【摘要】： 目的：通過建立兔角膜堿燒傷模型,探討刮除與保留角膜上皮后,地塞米松聯(lián)合羊膜勻漿上清液與地塞米松單獨用藥治療角膜堿燒傷的療效差異。 方法：24只成年家兔隨機分為A、B、C、D四組,每組6只眼,建立右眼角膜堿燒傷模型。A組刮除角膜上皮+地塞米松結(jié)膜下注射；B組刮除角膜上皮+地塞米松結(jié)膜下注射+羊膜勻漿上清液點眼；C組保留角膜上皮+地塞米松結(jié)膜下注射；D組保留角膜上皮+地塞米松結(jié)膜下注射+羊膜勻漿上清液點眼。在堿燒傷后不同時點,角膜1%熒光素鈉染色,眼前節(jié)拍照,計算機圖像分析；不同時點制作病理切片,進行光鏡及電鏡觀察。 結(jié)果： 1、角膜上皮修復(fù)率：角膜堿燒傷后,各組角膜上皮逐漸愈合,1d各組角膜上皮修復(fù)率比較,差異均有統(tǒng)計學意義(P0.05),B組(0.4632±0.01222)優(yōu)于A組(0.3925±0.03352),A組優(yōu)于D組(0.3541±0.01457),D組優(yōu)于C組(0.3009±0.02575)。3d時B組(0.8143±0.02444)分別與A組(0.7694±0.02181)、C組(0.7025±0.01258)、D組(0.7625±0.03187)比較,差異均有統(tǒng)計學意義(P0.05),B組優(yōu)于其它各組,C組與A組、D組比較,結(jié)果有統(tǒng)計學意義(P0.05),C組角膜上皮愈合較A、D組差,A組與D組比較,差異無統(tǒng)計學意義(P0.05)。7d除A組(0.9620±0.02681)與D組(0.9594±0.02607)比較差異無統(tǒng)計學意義(P0.05)外,其余各組間比較,差異均有統(tǒng)計學意義(P0.05),B組(0.9905±0.01075)優(yōu)于A、D組,A、D組優(yōu)于C組(0.9057±0.00853)。 2、光鏡檢查：堿燒傷后7d,B組角膜上皮約3-4層,細胞形態(tài)規(guī)則；C組角膜上皮約2-3層,細胞形態(tài)異常且排列紊亂,A、D組角膜上皮2-4層,部分細胞排列不規(guī)則。堿燒傷后14d,B組角膜基質(zhì)層膠原纖維排列較A、C、D組整齊,炎胞浸潤亦較少；C組與A、D組比較,C組膠原纖維排列紊亂且炎細胞浸潤較多；A、D組形態(tài)改變相似,膠原纖維排列情況及炎細胞浸潤介于B、C組之間。 3、透射電鏡檢查：堿燒傷后14d,B組角膜上皮細胞形態(tài)大致正常,細胞間橋粒數(shù)量較多,細胞內(nèi)線粒體、粗面內(nèi)質(zhì)網(wǎng)、高爾基復(fù)合體較多,染色質(zhì)豐富,基質(zhì)層膠原纖維排列較整齊；C組角膜上皮細胞形態(tài)不規(guī)則,細胞間隙大,未見橋粒連接,可見大量線粒體固縮或空泡化,可見核旁脂滴,基質(zhì)層膠原纖維排列紊亂；A、D組介于B、C組之間,可見少量橋粒連接及核旁脂滴。 結(jié)論： 1、角膜堿燒傷后,早期刮除角膜上皮后再進行藥物治療療效優(yōu)于未刮除上皮組。 2、地塞米松聯(lián)合羊膜勻漿上清液治療角膜堿燒傷比地塞米松單獨用藥療效好。
[Abstract]:Aim: to investigate the therapeutic effect of dexamethasone combined with amniotic membrane homogenate supernatant and dexamethasone alone on corneal alkali burn by establishing rabbit corneal alkali burn model after curettage and preservation of corneal epithelium. Methods: twenty-four adult rabbits were randomly divided into four groups (group A, B, C, D, 6 eyes in each group) to establish corneal alkali burn model in right eye. Group A was given subconjunctival injection of dexamethasone and scraped corneal epithelium. Group B received subconjunctival injection of amniotic membrane homogenate supernatant, group C retained subconjunctival injection of corneal epithelium dexamethasone, and group D retained corneal epithelial dexamethasone subconjunctival injection of amniotic membrane homogenate supernatant. At different time points after alkali burn, the cornea was stained with 1% fluorescein sodium, the anterior segment was photographed and the image was analyzed by computer, the pathological sections were made at different time points and observed by light and electron microscope. Results: 1, corneal epithelial repair rate: after alkali burn, corneal epithelium gradually healed in each group, and there was significant difference in corneal epithelial repair rate in each group on the 1st day (P0.05). Group B (0.4632 鹵0.01222) was superior to Group A (0.3925 鹵0.03352), A) than Group D (0.3541 鹵0.01457), D) better than Group C (0.3009 鹵0.02575). On the 3rd day, Group B (0.8143 鹵0.02444) was better than Group A (0.7694 鹵0.02181). C group (0.7025 鹵0.01258), D group (0.7625 鹵0.03187), the difference was statistically significant (P0.05), B group was better than other groups, C group and A, D group, the results were statistically significant (P0.05), the results were statistically significant (P0.05). The corneal epithelium healing in group C was worse than that in group A and D, and there was no significant difference between group A and group D (P0.05). There was no significant difference in corneal epithelial healing between group A (0.9620 鹵0.02681) and group D (0.9594 鹵0.02607) (P0.05) at 7d, except for group A (0.9620 鹵0.02681) and group D (0.9594 鹵0.02607). The difference among the other groups was statistically significant (P0.05:), B group (0.9905 鹵0.01075) was better than A, D group, A, D group was better than C group (0.9057 鹵0.00853). 2. Light microscopy: on the 7th day after alkali burn, the corneal epithelium of group B was about 3 and 4 layers, and the morphology of the cells was regular. In group C, the corneal epithelium was about 2 ~ 3 layers, the morphology of the cells was abnormal and the arrangement was disordered. In group A, the corneal epithelium of group D was 2 ~ 4 layers, and some of the cells were arranged irregularly. On the 14th day after alkali burn, collagen fibers in group B were more orderly than those in group A, C, D, and there were fewer inflammatory cells in group C than those in group A and D, and the arrangement of collagen fibers in group C was more irregular than that in group A and D, and the infiltration of inflammatory cells was more in group C than that in group A and D. The morphological changes of group A and D were similar. The arrangement of collagen fibers and infiltration of inflammatory cells in group A and D were between B group and C group. 3. Transmission electron microscopy (TEM): on the 14th day after alkali burn, corneal epithelial cells in group B were almost normal in shape, with a large number of desmosomes, intracellular mitochondria, rough endoplasmic reticulum, Golgi complex and abundant chromatin. The collagen fibers in the matrix layer were arranged neatly. In group C, the corneal epithelial cells were irregular in shape, with large gap, no desmosome junction, a large number of mitochondria pyknosis or vacuolization, lipid droplets around nucleus and disordered arrangement of collagen fibers in the stroma. A, D group was between B group and C group, a small number of desmosome junctions and lipid droplets were observed. Conclusion: 1. After alkali burn of cornea, the curative effect of drug therapy after early curettage of corneal epithelium is better than that of non-curettage group. 2.Dexamethasone combined with amniotic membrane homogenate supernatant was better than dexamethasone alone in the treatment of corneal alkali burn.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R779.1

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