本地区原发性青光眼患者房水与血清幽门螺杆菌IgG抗体的研究

发布时间：2018-04-19 17:38

本文选题：原发性开角型青光眼 + 原发性闭角型青光眼　；参考：《河北医科大学》2012年硕士论文

【摘要】：目的：青光眼是世界上最常见的致盲原因之一，是由多种因素引起的进展性视神经病变，具体机制尚不是很清楚。现在较公认的是把青光眼按房角开放程度分为原发性开角型青光眼（primary open angle glaucoma，POAG）和原发性闭角型青光眼（primary angle-closure glaucoma，PACG）。人们对原发性闭角型青光眼的发病机制研究的比较清楚，而原发性开角型青光眼的病因和发病机制较为复杂，一直是青光眼研究领域的重要问题，但至今尚不完全清楚，随着研究的深入，目前倾向于由于小梁细胞的形态和功能异常，导致房水流出受阻，眼压升高所造成的，而青光眼视神经损害的多因素综合理论，包括机械学说和血管血流学说，并重视细胞凋亡和线粒体的作用，并且自身免疫反应应激机制可能产生直接损害视网膜细胞的抗体而发挥作用，随后一些学者发现幽门螺杆菌作为病原体也参与了青光眼发病的过程，但其相关性由于不同学者的研究方法不同而有不同的结论，具体作用机制目前仍不是很清楚，仍需进一步研究。幽门螺杆菌为革兰阴性、微需氧链球菌，病理学和临床研究均明确了幽门螺杆菌在慢性胃炎和消化道溃疡的作用机制以及作为胃癌的危险因素，幽门螺杆菌感染引起胃部疾病的严重性及最终的临床结果由宿主、菌株及细菌毒力共同决定。除胃部疾病，幽门螺杆菌还与心脑血管疾病、血液系统疾病、和自身免疫性疾病如干燥综合症、免疫性血小板减少性紫癜等胃肠道以外疾病相关联。Kountouras等最先报道在希腊人群中青光眼幽门螺杆菌感染率明显高于正常对照组，推测幽门螺杆菌感染可能与青光眼的发病机制相关联。此外，还有多数学者通过不同的研究方法得出相同的结论，然而，也有学者通过研究认为它们之间没有相关性。我们的研究在于比较本地区原发性开角型青光眼、原发性闭角型青光以及白内障患者房水和血清中幽门螺杆菌IgG抗体的水平，以此来探讨幽门螺杆菌感染是否与原发性开角型青光眼有关联，借以探索青光眼的发病机制，从而为临床治疗提供指导意见和理论依据。方法：本实验患者来源于2010年11月到2011年8月在河北医大二院眼科及邢台眼科医院住院治疗的原发性开角型青光眼患者，于同期在河北医大二院住院治疗的原发性闭角型青光眼和单纯白内障患者。在青光眼患者小梁切除手术进入前房之前收集25例25眼原发性开角型青光眼（POAG组）、30例30眼原发性闭角型青光眼（PACG组）；在白内障超声乳化吸除术行角膜切口之前收集33例33眼单纯老年性白内障患者（正常对照组）房水约0.06ml，放入-70°C的冰箱保存，并与手术同一天采集患者静脉血3ml，离心，4000转/分，十分钟，获得血清放入-70°C的冰箱保存，20-25天之内应用胶体金标记免疫斑点渗滤法测定88例患者房水和血清幽门螺杆菌IgG抗体的阳性率。用SPSS13.0软件进行统计学分析，三组中计量资料均数的比较采用方差分析，幽门螺杆菌阳性率用卡方检验进行分析。结果：本研究共收集血清和房水各88例，原发性开角型青光眼组病例25例25眼；原发性闭角型青光眼组病例30例30眼；单纯性白内障组病例33例33眼，三组之间平均年龄和性别分别应用方差分析和卡方检验进行统计学分析，，三组人口构成比之间差异不显著，青光眼各组之间平均光敏度缺损差异不显著，青光眼各组平均眼内压明显高于正常对照组，具有统计学意义，而青光眼各组之间无明显差别。19/25（76%）的原发性开角型青光眼组患者，13/30(43.3%)原发性闭角型青光眼组患者,10/33(30.3%)单纯性白内障组患者血清中检测到幽门螺杆菌IgG抗体,各组之间应用χ2检验进行比较，原发性开角型青光眼组明显高于原发性闭角型青光眼组和单纯性白内障组患者，有统计学意义(分别为P=0.014，P=0.001)，而原发性闭角型青光眼组和单纯性白内障组患者之间差异不显著，无统计学意义(P=0.283)。6/25（24%）的原发性开角型青光眼组患者，7/30(23.3%)原发性闭角型青光眼组患者,7/33(21.2%)单纯性白内障组患者房水中检测到幽门螺杆菌IgG抗体，应用χ2检验进行统计学分析，认为三组房水之间差异不显著（P=0.964），无统计学意义。结论：虽然原发性开角型青光眼组，原发性闭角型青光眼组，单纯性白内障组房水中幽门螺杆菌IgG抗体阳性率没有明显差异性，但是原发性开角型青光眼组血清中幽门螺杆菌IgG抗体明显高于其他两组，可能由于我们的实验试剂以及房水中幽门螺杆菌IgG抗体滴度比血清低的原因，因此我们认为幽门螺杆菌感染可能是原发性开角型青光眼的危险因素之一，并且在促进原发性开角型青光眼的发生和进展中发挥一定的作用。同时我们还需要在大量青光眼人群中根据临床表现和客观检查进一步研究验证幽门螺杆菌的存在是否会影响青光眼视神经病变的发展。
[Abstract]:Objective: glaucoma is one of the most common causes of blindness in the world. It is a progressive optic neuropathy caused by a variety of factors. The specific mechanism is not yet clear. It is now recognized that glaucoma is divided into primary open angle glaucoma (primary open angle glaucoma, POAG) and primary angle closure glaucoma (PRI). Mary angle-closure glaucoma, PACG). People are quite clear about the pathogenesis of primary angle closure glaucoma, and the etiology and pathogenesis of primary open angle glaucoma are more complex. It has been an important problem in the field of glaucoma research. But it is not completely clear now. With the further research, it is inclined to be the trabecula. The morphological and functional abnormalities of the cells, resulting in the obstruction of the aqueous humor and the increase of intraocular pressure, and the multifactor theory of glaucomatous optic nerve damage, including the theory of mechanical and vascular blood flow, and the importance of apoptosis and the role of mitochondria, and the mechanism of autoimmune reaction may produce direct damage to retinal cells. Some scholars have found that Helicobacter pylori has also been involved in the pathogenesis of glaucoma, but its relevance has different conclusions due to different research methods of different scholars. The specific mechanism is still not very clear and still needs further research. Helicobacter pylori is a gram negative, microaerobic chain ball. The mechanism of Helicobacter pylori in chronic gastritis and alimentary tract ulcers and the risk factors of gastric cancer, the severity of Helicobacter pylori infection caused by Helicobacter pylori infection and the final clinical results are determined by the host, strain and bacterial virulence. Vascular disease, blood system disease, and autoimmune diseases such as Sjogren syndrome, immune thrombocytopenic purpura, and other gastrointestinal diseases associated with.Kountouras, the first reported in the Greek population of Helicobacter pylori infection rate is significantly higher than the normal control group, it is presumed that Helicobacter pylori infection may be associated with the hair of glaucoma. In addition, many mathematicians come to the same conclusion by different methods of study. However, some scholars have also found that there is no correlation between them. Our study is to compare the primary open angle glaucoma in the region, the primary angle closure, and the aqueous and serum pyloric screw in the patients with cataract. The level of IgG antibody is used to investigate whether Helicobacter pylori infection is associated with primary open angle glaucoma, to explore the pathogenesis of glaucoma and to provide guidance and theoretical basis for clinical treatment.
