激光光凝对糖尿病视网膜病变细胞因子的影响

发布时间：2018-05-30 16:56

本文选题：阈值下577nm微脉冲激光 + 血管内皮生长因子　；参考：《南方医科大学》2017年硕士论文

【摘要】：第一章阈值下577nm微脉冲激光光凝对早期糖尿病大鼠视网膜VEGF、NGF和Chemerin的影响目的观察阈值下577nm微脉冲激光光凝对早期糖尿病大鼠视网膜血管内皮生长因子(Vascular endothelial growth factor,VEGF)、神经生长因子(Nerve growth factor,NGF)和趋化素(Chemerin)的影响。方法采用65mg·kg-1链脲佐菌素对40只棕色挪威(Brown Norway,BN)大鼠建立糖尿病大鼠模型。造模成功后2周选取20只大鼠,采用lQ577nm(美国IRIDEX公司)激光行阈值下微脉冲激光处理。先将激光调成连续波模式在右眼周边部视网膜行阈能量测定,设定光斑直径:200 μm,曝光时间200sm,设定视网膜刚变白时的能量为阈值能量。然后转换成微脉冲模式,微脉冲激光参数:光斑直径:200 μ m,曝光时间200sm,负载系数5%,400%的阈能量,在视盘周围以4点距阵方法行200个光凝点。左眼不做任何处理,作为对照组。在微脉冲激光光凝后3d、7d、14d、28d随机各选取5只大鼠,应用实时荧光定量PCR和Western blot方法检测BN大鼠双眼视网膜VEGF、NGF和Chemerin表达情况。结果对照组VEGFmRNA和蛋白在3d、7d、14d、28d表达均增加,差异有统计学意义(P0.05);微脉冲激光组VEGF mRNA和蛋白在3d、7d、14d、28d相比于对照组下降,差异有统计学意义(均为P0.05)。对照组3d、7d、14d、28d NGF mRNA和蛋白逐渐下降(P0.05),7d NGF比3d下降,差异无统计学意义(P0.05);微脉冲激光组NGFmRNA和蛋白在3d、7d、14d、28d相比于对照组上升,且在14d达到峰值,差异有统计学意义(均为P0.05)。对照组ChemerinmRNA和蛋白在3d、7d、14d、28d表达均增加,差异有统计学意义(P0.05);微脉冲激光组ChemerinmRNA和蛋白在3d、7d、14d、28d相比于对照组下降,差异有统计学意义(均为P0.05)。结论阈值下577nm微脉冲激光光凝可降低早期糖尿病大鼠视网膜VEGF、Chemerin表达,上调NGF表达。第二章比较传统激光光凝与阈值下微脉冲激光光凝对增生型糖尿病性视网膜病变患者玻璃体组织内VEGF、IL-33及NO浓度的影响目的对比传统激光光凝与阈值下微脉冲激光光凝对增生型糖尿病性视网膜病变(Proliferative diabetic retinopathy,PDR)患者玻璃体组织中血管内皮生长因子(Vascular endothelial growth factor,VEGF),白细胞介素-33(Interleukin-33,IL-33)和一氧化氮(Nitric oxide,NO)浓度的影响。方法确诊为PDR患39例39只眼纳入研究。将就诊患者分为传统激光治疗PDR(15例15只眼)、阈值下微脉冲激光光凝治疗PDR(13例13只眼)组和未行任何激光治疗的PDR(11例11只眼)。同时11例11只眼特发性黄斑皱褶(Idiopathic macular pucker,IMP)患者作为非糖尿病对照组。两组激光治疗后3天及及所有入组患眼均行常规玻璃体切割术。术中收集患者玻璃体组织,采用酶联免疫吸附法测定玻璃体组织中VEGF、IL-33、NO浓度,术后行光相干断层扫描测量黄斑中心凹厚度。对比传统激光与阈值下微脉冲激光光凝对PDR患者玻璃体组织中VEGF、IL-33及NO浓度的影响,分析各组蛋白浓度与黄斑中心凹厚度相关性。结果未行任何激光治疗的PDR组VEGF浓度最高,高于传统激光治疗PDR组(P=0.005),高于阈值下微脉冲激光光凝治疗PDR组(P=0.018),高于IMP组(P0.001);传统激光治疗PDR组与阈值下微脉冲激光光凝治疗PDR组VEGF浓度无统计学差异(P=0.69)。传统激光治疗PDR组IL-33浓度最高,高于阈值下微脉冲激光光凝治疗PDR组(P=0.001),高于未行任何激光治疗的PDR组(P0.001),高于IMP组(P0.001);阈值下微脉冲激光光凝治疗PDR组和未行任何激光治疗的PDR组IL-33浓度无统计学差异(P=0.30)。IMP组NO浓度最低,低于传统激光治疗PDR组(P0.001),低于阈值下微脉冲激光光凝治疗PDR组(P0.001),低于未行任何激光治疗的PDR组(P0.001)。传统激光治疗PDR组与阈值下微脉冲激光光凝治疗PDR组NO浓度无差异(P=0.23)。在未行任何激光治疗的PDR组内,CFT与NO浓度具有相关性(r=0.67,P=0.025)。结论氪激光光凝与阈值下微脉冲激光光凝在3天后可降低PDR患玻璃体组织中VEGF浓度,阈值下微脉冲激光光凝产生的炎性反应更小。
[Abstract]:The effects of 577nm micropulse laser photocoagulation on VEGF, NGF and Chemerin in the retina of early diabetic rats under threshold value were observed. Objective To observe the retinal vascular endothelial growth factor (Vascular endothelial growth factor, VEGF) and nerve growth factor (Nerve growth) in early diabetic rats under the threshold value of 577nm micropulse laser The effect of chemokine (Chemerin). Methods the diabetic rat model was established by 65mg kg-1 streptozotocin in 40 brown Norway (Brown Norway, BN) rats. 20 rats were selected at 2 weeks after the model was successful, and the laser irradiation threshold of lQ577nm (American IRIDEX company) was used. Retina line threshold energy measurement, setting light spot diameter: 200 mu m, exposure time 200sm, setting the energy of the retinal rigid white energy as threshold energy. Then convert into micro pulse mode, micro pulse laser parameters: light spot diameter: 200 mu m, exposure time 200sm, load coefficient 5%, 400% threshold energy, 200 photocoagulation around disc 4 point array method around the disc. The left eye did not do any treatment, as the control group. After the micro pulse laser photocoagulation 3D, 7d, 14d, 28d randomly selected 5 rats, the real time fluorescence quantitative PCR and Western blot methods were used to detect the VEGF, NGF and Chemerin expression in the retina of BN rats. The VEGF mRNA and protein in the micro pulse laser group decreased in 3D, 7d, 14d, and 28d compared to the control group, and the difference was statistically significant (all P0.05). The control group was 3D, 7d, 14d, 28d, and protein gradually descended. In the control group, the difference was statistically significant (P0.05). The expression of ChemerinmRNA and protein in the control group increased in 3D, 7d, 14d, 28d, and the difference was statistically significant (P0.05). The difference was statistically significant compared with the control group (3D, 7d, 14d, and 14d). The difference was statistically significant (all 14d). 