外傷性睫狀體脫離的臨床研究及睫狀上腔滲液中炎性因子的實驗研究
發(fā)布時間：2019-01-19 14:05
【摘要】：目的：探討眼前節(jié)光學相干斷層掃描(AS-OCT)與眼超聲生物顯微鏡(UBM)在診斷睫狀體脫離中的臨床應用價值,為豐富及優(yōu)化臨床檢查選擇提供依據。評價一種新的改良睫狀體縫合復位術與傳統(tǒng)的睫狀體縫合復位術治療外傷性睫狀體脫離的臨床效果,為優(yōu)化手術方案提供依據。檢測外傷性睫狀體脫離患者睫狀體上腔滲液中interleukin-6(IL-6)、tumor necrosis factor-alpha(TNF-α)的含量,探討其在睫狀體脫離發(fā)生發(fā)展中的作用,為臨床治療促使睫狀體脫離復位提供思路。 方法： 1臨床病例對照研究。外傷性睫狀體脫離病人30例入組,每個病例均采用房角鏡、UBM和AS-OCT三項檢查,其中任意一項檢查發(fā)現(xiàn)睫狀體脫離即可確診。比較UBM和AS-OCT診斷睫狀體脫離的陽性率,應用SPSS配對χ2檢驗進行統(tǒng)計分析,探討其不同機制及優(yōu)劣。 2臨床隨機對照研究。行手術治療的外傷性睫狀體分離患者23例,隨機分為2組。傳統(tǒng)組11例,改良組12例,傳統(tǒng)組行傳統(tǒng)睫狀體脫離縫合復位術,改良組行改良的睫狀體縫合復位術。比較兩組術后睫狀體復位情況、眼壓及視力,進行統(tǒng)計分析,評價療效。注意兩組臨床資料的匹配情況。統(tǒng)計方法采用SPSS16.0統(tǒng)計軟件,術前術后兩組睫狀體脫離情況的比較采用四格表資料的確切概率法(Fisher's exact test),術前術后兩組眼壓、視力對比采用配對資料t檢驗。兩組間術后睫狀體復位情況、眼壓、視力比較分別四格表資料的確切概率法(Fisher's exact test)和獨立樣本t檢驗。 3實驗研究。于天津市眼科醫(yī)院住院行手術治療并成功取得檢測樣本的外傷性睫狀體脫離患者12例,取其睫狀體上腔滲液作為實驗組,取其自身血清作為對照組,應用酶聯(lián)免疫吸附試驗法檢測兩組的interleukin-6(IL-6)、tumor necrosis factor-alpha(TNF-α)含量,應用SPSS統(tǒng)計軟件計量資料配對t檢驗進行統(tǒng)計學分析。 結果： 1房角鏡組、UBM組、AS-OCT組三組檢查睫狀體脫離陽性率分別為63.33%、100%、60%,其中UBM檢查組與房角鏡組、AS-OCT組相比差異均具有統(tǒng)計學意義(P值分別為0.001、0.000,均0.05),而房角鏡組與AS-OCT組比較差異無統(tǒng)計學意義(P值=1.000,0.05)。 2傳統(tǒng)睫狀體縫合復位組中11例有10例一次手術復位成功,改良睫狀體縫合復位組中12例全部一次手術復位成功,兩組術前術后比較差異均有統(tǒng)計學意義(P0.05),兩組復位率分別為90.9%(10/11)、100%(12/12),兩組間復位率比較差異無統(tǒng)計學意義(P0.05)。兩組術后眼壓較術前均有明顯回升,差異均有統(tǒng)計學意義。傳統(tǒng)睫狀體縫合復位組及改良睫狀體縫合復位組術前平均眼壓分別為6.45±1.58mmHg、6.78±1.43mmHg,術后兩組平均眼壓均有回升,分別達到了13.35±2.08mmHg、14.57±2.96mmHg,兩組術前術后差異比較具有統(tǒng)計學意義(傳統(tǒng)組t=-12.34,P0.01；改良組t=-11.85,P0.01),但兩組間術后2周眼壓值比較差異無統(tǒng)計學意義(t=-1.17,P0.05)。傳統(tǒng)睫狀體縫合復位組及改良睫狀體縫合復位組術前視力分別為0.25±0.21、0.29±0.23,術后2周分別為0.42±0.26、0.45±0.21,其中視力0.3者分別達到了63.6%、66.6%,與術前比較差異具有統(tǒng)計學意義(傳統(tǒng)組t=-5.27,P0.01；改良組t=-5.89,P0.01)。兩組間術后2周視力比較差異無統(tǒng)計學意義(P0.05)。 3本組睫狀體脫離患者IL-6的含量在睫狀體上腔滲液和自體血清中分別為70.25±58.64pg/ml、6.29±1.25pg/ml,TNF-α的含量在睫狀體上腔滲液和自體血清中分別為18.59±5.75pg/ml、8.93±1.82pg/ml。睫狀體脫離患者的睫狀體上腔滲液中IL-6、TNF-α的含量均高于自體血清中IL-6、TNF-α的含量,差異均有統(tǒng)計學意義(P0.05)。 結論：眼前節(jié)OCT與UBM比較并無明顯診斷優(yōu)勢,但其為非接觸式檢查,為睫狀體脫離提供了新的檢查手段,尤其是對于一些不適于房角鏡和UBM等需行接觸式檢查的患者及對檢查過程中舒適度要求比較高的患者；傳統(tǒng)的睫狀體縫合復位術和改良的睫狀體縫合復位術均能有效復位睫狀體,眼壓、視力等指標均有改善,取得了良好的效果,但改良術式較傳統(tǒng)術式操作相對簡化,費時更少,應用范圍更寬,效果確切。外傷性睫狀體脫離患者睫狀體上腔滲液中IL-6與TNF-α的含量均高于自身血清中的含量,提示兩者可能參與了睫狀體上腔滲液形成發(fā)展的過程,在其中發(fā)揮了作用,為防治睫狀體脫離提供了新的思路和切入點。
[Abstract]:Objective: To study the clinical application value of the anterior segment optical coherence tomography (AS-OCT) and the ocular ultrasound biomicroscope (UBM) in the diagnosis of the detachment of the ciliary body and to provide the basis for enriching and optimizing the selection of clinical examination. To evaluate the clinical effect of a new method of improved ciliary body suture reduction and traditional ciliary body suture reduction in the treatment of traumatic cyclodialysis, and to provide the basis for the optimization of the operation plan. The content of interleukin-6 (IL-6), tumornecrosis factor-alpha (TNF-1) in the ciliary body of the patients with traumatic ciliary body detachment was examined, and its role in the development of the detachment of the ciliary body was discussed. square Method: 1 Clinical case pair According to the study, 30 cases of traumatic cyclodialysis patients were enrolled in the group, and each case was examined by gonioscope, UBM and AS-OCT, and any one of them found that the ciliary body was separated. The positive rate of the detachment of the ciliary body was compared with that of the UBM and AS-OCT, and the statistical analysis was carried out by using the SPSS. clinical follow-up machine-controlled study: 23 cases of traumatic