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  本文選題：膠原交聯(lián) + 角膜�。� 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:探討核黃素聯(lián)合紫外光A(Ultraviolet-A,UVA)誘導(dǎo)兔眼角膜穿通傷膠原交聯(lián)(corneal collagen crosslinking,CXL)后對角膜瘢痕的生物力學(xué)的影響,為預(yù)防外傷性角膜葡萄腫的形成探索新方法。方法:選86只健康家兔。80只隨機分為正常對照組(A組)和實驗組(B、C、D 3組,均制作角膜全層穿通傷模型),B組(單純縫合組)、C組(縫合+術(shù)后即刻CXL)、D組(縫合+第7天CXL),B、C、D每組又根據(jù)不同處死時間(4周、6周、8周)分為a、b、c3組,即Ba、Bb、Bc;Ca、Cb、Cc;Da、Db、Dc組,每組8只。在相應(yīng)的時間統(tǒng)一取4mm×10mm角膜試件在生物力學(xué)實驗機上進(jìn)行角膜拉伸,記錄每個角膜瘢痕試件所拉伸的應(yīng)力、應(yīng)變,然后計算在10%應(yīng)變時的楊氏模量(Young's modulus,E),繪制應(yīng)力-應(yīng)變曲線。根據(jù)所測出的CXL組及單純縫合組中生物力學(xué)特性最強組,按相應(yīng)的處理方法再次建模,每組3只,通過蛋白免疫印跡(Western Boltting,WB)檢測α-平滑肌肌動蛋白(Alpha smooth muscle action,α-SMA)表達(dá)情況。結(jié)果:(1)角膜瘢痕最大的應(yīng)力:A組為5.71±1.29MPa,B組:Ba、Bb、Bc組分別為1.37±0.62MPa,2.21±0.30MPa,3.14±0.74MPa;C組:Ca、Cb、Cc組分別為1.87±0.56MPa,2.83±0.54MPa,3.26±0.83MPa;D組:Da、Db、Dc組分別為2.17±0.52MPa,2.92±0.63MPa,4.21±0.68MPa。與A組比較,各組均有統(tǒng)計學(xué)差異(P=0.00),即穿通傷后所形成的瘢痕的應(yīng)力較正常角膜明顯降低。楊氏模量:A組為:16.37±4.06MPa;B組:Ba、Bb、Bc組分別為4.64±1.69MPa,7.75±0.82MPa,9.02±0.87MPa;C組:Ca、Cb、Cc組分別為9.67±2.42MPa,10.67±2.07MPa,11.08±1.61MPa;D組:Da、Db、Dc組分別為10.94±1.57MPa,11.16±2.50MPa,13.36±2.10MPa。除了Dc組與A組織比較(P=0.007),其余與A組比較,均有統(tǒng)計學(xué)差異(P=0.00),即穿通傷后所形成的瘢痕的楊氏模量明顯降低。(2)組內(nèi)最大應(yīng)力比較:隨時間推移,應(yīng)力明顯增加。Ba與Bb相比,具有統(tǒng)計學(xué)差異(P=0.026),Bb與Bc 3組相比,有統(tǒng)計學(xué)差異(P=0.015);Ca與Cb相比有統(tǒng)計學(xué)差異(P=0.010),而Cb與Cc組無明顯差異(P=0.235);Da與Db相比具有統(tǒng)計學(xué)差異(P=0.042),Db與Dc相比有統(tǒng)計學(xué)差異(P=0.01)。(3)組內(nèi)楊氏模量比較:隨時間推移,單純縫合組楊氏模量在增加,在第6周后增加緩慢,縫合后第7天CXL在第8周最強,而縫合后即刻CXL雖呈增加趨勢,但變化較為緩慢。Ba、Bb、Bc 3組相比,Ba與Bb有統(tǒng)計學(xué)差異(P=0.008),Bb相比Bc相比無統(tǒng)計學(xué)差異(P=0.264);Ca、Cb、Cc 3組相比,Ca與Cb相比,無統(tǒng)計學(xué)差異(P=0.364),Cb與Cc相比無統(tǒng)計學(xué)差異(P=0.707);Da與Db相比無統(tǒng)計學(xué)差異(P=0.842),Db與Dc相比有統(tǒng)計學(xué)差異(P=0.047)。(4)組間最大應(yīng)力比較:總體上看,單純縫合后形成的瘢痕的應(yīng)力低于縫合后第7天CXL后的應(yīng)力。Ba、Ca、Da 3組相比,Ba與Ca比較無統(tǒng)計學(xué)差異(P=0.181),Ca與Da相比無統(tǒng)計學(xué)差異(P=0.405),Ba與Da相比有統(tǒng)計學(xué)差異(P=0.034);Bb、Cb、Db 3組相比,Bb與Cb相比,無統(tǒng)計學(xué)差異(P=0.094),Cb與Db相比無統(tǒng)計學(xué)差異(P=0.805);Bc、Cc、Dc 3組相比,除Bc與Cc組對比無統(tǒng)計學(xué)差異(P=0.764),Cc與Dc相比,有統(tǒng)計學(xué)差異(P=0.010),Bc與Dc相比有統(tǒng)計學(xué)差異(P=0.005)。(5)組間楊氏模量比較:總體上看,單純縫合后所形成的瘢痕的抗變形能力低于縫合后第7天CXL的。Ba、Ca、Da 3組相比,Ba與Ca及Da相比有統(tǒng)計學(xué)差異(P值均=0.000),Ca與Da組對比無統(tǒng)計學(xué)差異(P=0.249);Bb、Cb、Db 3組相比,Bb與Cb及Da對比均有統(tǒng)計學(xué)差異(P分別為0.009、0.003),Cb與Db對比無統(tǒng)計學(xué)差異(P=0.654);Bc、Cc、Dc 3組相比,Bc與Cc組對比無明顯統(tǒng)計學(xué)差異(P=0.072),Cc及Dc相比有統(tǒng)計學(xué)差異(P=0.040)。(6)WB的結(jié)果顯示:兔角膜穿通傷單純縫合組與縫合+第7天CXL的α-SMA的表達(dá)比率分別為0.28±0.11和0.65±0.20,差異有統(tǒng)計學(xué)意義(P=0.048)。結(jié)論:(1)兔角膜穿通傷縫合術(shù)后所形成的瘢痕的生物力學(xué)特性隨時間延長而增強,本次實驗在第8周最強。(2)CXL可以增強兔角膜穿通傷形成瘢痕的生物力學(xué)特性,隨時間推移抗生物力學(xué)特性逐漸增強,在兔角膜穿通傷縫合后第7天進(jìn)行CXL要好于即刻CXL,可能可以預(yù)防角膜葡萄腫發(fā)生。(3)在角膜穿通傷后CXL可以增加α-SMA的分泌。
[Abstract]:Objective: To explore the effect of collagen cross-linking (corneal collagen crosslinking, CXL) on corneal scar after corneal perforating injury in rabbits induced by riboflavin combined with A (Ultraviolet-A, UVA), and to explore a new method to prevent the formation of traumatic corneal staphyloma. Methods: 86 healthy rabbits were selected to be randomly divided into normal control group (A group). And the experimental group (group B, C, D 3, all corneal penetrating injury models), group B (simple suture group), group C (suture + immediate CXL), D group (suture + seventh days CXL), B, C, D each group were divided into a, i.e., 4 weeks, 6 weeks, 8 weeks. The tensile stress and strain of each corneal scar specimen were recorded on the biomechanical experiment machine, and then the young modulus (Young's modulus, E) at the 10% strain was calculated and the stress strain curve was drawn. According to the strongest group of biological mechanics characteristics in the CXL group and the simple suture group, the model was modeled again according to the corresponding treatment method. The expression of alpha smooth muscle actin (Alpha smooth muscle action, alpha -SMA) was detected by Western Boltting (Western, WB) in each group. Results: (1) the maximum stress of corneal scar: A group was 5.71 + 1.29MPa, B group was 1.37 +, 2.21 +, 3.14 +. 