均59.05±21.33mmHg。糖尿病性視網(wǎng)膜病變（DR）14例、視網(wǎng)膜中央靜脈阻塞（CRVO）2例、病因不明4例。 B組：同時期我科住院的原發(fā)性慢性閉角型青光眼患者，20例（20眼），其中男8例（8眼），女12例（12眼）；右眼10例，左眼10例；年齡49.0歲-76.0歲，，平均年齡60.00±8.96歲。術(shù)前眼壓范圍22-71mmHg，平均45.80±16.79mmHg。 C組：同時期我科住院的老年性白內(nèi)障患者，20例（20眼），其中男14例（14眼），女6例（6眼）；右眼9例，左眼11例；年齡48.0歲-76.0歲，平均年齡71.95±11.24歲。術(shù)前眼壓范圍10-21mmHg，平均15.90±2.05mmHg。 各組間年齡、性別、眼別差異無統(tǒng)計學(xué)意義（P＞0.05） 2. PEDF的水平 ①房水中PEDF水平：A組217.15±30.12pg/ml明顯低于B組460.85±1.86pg/ml和C組520.10±9.59pg/ml，三組間兩兩比較，差異均具有統(tǒng)計學(xué)意義（F=155.01,P＜0.05）。 ②血清中PEDF水平：A組12.65±7.66mg/L、B組15.20±2.70mg/L和C組13.35±4.21mg/L，三組間兩兩比較，差異均不具有統(tǒng)計學(xué)意義（P＞0.05）。 3. VEGF的水平 ①房水中VEGF水平： A組1481.69±88.15pg/ml明顯高于B組300.98±53.71pg/ml和C組180.23±15.01pg/ml，三組間兩兩比較，差異均具有統(tǒng)計學(xué)意義（F=1.63, P＜0.05）。 ②血清中VEGF水平：A組98.63±6.83pg/ml明顯低于B組279.61±94.02pg/ml和C組142.05±34.99pg/ml，三組間兩兩比較，差異均具有統(tǒng)計學(xué)意義（F=2.66,P＜0.05）。 4.NVG患者房水與血清中PEDF水平的比較 A組患者房水中PEDF的水平低于血清中，差異具有統(tǒng)計學(xué)意義（t=7.170，P＜0.05）,但各組房水中PEDF濃度與相應(yīng)血清中的含量無顯著的相關(guān)性（P＞0.05）。 5.NVG患者房水與血清中VEGF水平的比較 NVG組患者房水中VEGF的水平明顯高于血清中，差異具有統(tǒng)計學(xué)意義（t=-20.445，P＜0.05），但各組房水中VEGF濃度與相應(yīng)血清中的含量無顯著的相關(guān)性（P＞0.05）。6.三組房水中PEDF與VEGF水平的相關(guān)性 三組房水中PEDF與VEGF水平呈負(fù)相關(guān)性，差異具有統(tǒng)計學(xué)意義（r=-0.67，r=-0.58，r=-0.47，P＜0.05）。 結(jié)論：1.NVG患者虹膜新生血管形成可能與房水中PEDF水平降低、 VEGF水平升高有關(guān)。 2. PEDF和VEGF分別作為血管抑制因子和血管刺激因子，可能是促成NVG發(fā)生的重要因素。
[Abstract]:Objective: nonvascular glaucoma (NVG) is a secondary glaucoma caused by the formation of the iris surface and the angle of the atrial angle with the formation of the fibrous vascular membrane, resulting in the closure of the corner of the room. The joint action of ischemia and hypoxia leads to the production of the iris and the angle new blood tube, which contains a series of complicated pathological changes. Ischemia and hypoxia can cause the release of new vascular promoting factors, and also cause the production of angiogenesis inhibitors. When the current role is greater than that of the latter, the [1]. pigment epithelium derived factor (pigment epithelium derived factor, PEDF) and vascular endothelial growth factor (vascularendothelial growth factor) will be produced. VEGF) is considered to be a typical representative of angiogenesis inhibitors and inducible factors. By detecting the level of PEDF and VEGF in NVG patients' serum and aqueous humor, this experiment further explores the mechanism of PEDF and VEGF on ocular neovascularization, providing new ideas for the prevention and treatment of neovascularization of the eyes; and through serum and blood blood. In order to find out the indicators that can reflect the level of the related factors in the aqueous humor in the serum, the study and establishment of objective indicators that can correctly predict the incidence of NVG and the progression of the disease can provide a theoretical basis for the early clinical prediction, the assessment of the condition and the prognosis of the prognosis.
Methods: 20 cases of NVG patients were selected as experimental group (group A), 20 cases of primary chronic angle closure glaucoma (group B), 20 cases of high intraocular pressure control group and 20 cases of senile cataract (group C) as normal control group. The serum and aqueous humor samples were collected by double antibody sandwich enzyme linked immunosorbent assay (enzyme-linked immuno sorbent assay,) The levels of PEDF and VEGF in serum and aqueous humor were detected by ELISA method respectively. The data were processed with SPSS18.0 statistical software, and the same factor in the serum and aqueous humor in the same group was compared with the independent sample t test. The comparison of the same factors among the different groups was compared with the single factor variance analysis (ANOVA). The correlation analysis adopted the Pearson correlation coefficient test. P 0.05 indicated that the difference was statistically significant.
Results: 1. general situation
Group A: 20 patients (20 eyes) were collected from March 2011 to March 2012 at the ophthalmology department of the Second Affiliated Hospital of Dalian Medical University. There were 11 men (11 eyes), 9 women (9 eyes), 12 in the right eye, 8 in the left eye; the average age 36 years old and 66.16 + 15.12 years old. The preoperative intraocular pressure range was 21-94mmHg, average 59.05 + 21.33mmHg. diabetic retina. There were 14 cases of membrane lesion (DR), 2 cases of central retinal vein occlusion (CRVO) and 4 cases of unknown etiology.
Group B: 20 cases of primary chronic angle closure glaucoma hospitalized at the same time, 20 cases (20 eyes), including 8 men (8 eyes), 12 women (12 eyes), 10 right eyes and 10 left eyes, age 49 years -76.0 years old, average age 60 + 8.96 years. The preoperative intraocular pressure range was 22-71mmHg, average 45.80 + 16.79mmHg.
Group C: 20 cases of senile cataract in our hospital at the same time, 20 cases (20 eyes), of which 14 cases (14 eyes), 6 women (6 eyes), 9 right eyes, 11 left eye, age 48 years -76.0 years old, average age 71.95 + 11.24 years. The preoperative intraocular pressure range is 10-21mmHg, average 15.90 + 2.05mmHg.
There was no significant difference in age, sex and eye difference among groups (P > 0.05).
2. PEDF level
(1) PEDF level in aqueous humor: 217.15 + 30.12pg/ml in group A was significantly lower than that in group B, 460.85 + 1.86pg/ml and C group 520.10 + 9.59pg/ml, and 22 of the three groups were statistically significant (F=155.01, P < 0.05).
(2) the level of PEDF in serum: group A was 12.65 + 7.66mg/L, group B was 15.20 + 2.70mg/L and C group was 13.35 + 4.21mg/L, and the difference between the three groups was not statistically significant (P > 0.05).
3. VEGF level
(1) VEGF level in aqueous humor: 1481.69 + 88.15pg/ml in group A was significantly higher than that in group B, 300.98 + 53.71pg/ml and C group 180.23 + 15.01pg/ml, and 22 of the three groups were statistically significant (F=1.63, P < 0.05).
(2) the level of VEGF in serum: 98.63 + 6.83pg/ml in group A was significantly lower than that in group B, 279.61 + 94.02pg/ml and C group 142.05 + 34.99pg/ml, and 22 of the three groups were statistically significant (F=2.66, P < 0.05).
Comparison of the level of PEDF in water and serum in 4.NVG patients
The level of PEDF in aqueous humor of group A was lower than that in serum (t=7.170, P < 0.05), but there was no significant correlation between the concentration of PEDF in the aqueous humor of each group and the content of the corresponding serum (P > 0.05).
Comparison of the level of VEGF in water and serum in 5.NVG patients
The level of VEGF in aqueous humor of group NVG was significantly higher than that in serum, the difference was statistically significant (t=-20.445, P < 0.05), but there was no significant correlation between the concentration of VEGF in aqueous humor and the content of the corresponding serum (P > 0.05) the correlation between PEDF and VEGF levels in the aqueous humor of.6. three groups
There was a negative correlation between PEDF and VEGF level in three groups of aqueous humor, and the difference was statistically significant (r=-0.67, r=-0.58, r=-0.47, P < 0.05).
Conclusion: the formation of iris neovascularization in 1.NVG patients may be related to the decrease of PEDF level and the increase of VEGF level in aqueous humor.
2. PEDF and VEGF as vascular inhibitors and vascular stimulators may be important factors contributing to the occurrence of NVG.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R775

