本文選題：新生血管性青光眼 + 血管內(nèi)皮生長因子��； 參考：《大連醫(yī)科大學》2011年碩士論文

【摘要】：目的:新生血管性青光眼(neovascular glaucoma, NVG)是一種病因復雜、臨床表現(xiàn)嚴重的難治性、頑固性青光眼,是一種常見的致盲眼病。通常繼發(fā)于眼后段廣泛的缺血性疾病,如糖尿病視網(wǎng)膜病變(diabetic retinopathy, DR),視網(wǎng)膜靜脈阻塞(retinal vein occlusion, RVO)等。NVG的臨床特點主要為難以控制的高眼壓和劇烈眼痛,同時行常規(guī)青光眼治療往往無效,最終常導致視功能的嚴重喪失甚至眼球摘除等后果。然而,早期的診斷、積極的預防和有效的治療等措施是可以達到控制病情發(fā)展和保留較好視功能的目的。目前,對于NVG的具體發(fā)病機制尚不清楚,但國內(nèi)外對它的研究卻從未間斷。隨著分子生物學和免疫學的發(fā)展,與新生血管形成有關(guān)的一些細胞因子及其受體的研究越來越受到眼科學界的關(guān)注。血管內(nèi)皮生長因子(vascular endothelial growth factor, VEGF)是一種具有特異性地刺激血管內(nèi)皮細胞增殖及新生血管形成的血小板源性蛋白。白細胞介素-6(interleukin, IL-6)是感染或外傷急性期應激反應的主要誘導因子,也是一種調(diào)節(jié)炎癥反應的多功能細胞因子。本實驗的目的在于通過檢測NVG患者血清與房水中VEGF和IL-6的水平,觀察兩者之間以及它們與NVG的關(guān)系,進一步明確促血管生長因子對NVG發(fā)病的影響,揭示NVG可能的發(fā)病機理;并通過血清與房水中血管因子的相關(guān)性研究,試圖找到能夠反應眼內(nèi)液相關(guān)因子水平情況的指標,為臨床早期預測、評估病情和判斷預后提供相關(guān)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。采集三組患者血清及房水標本,通過雙抗體夾心酶聯(lián)免疫吸附試驗方法(enzyme-linked immuno sorbent assay, ELISA法)分別檢測血清與房水中VEGF、IL-6的濃度水平。比較VEGF、IL-6水平在各組間的差異;分析各組VEGF與IL-6的相關(guān)性;研究各組VEGF、IL-6在血清與房水間的濃度差異及其相關(guān)性。應用SPSS17.0統(tǒng)計軟件處理數(shù)據(jù),同組內(nèi)同一因子在不同標本間的數(shù)據(jù)比較用獨立樣本的t檢驗;所有數(shù)據(jù)均具有方差齊性,不同組間的各因子比較用方差分析(ANOVA)。相關(guān)性分析采用Pearson相關(guān)系數(shù)檢驗。P0.05表示差異具有統(tǒng)計學意義。 結(jié)果:1.各組VEGF、IL-6的濃度水平: ①房水中VEGF的濃度水平:A組(1336.80±70.15)pg/ml明顯高于B組(311.60±31.06)pg/ml和C組(165.75±13.95)pg/ml,三組間兩兩比較,差異均具有統(tǒng)計學意義(F=4019.334, P0.05)。 ②房水中IL-6的濃度水平: A組(691.15±50.09)pg/ml明顯高于B組(168.25±11.95)pg/ml和C組(92.10±9.59)pg/ml,三組間兩兩比較,差異均具有統(tǒng)計學意義(F=2275.019,P0.05)。 ③血清中VEGF的濃度水平:A組(545.40±155.49)pg/ml高于B組(321.15±52.57)pg/ml和C組(176.30±20.38)pg/ml,三組間兩兩比較,差異均具有統(tǒng)計學意義(F=75.940,P0.05)。 ④血清中IL-6的濃度水平: A組(291.35±22.66)pg/ml高于B組(104.35±13.21)pg/ml和C組(87.00±12.70)pg/ml,三組間兩兩比較,差異均具有統(tǒng)計學意義(F=906.947,P0.05)。 2.NVG組房水中VEGF與IL-6的水平呈顯著的正相關(guān)性,差異具有統(tǒng)計學意義(r=0.857,P0.05)。其余各組標本中無顯著的相關(guān)性(P0.05)。 3.NVG組患者房水中VEGF、IL-6的含量明顯高于血清中,差異具有統(tǒng)計學意義(t=-20.748,P0.05;t= -32.199,P0.05)。 4.各組血清中VEGF、IL-6濃度與相應房水中的含量無顯著的相關(guān)性(P0.05)。 結(jié)論:1. VEGF、IL-6可能促進了NVG的發(fā)生發(fā)展。 2. VEGF、IL-6在NVG的形成過程中,具有相互協(xié)同的作用。 3. NVG眼局部可能存在著VEGF、IL-6獨立的產(chǎn)生和作用機制。
[Abstract]:Objective: neovascular glaucoma (NVG) is a complicated, clinically severe refractory, refractory glaucoma, which is a common blind eye disease. It is usually secondary to extensive ischemic diseases in the posterior segment of the eye, such as diabetic retinopathy (diabetic retinopathy, DR), retinal vein occlusion (retinal vein). Occlusion, RVO) and other clinical features of.NVG are mainly difficult to control high intraocular pressure and severe ocular pain, and routine glaucoma treatment is often ineffective, and eventually results in severe loss of visual function and even exucleation of the eyeball. However, early diagnosis, active prevention and effective treatment are possible to control the development of the disease and At present, the specific pathogenesis of NVG is not clear, but the research at home and abroad has never been interrupted. With the development of molecular biology and immunology, the research of some cytokines and their receptors related to the formation of neovascularization has attracted more and more attention in the field of Ophthalmology. Vascular endothelial growth factor (v Ascular endothelial growth factor, VEGF) is a kind of thrombocytopenia that specifically stimulates the proliferation of vascular endothelial cells and the formation of neovascularization. Interleukin -6 (interleukin, IL-6) is the main inducer of the acute stress response to infection or trauma, and is also a multifunctional cytokine that regulates the inflammatory