M受体阻滞剂控制近视的实验和临床研究

发布时间：2018-03-21 03:33

本文选题：非选择性M受体阻滞剂　切入点：托吡卡胺　出处：《复旦大学》2012年硕士论文　论文类型：学位论文

【摘要】：第一部分三种非选择性M受体阻滞剂对豚鼠形觉剥夺性近视的影响目的：探讨非选择性M受体阻滞剂在豚鼠形觉剥夺性近视中的作用。材料和方法：将2～3周龄英国种短毛花色豚鼠60只,随机分为6组,每组10只：Ⅰ组单纯形觉剥夺组、Ⅱ组形觉剥夺+生理盐水组即阴性治疗组、Ⅲ组形觉剥夺+托吡卡胺组、Ⅳ组形觉剥夺+环戊通组、Ⅴ组形觉剥夺+阿托品组、Ⅵ组正常对照组。Ⅰ组仅右眼采用半透明眼罩进行形觉剥夺；Ⅱ～Ⅴ组右眼采用半透明眼罩进行形觉剥夺,相应每组豚鼠右眼分别给予玻璃体腔注射0.9%生理盐水、0.5%托吡卡胺、1%环戊通和0.5%阿托品,每次10μl,每4天注射1次,共7次；Ⅵ组豚鼠双眼开放饲养。所有豚鼠左眼均作为自身对照。屈光度测量采用睫状肌麻痹后带状光检影；A超测量前房深度、晶体厚度和眼轴长度,算出玻璃体腔长度；干预后游标卡尺测量离体眼球前后径。组内采用配对t检验,组间采用单因素方差分析(ANOVA),玻璃体腔长度差值和眼轴差值采用线性回归分析。以P0.05作为差异有统计学意义的标准。结果：形觉剥夺4周后,Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ组实验眼分别诱导出-5.11±1.78D、-5.75±2.27D、-5.50±1.47D、-4.20±2.06D和-2.13±0.48D相对近视；Ⅵ组相对近视量分别与Ⅰ、Ⅱ、Ⅲ、Ⅳ组存在统计学差异(P0.0001,P0.0001,P0.0001,P0.0001)。Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ组实验眼玻璃体腔比对侧眼分别延长0.2907±0.1358mm、0.2886±0.0946mm、0.1208±0.1867mm、0.2259±0.2814mm和0.1268±0.1540mm；6组间实验眼与对侧眼的玻璃体腔长度差值无统计学意义。Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ组实验眼眼轴比对侧眼分别延长0.2083±0.0758mm、0.2829±0.0765mm、0.0904±0.1740mm、0.0969±0.0647mm和0.0923±0.1304mm；Ⅵ组实验眼和对侧眼眼轴差值分别与Ⅰ、Ⅱ组有统计学差异(P=0.003,P0.0001),分别与Ⅲ、Ⅳ、Ⅴ组无统计学差异。6组实验眼与对侧眼玻璃体腔长度差值和眼轴长度差值呈显著正相关(r=0.685,P0.0001)。游标卡尺所测离体眼球前后径(8.43±0.26mm)显著大于A超所测活体眼轴长度值(8.09±0.12mm)(P0.0001)。结论：三种非选择性M受体阻滞剂均可减少豚鼠形觉剥夺性近视眼的眼轴延长；豚鼠形觉剥夺后玻璃体腔长度与眼轴长度的增加一致；游标卡尺法的眼轴测量值大于A超法测量值。第二部分近视儿童应用0.05%消旋山莨菪碱的临床观察目的：探讨非选择性M受体阻滞剂消旋山莨菪碱对儿童近视的控制作用。对象与方法：复旦大学附属眼耳鼻喉科医院视光中心门诊的近视儿童中选择合理期待并签署知情同意书的93名学龄儿童,符合以下条件：①6～14岁；②球镜范围为-0.50DS～-6.OODS,散光≤1.50DC；③双眼屈光间质清；④排除眼部器质性疾病。被试儿童分为药物干预组(n=50)和对照组(n=43)：①药物干预组儿童滴用0.05%消旋山莨菪碱眼液,每晚睡前使用1次,使用1年；②对照组儿童不给予任何近药物。药物干预组平均年龄为9.94±1.97岁,对照组为10.64±1.52岁；药物干预组平均等效球镜和眼轴长度分别为-2.14±1.60D和24.23±0.80mm,对照组为-2.28±0.78D和24.59±0.72mm。随访期为1年,每半年随访1次,给予主觉验光(?)(?)IOL Master测量眼轴长度。两组儿童不同时间点等效球镜和眼轴长度采用独立样本t检验。以P0.05作为差异有统计学意义的标准。结果：6个月、12个月时药物干预组平均等效球镜分别为-2.60±1.69D、-3.35±1.40D,对照组分别为-2.64±0.82D、-3.09±0.90D,两组间差异均无统计学意义(P=0.99,P=0.17)。药物干预组平均等效球镜分别增加-0.47±0.75D、-0.42±1.16D,对照组分别增加-0.33±0.37D、-0.45±0.35D,两组间差异无统计学意义(P=0.11,P=0.79)。6个月、12个月时药物干预组平均眼轴长度为24.52±0.80mm、24.97±0.76mm,对照组分别为24.75±0.72mm、24.88±0.74mm,两组间差异均无统计学意义(P=0.06,P=0.55)。药物干预组平均眼轴长度分别增加0.30±0.34mm、0.25±0.14mm,对照组分别增加0.17±0.10mm、0.12±0.09mm,两组间差异均有统计学意义(P0.001,P0.001)。结论：0.05%消旋山莨菪碱对儿童近视进展和眼轴延长的控制作用不明显；0.05%消旋山莨菪碱在部分儿童中的潜在有效性有待进一步探讨。
[Abstract]:The effect of three non selective M receptor blockers on form deprivation myopia in guinea pigs
Objective: To investigate the role of non selective M receptor blockers in the form deprivation myopia of guinea pigs.
Materials and methods: 2~3 week old British Shorthair color for 60 guinea pigs were randomly divided into 6 groups, 10 rats in each group: group I simplex deprivation group, group II deprivation + saline group: negative treatment group, III group deprivation + tropicamide group, group IV deprivation + cyclopentasiloxane the group V group form deprivation group VI + atropine group, normal control group. Group I only used translucent goggles for eye form deprivation; II to V group the right eyes of the translucent goggles for form deprivation, each group were given corresponding guinea pig right after intravitreal injection of 0.9% saline, 0.5% tropicamide and cyclopentolate 1%. 0.5% atropine, each 10 L, 1 injections every 4 days, a total of 7 times; VI group open eyes of guinea pigs. All guinea pigs were reared as control group. The left eye diopter measured by streak retinoscopy after cycloplegia; A ultrasound in measuring anterior chamber depth, thickness and axial length of crystal, Calculate the length of vitreous; after the intervention of vernier caliper to measure the eyeball in vitro. The group using paired t test, single factor analysis of variance between the groups (ANOVA), vitreous cavity length difference and axial difference using linear regression analysis. The difference was statistically significant with P0.05 as the standard.