2.83 + 0.54MPa, 3.26 + 0.83MPa, group D: Da, Db, Dc group were 2.17 + 0.52MPa, 2.92 + 0.63MPa and 4.21 + 0.68MPa. compared with A group. All groups were statistically different (P=0.00), that is, the stress of scar formed after penetrating injury was significantly lower than that of normal cornea. Young's modulus: A group was 16.37 + 4.64, 7.75 + 0. respectively. 82MPa, 9.02 + 0.87MPa, group C: Ca, Cb, Cc group were 9.67 + 2.42MPa, 10.67 + 2.07MPa, 11.08 + 1.61MPa, D group: Da, Db, 11.16 +, 13.36 + and 13.36. (2) the maximum stress comparison in the group: compared with Bb, the stress increased significantly (P=0.026) compared with Bb (P=0.026). Compared with the Bc 3 groups, there were statistical differences (P=0.015); Ca and Cb had statistical differences (P=0.010), while Cb and Cc group had no significant difference (P=0.235). There was a statistical difference (P=0.01). (3) the young modulus of the group was compared: the young's modulus of the simple suture group increased as time went on, increased slowly after sixth weeks, and the CXL was the strongest in seventh days after the suture, while the CXL after the suture increased, but the change was slow.Ba, Bb, and Bc 3 groups, Ba and Bb were statistically different (P=0.008), Bb B compared to B. There was no statistical difference in C (P=0.264); there was no statistical difference between Ca and Cb (P=0.364) compared with Cb in Ca, Cb and Cc 3 groups, and there was no statistical difference between Cb and Cc (P=0.707). (4) the maximum stress comparison between groups: in general, the scar formation after simple suture should be compared. There was no statistical difference between Ba and Ca (P=0.181) compared to the stress.Ba, Ca and Da after CXL seventh days after suture (P=0.181), Ca and Da had no statistical difference compared with Da (P=0.405), Ba compared with Da, and there were no statistical differences compared with those of the 3 groups. Compared to group Bc and Cc, there was no statistical difference (P=0.764), compared with Dc (P=0.010), there was a statistical difference (P=0.010), and there was a statistical difference between Bc and Dc (P=0.005). (5) the young modulus of the group was compared: in general, the anti deformation ability of the scar formed after the simple suture was lower than that of the.Ba on the seventh day CXL after the suture, and compared with the 3 groups. There was no statistical difference (P value =0.000), and there was no statistical difference between Ca and Da group (P=0.249), and there was no statistical difference between Bb and Cb and Da compared with the 3 groups of Bb, Cb, Db. The difference (P=0.040). (6) the results of WB showed that the ratio of the expression of the simple suture group and the suture + seventh day CXL of the rabbit cornea was 0.28 + 0.11 and 0.65 + 0.20, respectively, and the difference was statistically significant (P=0.048). Conclusion: (1) the biomechanical properties of the scar formed after corneal perforation suture in rabbits increased with time, this experiment The strongest in the eighth week. (2) CXL can enhance the biomechanical properties of the rabbit corneal perforation scar formation scar. The anti biomechanical properties gradually increase with time, and CXL is better than immediate CXL at seventh days after the wound suture of the rabbit cornea. It may prevent the occurrence of corneal staphyloma. (3) CXL can increase the secretion of alpha -SMA after the penetrating injury of the cornea.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R779.1

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