response. The purpose of the experiment is to observe the relationship between the serum and the VEGF and IL-6 levels in the NVG patients and the aqueous humor, to observe the relationship between the two and the NVG, to further clarify the effect of vascular growth factor on the pathogenesis of NVG and to reveal the possible pathogenesis of NVG, and to try to find a response through the study of the correlation between serum and blood tube factors in the aqueous humor. Indicators of the level of intraocular fluid related factors provide a theoretical basis for early clinical prediction, assessment of disease and 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 the normal control group. The serum and aqueous humor samples were collected and the double anti body sandwich enzyme-linked immunosorbent assay (enzyme-linked immuno sorbe) was used. NT assay, ELISA method) detection of serum and aqueous VEGF, IL-6 concentration level respectively. Compare the difference between VEGF and IL-6 levels in each group; analyze the correlation between VEGF and IL-6 in each group; study the difference and correlation between the concentration of VEGF, IL-6 in the serum and the aqueous humor in each group. The same factor in the same group is different with the same factor in the same group. The data in this room were compared with the t test of independent samples; all the data were homogeneity of variance, and the factors of different groups were compared with the analysis of variance (ANOVA). The correlation analysis used the Pearson correlation coefficient to test.P0.05 to indicate that the difference was statistically significant.
Results: 1. the concentration level of VEGF and IL-6 in each group:
(1) the concentration level of VEGF in aqueous humor: group A (1336.80 + 70.15) pg/ml was significantly higher than that of group B (311.60 + 31.06) pg/ml and C (165.75 + 13.95) pg/ml, and 22 of the three groups were statistically significant (F=4019.334, P0.05).
(2) the concentration level of IL-6 in aqueous humor: group A (691.15 + 50.09) pg/ml was significantly higher than that of group B (168.25 + 11.95) pg/ml and C (92.10 + 9.59) pg/ml, and 22 of the three groups were statistically significant (F=2275.019, P0.05).
(3) the level of serum VEGF concentration: group A (545.40 + 155.49) pg/ml was higher than that of group B (321.15 + 52.57) pg/ml and C group (176.30 + 20.38) pg/ml, and 22 of the three groups were statistically significant (F=75.940, P0.05).
(4) the level of serum IL-6 concentration: group A (291.35 + 22.66) pg/ml was higher than that of group B (104.35 + 13.21) pg/ml and C group (87 + 12.70) pg/ml, and 22 of the three groups were statistically significant (F=906.947, P0.05).
There was a significant positive correlation between the level of VEGF and IL-6 in the aqueous humor of 2.NVG group, and the difference was statistically significant (r=0.857, P0.05). There was no significant correlation between the other groups (P0.05).
In group 3.NVG, the levels of VEGF and IL-6 in aqueous humor were significantly higher than those in serum, and the difference was statistically significant (t=-20.748, P0.05, t= -32.199, P0.05).
4. there was no significant correlation between serum VEGF and IL-6 concentration and the content of corresponding aqueous humor in each group (P0.05).
Conclusion: 1. VEGF and IL-6 may promote the occurrence and development of NVG.
2. VEGF, IL-6 plays a synergistic role in the formation of NVG.
3. there may be VEGF and IL-6 independent production and mechanism in NVG eyes.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R775

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