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 蔣瑤祁;彭輝燦;;VEGF家族及其受體與視網(wǎng)膜新生血管形成[J];國際眼科雜志;2006年05期

2 崔蕾;盧海;;眼內(nèi)液中PEDF、VEGF含量變化對糖尿病視網(wǎng)膜病變的意義(英文)[J];國際眼科雜志;2007年01期

3 周洪偉;吳強;;血管內(nèi)皮生長因子及其受體與眼底新生血管[J];國際眼科雜志;2007年03期

4 劉東敬;新生血管性青光眼的治療研究進(jìn)展[J];臨床眼科雜志;2002年05期

5 呂明良;曾水清;肖青;夏又清;;高糖聯(lián)合低氧對體外培養(yǎng)的人視網(wǎng)膜色素上皮細(xì)胞HIF-1ɑ及VEGF表達(dá)的影響[J];華中科技大學(xué)學(xué)報(醫(yī)學(xué)版);2006年04期

6 張雷,王康孫,王玲,陳榮家;PEDF和VEGF mRNA在實驗性脈絡(luò)膜新生血管組織中的表達(dá)[J];眼科新進(jìn)展;2004年02期

7 穆華;董麗;馮卓蕾;張曉梅;;Müller細(xì)胞內(nèi)色素上皮衍生因子與血管內(nèi)皮生長因子的相互作用[J];眼科新進(jìn)展;2010年10期

8 趙世紅;血管內(nèi)皮生長因子及其受體與眼內(nèi)新生血管性疾病[J];眼科研究;2003年01期

9 呂明良;曾水清;肖青;李敏;夏輝;;shRNA抑制人RPE細(xì)胞HIF-1α基因表達(dá)對VEGF及PEDF表達(dá)的影響[J];眼科研究;2007年09期

10 萬新順,劉瑞芳,王輝,劉向玲,李曉鵬,裴玉明;新生血管性青光眼患者眼內(nèi)液血管內(nèi)皮生長因子的檢測[J];中華眼底病雜志;2001年04期

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