新生血管性青光眼患者血清及房水中PEDF、VEGF水平及其病因相关性研究

发布时间：2018-06-24 05:17

本文选题：新生血管性青光眼 + 色素上皮衍生因子　；参考：《大连医科大学》2012年硕士论文

【摘要】：目的：新生血管性青光眼（nonvascular glaucoma, NVG）系虹膜表面及房角有新生血管,合并纤维血管膜形成,导致房角关闭进而产生的一种继发性青光眼。缺血和缺氧共同作用导致虹膜及房角新生血管的产生,其中包含了一系列的复杂病理过程。缺血缺氧既会引起新生血管促进因子的释放,同时也会引起血管生成抑制因子的产生,当前者作用大于后者时,便会产生新生血管[1]。色素上皮衍生因子（pigment epithelium derived factor, PEDF）和血管内皮生长因子(vascularendothelial growth factor, VEGF)被认为是血管形成抑制因子和诱导因子的一对典型代表，本实验通过检测NVG患者血清与房水中PEDF和VEGF的水平，进一步探索PEDF和VEGF对眼部新生血管的作用机制，为眼部新生血管的预防和治疗提供新的思路；通过血清与房水中血管因子的相关性研究，试图找到血清中能够反应房水中相关因子水平的指标，进而研究和建立能够正确预测NVG发病及病情进展情况的客观指标，为临床的早期预测、评估病情和判断预后提供相关的理论依据。方法：选取NVG患者20例作为实验组（A组），原发性慢性闭角型青光眼患者（B组）作为高眼压对照组20例、老年性白内障患者（C组）作为正常对照组20例。采集患者血清及房水标本，通过双抗体夹心酶联免疫吸附试验(enzyme-linked immuno sorbent assay, ELISA法)分别检测血清与房水中PEDF、VEGF的水平。应用SPSS18.0统计软件处理数据，同组内同一因子在血清及房水间的数据比较用独立样本t检验；不同组间的相同因子的比较用单因素方差分析（ANOVA）。相关性分析采用Pearson相关系数检验。 P＜0.05表示差异具有统计学意义。结果：1.一般情况 A组：收集2011年3月至2012年3月在大连医科大学附属第二医院眼科住院的NVG患者20例（20眼），其中男性11例（11眼），女9例（9眼）；右眼12例，左眼8例；年龄36.0岁-85.0岁，平均年龄66.16±15.12岁。术前眼压范围21-94mmHg，平均59.05±21.33mmHg。糖尿病性视网膜病变（DR）14例、视网膜中央静脉阻塞（CRVO）2例、病因不明4例。 B组：同时期我科住院的原发性慢性闭角型青光眼患者，20例（20眼），其中男8例（8眼），女12例（12眼）；右眼10例，左眼10例；年龄49.0岁-76.0岁，，平均年龄60.00±8.96岁。术前眼压范围22-71mmHg，平均45.80±16.79mmHg。 C组：同时期我科住院的老年性白内障患者，20例（20眼），其中男14例（14眼），女6例（6眼）；右眼9例，左眼11例；年龄48.0岁-76.0岁，平均年龄71.95±11.24岁。术前眼压范围10-21mmHg，平均15.90±2.05mmHg。各组间年龄、性别、眼别差异无统计学意义（P＞0.05） 2. PEDF的水平 ①房水中PEDF水平：A组217.15±30.12pg/ml明显低于B组460.85±1.86pg/ml和C组520.10±9.59pg/ml，三组间两两比较，差异均具有统计学意义（F=155.01,P＜0.05）。 ②血清中PEDF水平：A组12.65±7.66mg/L、B组15.20±2.70mg/L和C组13.35±4.21mg/L，三组间两两比较，差异均不具有统计学意义（P＞0.05）。 3. VEGF的水平 ①房水中VEGF水平： A组1481.69±88.15pg/ml明显高于B组300.98±53.71pg/ml和C组180.23±15.01pg/ml，三组间两两比较，差异均具有统计学意义（F=1.63, P＜0.05）。 ②血清中VEGF水平：A组98.63±6.83pg/ml明显低于B组279.61±94.02pg/ml和C组142.05±34.99pg/ml，三组间两两比较，差异均具有统计学意义（F=2.66,P＜0.05）。 4.NVG患者房水与血清中PEDF水平的比较 A组患者房水中PEDF的水平低于血清中，差异具有统计学意义（t=7.170，P＜0.05）,但各组房水中PEDF浓度与相应血清中的含量无显著的相关性（P＞0.05）。 5.NVG患者房水与血清中VEGF水平的比较 NVG组患者房水中VEGF的水平明显高于血清中，差异具有统计学意义（t=-20.445，P＜0.05），但各组房水中VEGF浓度与相应血清中的含量无显著的相关性（P＞0.05）。6.三组房水中PEDF与VEGF水平的相关性三组房水中PEDF与VEGF水平呈负相关性，差异具有统计学意义（r=-0.67，r=-0.58，r=-0.47，P＜0.05）。结论：1.NVG患者虹膜新生血管形成可能与房水中PEDF水平降低、 VEGF水平升高有关。 2. PEDF和VEGF分别作为血管抑制因子和血管刺激因子，可能是促成NVG发生的重要因素。
[Abstract]:Objective: nonvascular glaucoma (NVG) is a secondary glaucoma caused by the formation of the iris surface and the angle of the atrial angle with the formation of the fibrous vascular membrane, resulting in the closure of the corner of the room. The joint action of ischemia and hypoxia leads to the production of the iris and the angle new blood tube, which contains a series of complicated pathological changes. Ischemia and hypoxia can cause the release of new vascular promoting factors, and also cause the production of angiogenesis inhibitors. When the current role is greater than that of the latter, the [1]. pigment epithelium derived factor (pigment epithelium derived factor, PEDF) and vascular endothelial growth factor (vascularendothelial growth factor) will be produced. VEGF) is considered to be a typical representative of angiogenesis inhibitors and inducible factors. By detecting the level of PEDF and VEGF in NVG patients' serum and aqueous humor, this experiment further explores the mechanism of PEDF and VEGF on ocular neovascularization, providing new ideas for the prevention and treatment of neovascularization of the eyes; and through serum and blood blood. In order to find out the indicators that can reflect the level of the related factors in the aqueous humor in the serum, the study and establishment of objective indicators that can correctly predict the incidence of NVG and the progression of the disease can provide a theoretical basis for the early clinical prediction, the assessment of the condition and the prognosis of the prognosis.
