【摘要】： 目的：角膜創(chuàng)傷是臨床上極為常見的眼外傷,無論是醫(yī)源性或是外傷性,完善的角膜創(chuàng)傷修復(fù)對于維持正常的視功能和屈光手術(shù)的矯正效果具有重要影響。準分子激光原位角膜磨鑲術(shù)(LASIK)因其矯治范圍廣、可預(yù)測性好、安全性及穩(wěn)定性強的優(yōu)勢,成為目前世界范圍內(nèi)矯正各種屈光不正的理想方法。LASIK手術(shù)效果受多種因素的影響,角膜愈合反應(yīng)的個體差異是重要因素之一。LASIK術(shù)后角膜傷口愈合是一復(fù)雜過程,近年來發(fā)現(xiàn)淚液中具有多種細胞因子,盡管含量很低,但在維持眼表正常功能、損傷修復(fù)中發(fā)揮重要作用。LASIK術(shù)后角膜傷口愈合是由多種細胞及細胞因子在時間與空間的高度協(xié)調(diào)作用下完成的。深入的研究與理解LASIK術(shù)后角膜愈合反應(yīng)的調(diào)控機制,對于獲得LASIK術(shù)后更好的臨床效果有重大意義。 本試驗通過收集2009年6-10月在我院行LASIK手術(shù)患者術(shù)前術(shù)后的淚液,通過采用雙抗體夾心酶聯(lián)免疫吸附分析法檢測淚液中轉(zhuǎn)化生長因子α(TGF-α)的濃度,尋求TGF-α在LASIK手術(shù)前后淚液中的的變化規(guī)律,以探討其在LASIK術(shù)前術(shù)后淚液中濃度變化及其對角膜愈合的作用。 方法：LASIK術(shù)前及術(shù)后1天、3天、7天及15天在患者眼結(jié)膜囊內(nèi)抽取淚液標本,采用雙抗體夾心酶聯(lián)免疫吸附法檢測30名(60眼,男性13例26眼,女性17例34眼)18-33歲患者淚液中TGF-α含量,對不同時間淚液中細胞因子平均濃度進行相關(guān)性分析。 結(jié)果：在LASIK術(shù)前及術(shù)后半個月隨訪期間,術(shù)前TGF-α平均含量為(175.19±61.22)pg/ml,術(shù)后1天,3天,7天含量分別為(606.01.±128.69)pg/ml,(439.38±90.57)pg/ml,(243.27±75.51)pg/ml,與術(shù)前比較TGF-α在淚液中的濃度差異有顯著統(tǒng)計學(xué)意義(P0.05),術(shù)后15天TGF-α平均含量為(191.63±20.51)pg/ml,與術(shù)前比較TGF-α在淚液中的濃度差異無顯著統(tǒng)計學(xué)意義(P0.05)。 結(jié)論：LASIK術(shù)后淚液中TGF-α的含量存在一個由增高到恢復(fù)術(shù)前水平的動態(tài)變化過程,這一結(jié)果提示LASIK術(shù)后TGF-α可促進角膜細胞增殖、分裂、趨化及移行等一系列生物學(xué)過程,從而有利于傷口愈合,為獲得LASIK術(shù)后更好的臨床效果提供理論依據(jù)。
[Abstract]:Objective: corneal trauma is a common ocular trauma in clinic. Whether iatrogenic or traumatic, perfect corneal wound repair has an important effect on maintaining normal visual function and correcting effect of refractive surgery. Excimer laser in situ keratomileusis (LASIK) is an ideal method for correction of various refractive errors in the world because of its wide range of correction, good predictability, safety and stability. The effect of laser in situ keratomileusis is affected by many factors. The individual difference of corneal healing response is one of the important factors. Corneal wound healing after LASIK is a complicated process. In recent years, it has been found that there are many cytokines in the tear, although the content is very low, it maintains the normal function of the eye surface. Corneal wound healing after LASIK is accomplished by a variety of cells and cytokines in high coordination of time and space. It is of great significance to study and understand the mechanism of corneal healing response after LASIK. In this study, tear samples were collected from patients undergoing LASIK operation in our hospital from June to October 2009. The concentrations of transforming growth factor 偽 (TGF- 偽) in tears were detected by double antibody sandwich enzyme-linked immunosorbent assay (Elisa). To explore the changes of TGF- 偽 in tear before and after LASIK operation, and to explore the effect of TGF- 偽 on corneal healing after LASIK. Methods tear samples were collected from conjunctival sac of 30 patients (60 eyes, 13 cases, 26 eyes) by double antibody sandwich enzyme-linked immunosorbent assay (Elisa). The content of TGF- 偽 in tear of 17 cases (34 eyes) of female patients aged 18 to 33 years was analyzed. The mean concentration of cytokines in tear at different time was analyzed. Results: during the follow-up period of half a month before and after LASIK, The mean level of TGF- 偽 was (175.19 鹵61.22) PG / ml before operation, (606.01 鹵128.69) PG / ml, (439.38 鹵90.57) PG / ml, (243.27 鹵75.51) PG / ml on day 1 and day 3 after operation, respectively. There was significant difference in the concentration of TGF- 偽 in tear between before and after operation (P0.05), and the mean content of TGF- 偽 in tear was (191.63 鹵20.51) pgml. the concentration of TGF- 偽 in tear was (191.63 鹵20.51) pgml-1 / ml on the 15th day after operation, compared with that before operation (439.38 鹵90.57) PG / ml, (243.27 鹵75.51) PG / ml respectively (P0.05). There was no significant difference in degree (P0.05). Conclusion there is a dynamic change process of TGF- 偽 content in tears after LASIK. The results suggest that TGF- 偽 can promote corneal cell proliferation, division, chemotaxis and migration after LASIK. It is beneficial to wound healing and provides theoretical basis for obtaining better clinical effect after LASIK.
【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】：2010
【分類號】：R779.63

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