Methods: primary open angle glaucoma patients were hospitalized in the second hospital of Hebei Medical University and Xingtai ophthalmology hospital from November 2010 to August 2011. Primary angle closure glaucoma and simple cataract patients were hospitalized in the second hospital of Hebei Medical University. Before trabeculectomy in glaucoma patients, the patients were treated with trabeculectomy. Before the room, 25 cases of 25 eyes primary open angle glaucoma (group POAG), 30 cases of 30 eyes with primary angle closure glaucoma (group PACG) were collected. Before the cataract phacoemulsification, 33 cases of 33 eyes of simple senile cataract patients (normal control group) were collected before the corneal incision, and the aqueous humor of the normal control group was about 0.06ml, and -70 degree C was stored in the refrigerator, and the day was collected on the same day with the operation. The patient's venous blood was 3ml, centrifuge, 4000 turns / minutes, ten minutes, and the serum was stored in the refrigerator of -70 C. The positive rate of IgG antibody in aqueous humor and sera Helicobacter pylori was measured by colloidal gold labeling immuno filtration method within 20-25 days. The statistical analysis was carried out by SPSS13.0 software, and the comparison of the data in the three groups was compared. The positive rate of Helicobacter pylori was analyzed by chi square test.
Results: 88 cases of serum and aqueous humor were collected, 25 cases of primary open angle glaucoma group were 25 eyes, 30 cases were 30 eyes of primary angle closure glaucoma group, 33 cases of simple cataract group were 33 eyes, and the average age and sex between three groups were analyzed statistically by variance analysis and chi square test, and the three groups were composed of population. There was no significant difference in the average light sensitivity difference between each group. The average intraocular pressure in each group was significantly higher than that of the normal control group. There was no significant difference between the groups of glaucoma groups and.19/25 (76%) of primary open angle glaucoma group, and 13/30 (43.3%) primary angle closure glaucoma group. The IgG antibody of Helicobacter pylori was detected in the serum of 10/33 (30.3%) simple cataract group. The x 2 test was used for comparison among the groups. The primary open angle glaucoma group was significantly higher than the primary angle closure glaucoma group and the simple cataract group. It was statistically significant (P=0.014, P=0.001, respectively). There was no significant difference between the patients in the light eye group and the simple cataract group. There was no statistical significance (P=0.283).6/25 (24%) primary open angle glaucoma group, 7/30 (23.3%) primary angle closure glaucoma group, and 7/33 (21.2%) simple cataract group with IgG antibody of Helicobacter pylori detected by Fang Shuizhong, and the x 2 test was used to make statistics Analysis showed that there was no significant difference between the three groups (P=0.964).
Conclusion: Although there is no significant difference in the positive rate of Helicobacter pylori IgG antibody in primary angle closure glaucoma group, primary angle closure glaucoma group and simple cataract group, the IgG antibody of Helicobacter pylori in serum of primary open angle glaucoma group is significantly higher than that of other two groups, which may be due to our experimental reagent and room. We think that Helicobacter pylori infection may be one of the risk factors for primary open angle glaucoma, and it may play a role in the development and progression of primary open angle glaucoma, and we also need to be in the presence of a large number of glaucoma people. We also need to be on the basis of a large number of glaucoma people in the water. Further studies on bed performance and objective examination confirm whether the presence of Helicobacter pylori affects the development of glaucomatous optic neuropathy.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R775

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