cyclodialysis patients treated with operation and follow-up The machine was divided into 2 groups, 11 in the traditional group, 12 in the modified group, the traditional group of the traditional group and the traditional group, and the modified group was used for the improvement of the ciliary body. The reduction of the ciliary body, the intraocular pressure and the visual acuity of the two groups after operation were compared. Evaluation of curative effect. Take care of two groups of clinical data The statistical method was based on the statistical software of SPSS16. 0. The comparison of the two groups of the two groups before and after the operation was the exact probability method of the four-cell table data (Fisher's exact test), and the two groups of IOP and visual acuity were paired before and after the operation. Data t-test. The exact probability method (Fisher's exact test) and independence of the four-cell table data were compared between the two groups. Sample t-test. 3. The experimental study was carried out in 12 cases of traumatic cyclodialysis patients who underwent surgical treatment and successfully obtained the test samples in the hospital of the Eye Hospital of Tianjin, and the internal cavity of the ciliary body was taken as the experimental group, and the self-contained serum was taken as the control group, and the interleukin-The content of 6 (IL-6), tumor necrosis factor-alpha (TNF-1) was measured by SPSS statistical software. to be in series The results showed that the positive rate of the detachment of the ciliary body was 63. 33%, 100% and 60% respectively in the first group, the UBM group and the AS-OCT group, among which the difference of the UBM group and the gonioscope group and the AS-OCT group was statistically significant (P = 0.001, 0, respectively).. 000, 0. 05), while the difference between the gonioscopic group and the AS-OCT group was not statistically significant (P value = 1. 000, 0. 05). 10 of the 11 cases of the traditional ciliary body suture reduction group were successfully reset, 12 of the modified ciliary body suture reduction group were successfully reset, the difference between the two groups was statistically significant (P0.05), and the reduction rates of the two groups were 90.9% (10/ 11), respectively.), 100% (12/ 12), difference between two groups There was no significant difference between the two groups (P0.05). The mean IOP of the two groups was 6.45, 1.58mmHg, 6.78% and 1.43mmHg, respectively. The mean IOP of the two groups recovered after the operation. The difference between the two groups was statistically significant (the traditional group t =-12.34, P0.01; modified group t =-11.85, P0.01), but there was no significant difference in IOP between the two groups (t The pre-operative visual acuity of the traditional ciliary body suture reduction group and the modified ciliary body suture reduction group were 0.25, 0.21, 0.29 and 0.23, respectively. The visual acuity was 0.42, 0.26, 0.45 and 0.21, respectively. The visual acuity of 0.3 was 63.6% and 66.6%, respectively. t =-5.27, P0.01; modified group t =-5.89, P0.01). There was a difference in visual acuity between the two groups. There was no statistical significance (P0.05). The content of IL-6 in the ciliary body was 70. 25, 58. 