Results: after 4 weeks of form deprivation, I, II, III, IV and V groups eyes were induced to -5.11 + 1.78D, -5.75 + 2.27D, -5.50 + 1.47D, -4.20 + 2.06D and -2.13 + 0.48D relative myopia; VI group relative myopic quantity and I, II, III, IV group, there was significant difference (P0.0001, P0.0001, P0.0001, P0.0001). I, II, III, IV and V groups extend into the vitreous side on the eyes of 0.2907 + 0.1358mm, 0.2886 + 0.0946mm, 0.1208 + 0.1867mm, 0.2259 + 0.2814mm and 0.1268 + 0.1540mm; the difference between the 6 groups of experimental vitreous length and the contralateral eyes without statistical significance. I, II, III, IV and V of experimental group prolonged ocular axial ratio lateral eye 0.2083 + 0.0758mm, 0.2829 + 0.0765mm, 0.0904 + 0.1740mm, 0.0969 + 0.0647mm and 0.0923 + 0.1304mm; VI group of experimental eyes and the contralateral eye axial difference respectively with I, II group was significantly different (P=0.003, P0.0001), respectively. III, IV, V group was positively related to no significant difference in the.6 group of experimental eyes and contralateral vitreous length difference and axial length difference (r=0.685, P0.0001). In vitro measured by vernier caliper eyeball (8.43 + 0.26mm) was significantly higher than that measured by in vivo A super axial length value (8.09. 0.12mm) (P0.0001).
Conclusion: three kinds of non selective M receptor blockers can reduce the axial lengthening of form deprivation myopia in guinea pigs. After the form deprivation in guinea pigs, the length of vitreous cavity is consistent with the increase of axial length. The axial measurement value of vernier caliper is larger than that of A.
Clinical observation on the application of 0.05% racemic anisodamine in second parts of myopic children
Objective: To investigate the control effect of non selective M receptor blocker racemic anisodamine on children's myopia.
Subjects and methods: select 93 school-age children of reasonable expectation and signed the informed consent of the Otolaryngological Hospital Affiliated to Fudan University outpatient optometry center of myopic children, meet the following conditions: 6~14 years old; the mirror ball is in the range of -0.50DS ~ -6.OODS, astigmatism less than 1.50DC; the refraction of interstitial Qing; the exclusion of ocular disease subjects. The children were divided into intervention group (n=50) and control group (n=43): drug intervention group children eye drops by 0.05% racanisodamine, every night before going to bed 1 times, 1 years; the control group not given any drug in drug intervention group. The average age was 9.94 + 1.97 years, control group 10.64 + 1.52 years; the drug intervention group average spherical equivalent and axial length were -2.14 + 1.60D and 24.23 + 0.80mm, the control group was -2.28 + 0.78D and 24.59 + 0.72mm. were followed up for a period of 1 years, every six months follow-up of 1 times, giving the main Jue Yanguang (IOL) Master measured the length of eye axis. The two groups of children were measured by the independent sample t test at different time points, and the P0.05 was used as a standard with statistically significant difference.
Results: 6 months, 12 months of drug intervention group average spherical equivalent were -2.60 + 1.69D, -3.35 + 1.40D, the control group was -2.64 + 0.82D, -3.09 + 0.90D, the difference between the two groups were not statistically significant (P=0.99, P=0.17). The drug intervention group the average spherical equivalent were increased -0.47. 0.75D, -0.42 + 1.16D, the control group increased in -0.33 + 0.37D, -0.45 + 0.35D, there was no significant difference between the two groups (P=0.11, P=0.79).6 months, 12 months of drug intervention group the mean axial length was 24.52 + 0.80mm, 24.97 + 0.76mm, the control group were 24.75 + 0.72mm, 24.88 + 0.74mm, the difference between the two groups were not statistically significant (P=0.06, P=0.55). The drug intervention group the mean axial length increased 0.30 + 0.34mm, 0.25 + 0.14mm, the control group were increased to 0.17 + 0.10mm, 0.12 + 0.09mm, there were significant differences between two groups (P0.001, P0.001).
Conclusion: 0.05%. The control effect of racanisodamine on myopia progression and axial lengthening in children is not obvious. 0.05%, the potential effectiveness of racanisodamine in some children needs further investigation.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R778.11

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