Methods: 20 cases of NVG patients were selected as experimental group (group A), 20 cases of primary chronic angle closure glaucoma (group B), 20 cases of high intraocular pressure control group and 20 cases of senile cataract (group C) as normal control group. The serum and aqueous humor samples were collected by double antibody sandwich enzyme linked immunosorbent assay (enzyme-linked immuno sorbent assay,) The levels of PEDF and VEGF in serum and aqueous humor were detected by ELISA method respectively. The data were processed with SPSS18.0 statistical software, and the same factor in the serum and aqueous humor in the same group was compared with the independent sample t test. The comparison of the same factors among the different groups was compared with the single factor variance analysis (ANOVA). The correlation analysis adopted the Pearson correlation coefficient test. P 0.05 indicated that the difference was statistically significant.
Results: 1. general situation
Group A: 20 patients (20 eyes) were collected from March 2011 to March 2012 at the ophthalmology department of the Second Affiliated Hospital of Dalian Medical University. There were 11 men (11 eyes), 9 women (9 eyes), 12 in the right eye, 8 in the left eye; the average age 36 years old and 66.16 + 15.12 years old. The preoperative intraocular pressure range was 21-94mmHg, average 59.05 + 21.33mmHg. diabetic retina. There were 14 cases of membrane lesion (DR), 2 cases of central retinal vein occlusion (CRVO) and 4 cases of unknown etiology.
Group B: 20 cases of primary chronic angle closure glaucoma hospitalized at the same time, 20 cases (20 eyes), including 8 men (8 eyes), 12 women (12 eyes), 10 right eyes and 10 left eyes, age 49 years -76.0 years old, average age 60 + 8.96 years. The preoperative intraocular pressure range was 22-71mmHg, average 45.80 + 16.79mmHg.
Group C: 20 cases of senile cataract in our hospital at the same time, 20 cases (20 eyes), of which 14 cases (14 eyes), 6 women (6 eyes), 9 right eyes, 11 left eye, age 48 years -76.0 years old, average age 71.95 + 11.24 years. The preoperative intraocular pressure range is 10-21mmHg, average 15.90 + 2.05mmHg.
There was no significant difference in age, sex and eye difference among groups (P > 0.05).
2. PEDF level
(1) PEDF level in aqueous humor: 217.15 + 30.12pg/ml in group A was significantly lower than that in group B, 460.85 + 1.86pg/ml and C group 520.10 + 9.59pg/ml, and 22 of the three groups were statistically significant (F=155.01, P < 0.05).
(2) the level of PEDF in serum: group A was 12.65 + 7.66mg/L, group B was 15.20 + 2.70mg/L and C group was 13.35 + 4.21mg/L, and the difference between the three groups was not statistically significant (P > 0.05).
3. VEGF level
(1) VEGF level in aqueous humor: 1481.69 + 88.15pg/ml in group A was significantly higher than that in group B, 300.98 + 53.71pg/ml and C group 180.23 + 15.01pg/ml, and 22 of the three groups were statistically significant (F=1.63, P < 0.05).
(2) the level of VEGF in serum: 98.63 + 6.83pg/ml in group A was significantly lower than that in group B, 279.61 + 94.02pg/ml and C group 142.05 + 34.99pg/ml, and 22 of the three groups were statistically significant (F=2.66, P < 0.05).
Comparison of the level of PEDF in water and serum in 4.NVG patients
The level of PEDF in aqueous humor of group A was lower than that in serum (t=7.170, P < 0.05), but there was no significant correlation between the concentration of PEDF in the aqueous humor of each group and the content of the corresponding serum (P > 0.05).
Comparison of the level of VEGF in water and serum in 5.NVG patients
The level of VEGF in aqueous humor of group NVG was significantly higher than that in serum, the difference was statistically significant (t=-20.445, P < 0.05), but there was no significant correlation between the concentration of VEGF in aqueous humor and the content of the corresponding serum (P > 0.05) the correlation between PEDF and VEGF levels in the aqueous humor of.6. three groups
There was a negative correlation between PEDF and VEGF level in three groups of aqueous humor, and the difference was statistically significant (r=-0.67, r=-0.58, r=-0.47, P < 0.05).
Conclusion: the formation of iris neovascularization in 1.NVG patients may be related to the decrease of PEDF level and the increase of VEGF level in aqueous humor.
2. PEDF and VEGF as vascular inhibitors and vascular stimulators may be important factors contributing to the occurrence of NVG.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R775

【参考文献】