64pg/ ml, 6.29 and 1.25pg/ ml, respectively, and the content of TNF-1 was 18.59 and 5.75pg/ ml, respectively. The content of IL-6 and TNF-1 in the body of the ciliary body from the patient's ciliary body was higher than that in the autoserum. There was no significant difference between OCT and UBM, but it was non-contact. The present invention provides a new examination method for the detachment of the ciliary body, in particular to a patient which is not suitable for the contact examination of the angle mirror and the UBM or the like and the patients with higher comfort requirements in the examination process, and the traditional ciliary body suture reduction method and the improved ciliary body The suture and reduction method can effectively reset the indexes of the ciliary body, the intraocular pressure, the vision and the like, and has good effect, but the improved operation is relatively simplified compared with the conventional operation type operation. and the content of the IL-6 and the TNF-1 in the cavity of the ciliary body of the patients with the traumatic ciliary body is higher than the content in the serum of the patient, and the two can be involved in the infiltration of the cavity of the ciliary body. The process of formation and development of liquid, in which the effect is played, to prevent
【學位授予單位】：天津醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R773.3
本文編號：2411443
[Abstract]:Objective: To study the clinical application value of the anterior segment optical coherence tomography (AS-OCT) and the ocular ultrasound biomicroscope (UBM) in the diagnosis of the detachment of the ciliary body and to provide the basis for enriching and optimizing the selection of clinical examination. To evaluate the clinical effect of a new method of improved ciliary body suture reduction and traditional ciliary body suture reduction in the treatment of traumatic cyclodialysis, and to provide the basis for the optimization of the operation plan. The content of interleukin-6 (IL-6), tumornecrosis factor-alpha (TNF-1) in the ciliary body of the patients with traumatic ciliary body detachment was examined, and its role in the development of the detachment of the ciliary body was discussed. square Method: 1 Clinical case pair According to the study, 30 cases of traumatic cyclodialysis patients were enrolled in the group, and each case was examined by gonioscope, UBM and AS-OCT, and any one of them found that the ciliary body was separated. The positive rate of the detachment of the ciliary body was compared with that of the UBM and AS-OCT, and the statistical analysis was carried out by using the SPSS. clinical follow-up machine-controlled study: 23 cases of traumatic cyclodialysis patients treated with operation and follow-up The machine was divided into 2 groups, 11 in the traditional group, 12 in the modified group, the traditional group of the traditional group and the traditional group, and the modified group was used for the improvement of the ciliary body. The reduction of the ciliary body, the intraocular pressure and the visual acuity of the two groups after operation were compared. Evaluation of curative effect. Take care of two groups of clinical data The statistical method was based on the statistical software of SPSS16. 0. The comparison of the two groups of the two groups before and after the operation was the exact probability method of the four-cell table data (Fisher's exact test), and the two groups of IOP and visual acuity were paired before and after the operation. Data t-test. The exact probability method (Fisher's exact test) and independence of the four-cell table data were compared between the two groups. Sample t-test. 3. The experimental study was carried out in 12 cases of traumatic cyclodialysis patients who underwent surgical treatment and successfully obtained the test samples in the hospital of the Eye Hospital of Tianjin, and the internal cavity of the ciliary body was taken as the experimental group, and the self-contained serum was taken as the control group, and the interleukin-The content of 6 (IL-6), tumor necrosis factor-alpha (TNF-1) was measured by SPSS statistical software. to be in series The results showed that the positive rate of the detachment of the ciliary body was 63. 