577nm micropulse laser photocoagulation can reduce the VEGF, Chemerin expression and up regulation of NGF expression in the retina of early diabetic rats. The second chapter compares the traditional laser photocoagulation and the threshold of micropulse laser photocoagulation to the concentration of VEGF, IL-33 and NO in the vitreous tissue of patients with proliferative diabetic retinopathy The effect of the concentration of vascular endothelial growth factor (Vascular endothelial growth factor, VEGF), interleukin -33 (Interleukin-33, IL-33) and nitric oxide in the vitreous tissue of patients with proliferative diabetic retinopathy (Proliferative diabetic retinopathy, PDR) by coagulation and threshold micropulse laser photocoagulation. The patients were diagnosed as PDR with 39 eyes in 39 cases. The patients were divided into traditional laser treatment PDR (15 cases 15 eyes), PDR (13 cases, 13 eyes) and PDR (11 cases, 11 eyes) without laser treatment under threshold, and 11 patients with 11 eyes (Idiopathic macular pucker, IMP) as non diabetic patients in 11 eyes. Normal vitrectomy was performed at 3 days after the two group of laser treatment and all the eyes of the two groups. The vitreous tissue was collected and the concentration of IL-33, NO in vitreous tissue was measured by enzyme linked immunosorbent assay (ELISA). The thickness of the macular fovea was measured by optical coherence tomography after the operation. The effect of photocoagulation on the concentration of VEGF, IL-33 and NO in the vitreous tissue of PDR patients was analyzed. The correlation between the concentration of protein and the thickness of the macular fovea was analyzed. Results the concentration of VEGF in the PDR group without any laser treatment was the highest, higher than that of the traditional laser therapy group (P=0.005), higher than the threshold of micropulse laser photocoagulation in the PDR group (P=0.018), higher than that of IMP group (P0.0). 01): there was no significant difference between the traditional laser treatment group PDR and the threshold of micropulse laser photocoagulation in group PDR (P=0.69). The concentration of IL-33 in the PDR group was highest in the traditional laser treatment group, higher than that in the PDR group (P=0.001) under the threshold of micropulse laser photocoagulation (P=0.001), higher than that of the group without any laser treatment (P0.001), higher than that of the IMP group (P0.001), and the micro pulse under the threshold value. The concentration of IL-33 in group PDR and PDR group without laser treatment was not statistically significant (P=0.30) in group.IMP, the NO concentration was the lowest, lower than the traditional laser treatment group PDR group (P0.001), lower than the threshold of micropulse laser photocoagulation in group PDR (P0.001), lower than that of no light therapy (P0.001). Traditional laser treatment group and threshold under the threshold There was no difference in the concentration of NO in the PDR group with micropulse laser photocoagulation (P=0.23). In the PDR group without any laser treatment, the concentration of CFT and NO was correlated (r=0.67, P=0.025). Conclusion krypton laser photocoagulation and the threshold of micro pulse laser photocoagulation can reduce the VEGF concentration in the PDR affected vitreous tissue in 3 days, and the inflammatory properties of the micropulse laser photocoagulation at the threshold value. The reaction is smaller.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R779.63

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