33%, 100% and 60% respectively in the first group, the UBM group and the AS-OCT group, among which the difference of the UBM group and the gonioscope group and the AS-OCT group was statistically significant (P = 0.001, 0, respectively).. 000, 0. 05), while the difference between the gonioscopic group and the AS-OCT group was not statistically significant (P value = 1. 000, 0. 05). 10 of the 11 cases of the traditional ciliary body suture reduction group were successfully reset, 12 of the modified ciliary body suture reduction group were successfully reset, the difference between the two groups was statistically significant (P0.05), and the reduction rates of the two groups were 90.9% (10/ 11), respectively.), 100% (12/ 12), difference between two groups There was no significant difference between the two groups (P0.05). The mean IOP of the two groups was 6.45, 1.58mmHg, 6.78% and 1.43mmHg, respectively. The mean IOP of the two groups recovered after the operation. The difference between the two groups was statistically significant (the traditional group t =-12.34, P0.01; modified group t =-11.85, P0.01), but there was no significant difference in IOP between the two groups (t The pre-operative visual acuity of the traditional ciliary body suture reduction group and the modified ciliary body suture reduction group were 0.25, 0.21, 0.29 and 0.23, respectively. The visual acuity was 0.42, 0.26, 0.45 and 0.21, respectively. The visual acuity of 0.3 was 63.6% and 66.6%, respectively. t =-5.27, P0.01; modified group t =-5.89, P0.01). There was a difference in visual acuity between the two groups. There was no statistical significance (P0.05). The content of IL-6 in the ciliary body was 70. 25, 58. 64pg/ ml, 6.29 and 1.25pg/ ml, respectively, and the content of TNF-1 was 18.59 and 5.75pg/ ml, respectively. The content of IL-6 and TNF-1 in the body of the ciliary body from the patient's ciliary body was higher than that in the autoserum. There was no significant difference between OCT and UBM, but it was non-contact. The present invention provides a new examination method for the detachment of the ciliary body, in particular to a patient which is not suitable for the contact examination of the angle mirror and the UBM or the like and the patients with higher comfort requirements in the examination process, and the traditional ciliary body suture reduction method and the improved ciliary body The suture and reduction method can effectively reset the indexes of the ciliary body, the intraocular pressure, the vision and the like, and has good effect, but the improved operation is relatively simplified compared with the conventional operation type operation. and the content of the IL-6 and the TNF-1 in the cavity of the ciliary body of the patients with the traumatic ciliary body is higher than the content in the serum of the patient, and the two can be involved in the infiltration of the cavity of the ciliary body. The process of formation and development of liquid, in which the effect is played, to prevent
【學位授予單位】：天津醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R773.3
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