神经生长因子对青光眼视神经保护的临床观察

发布时间：2018-05-27 21:33

本文选题：神经生长因子 + 原发性闭角型青光眼　；参考：《郑州大学》2010年硕士论文

【摘要】： 背景和目的青光眼是一组以视神经萎缩和视野缺损为共同特征的多因素、进展性神经退化疾病。视网膜神经节细胞(retinal ganglion cell, RGCs)进行性丧失是其共同的病理改变。眼内压的升高是青光眼最为显著的危险因素,因此,当前大部分的治疗都是围绕降低眼内压来开展的。然而,眼压控制良好的青光眼患者仍然会发生视野缺损的恶化和RGCs的死亡。因此,需要一种附加的治疗已经得到了广泛的认可。随着青光眼视神经损伤动物模型研究领域的飞速发展,我们对青光眼的病理过程的认识也在不断提高。视神经保护药物的作用在这些实验基础上表现出越来越多的优越性,神经生长因子(nerve growth factor, NGF)作为一种重要的生物活性分子广泛作用于中枢和周围的神经元。近年来青光眼动物模型研究已经证实,外源性NGF与其受体结合一方面可以通过清除氧自由基,阻止谷氨酸引起的兴奋性毒作用以及稳定细胞内Ga2+浓度抑制RGCs凋亡；另一方面通过激活不同的信号传导通路,促进RGCs及轴突的发育和损伤后再生。本研究拟通过观察神经生长因子(NGF)对原发性闭角型青光眼患者血浆内皮素(endothelin,ET)、血清一氧化氮(nitric oxide, NO)、视力、眼压、视野、视觉电生理(visual evoked potential, VEP)等指标的影响,进一步探讨其作用机制,为青光眼临床预防和治疗工作提供新的思路。方法本研究选择2008年12月至2009年10月间,在郑州大学第一附属医院眼科检查,临床确诊为原发性闭角型青光眼,住院后行小梁切除术治疗的患者。符合上述标准共56例(56眼)。56例病例中,男性24例,女性32例,年龄41～68岁,中位年龄54.3±7.97。其中8例双眼均行手术患者,取术后矫正视力较好眼为观察眼。随机分为NGF治疗组29例(29眼)与甲钴胺对照组27例(27眼)。治疗组术后给予注射用鼠神经生长因子治疗,对照组术后常规口服甲钴胺片。测定各组治疗前、后及1月后复查的视力、眼压、视野、视觉诱发电位(VEP)指标、血浆ET-1和血清NO水平。所有数据用均数±标准差表示,数据统计分析由SPSS17.0软件完成。对于组内比较采用t检验,同期组间比较采用单因素方差分析。计数资料采用χ2检验。取α=0.05为检验水准,以P0.05为差异具有统计学意义。结果 1.NGF组患者治疗前、后及复查时的视力与同期对照组对比差异无统计学意义(P0.05),1m复查视力较治疗前显著增加(P0.05)。 2.NGF组患者治疗前、后及复查的眼压与同期对照组对比差异均无统计学意义(P0.05)。 3.NGF组患者治疗后及复查视野MS、P100振幅、血清NO水平均较同期对照组显著增加(P0.05),视野MD、P100潜伏期和血浆ET-1水平显著低于同期对照组(P0.05)。结论 1.对于眼压控制良好的青光眼患者,NGF可以促进部分视神经功能的恢复。 2.NGF可能存在一种长效机制,在复查时视野、视力、电生理参数的改善仍在持续。 3.NGF对青光眼患者的眼压无明显影响。 4.NGF视神经保护机制可能与其对ET/NO的影响有关。
[Abstract]:Background and purpose
Glaucoma is a group of factors with the common characteristics of optic atrophy and visual field defect, progressive neurodegenerative disease. The progressive loss of retinal ganglion cell (RGCs) is a common pathological change. The increase of intraocular pressure is the most significant risk factor for glaucoma. Therefore, most of the current treatments are However, glaucoma patients with well controlled intraocular pressure still suffer from deterioration of the visual field and the death of RGCs. Therefore, the need for an additional treatment has been widely recognized.
With the rapid development of the research field of the animal model of optic nerve injury in glaucoma, our understanding of the pathological process of glaucoma is also increasing. The role of optic neuroprotective drugs has shown more and more advantages on these experiments. Nerve growth factor (NGF) is an important bioactive component. In recent years, the combination of exogenous NGF and its receptor has proved that the combination of exogenous NGF and its receptor can eliminate oxygen free radicals, prevent excitatory effects caused by glutamic acid, and stabilize intracellular Ga2+ concentration to inhibit RGCs withering; on the other hand, different signal transmission is activated by activating different signals. This study aims to observe the effects of neural growth factor (NGF) on plasma endothelin (endothelin, ET), serum nitric oxide (nitric oxide, NO), vision, intraocular pressure, visual field, visual electrophysiology (visual evoked potential, VEP) in patients with primary angle closure glaucoma. Objective to explore the mechanism of action and provide new ideas for clinical prevention and treatment of glaucoma.
Method
This study was conducted from December 2008 to October 2009 at the First Affiliated Hospital of Zhengzhou University. Patients with primary angle closure glaucoma and trabeculectomy after hospitalization were treated in the First Affiliated Hospital of Zhengzhou University. Of the 56 cases (56 eyes), 24 cases, 32 women, 41~68 years of age and 8 age of 54.3 + 7.97. of the median age were 8. Cases of both eyes were performed, and the corrected visual acuity was observed. 29 cases (29 eyes) and Mecobalamin control group were randomly divided into 29 cases (29 eyes) and 27 cases of mecobalamin control group (27 eyes). The treatment group was treated with Mouse Nerve Growth Factor for Injection after operation, and the control group was given the routine oral Mecobalamin Tablets after operation. The visual acuity and intraocular pressure were determined before and after January. Visual field, visual evoked potential (VEP), plasma ET-1 and serum NO levels.
All data were expressed with mean standard deviation, and data statistical analysis was completed by SPSS17.0 software. T test was used in group comparison, single factor analysis of variance was used in the same period. The count data was tested by x 2 test. Alpha =0.05 was taken as the test level, and P0.05 was statistically significant.
Result
There was no significant difference in visual acuity before and after treatment between the 1.NGF group and that of the control group (P0.05). The visual acuity of 1m reexamination increased significantly compared with that before treatment (P0.05).
There was no significant difference in the intraocular pressure before and after treatment in group 2.NGF compared with that in the control group (P0.05).
After treatment and reexamination of the 3.NGF group, the MS, P100 amplitude and serum NO level were significantly higher than those in the control group (P0.05), the visual field MD, the P100 latency and the plasma ET-1 level were significantly lower than those in the control group (P0.05).
conclusion
1. NGF can promote the recovery of some optic functions in glaucoma patients with good intraocular pressure control.
There may be a long-term mechanism for 2.NGF, which improves the visual acuity and electrophysiological parameters during reexamination.
3.NGF has no significant effect on intraocular pressure in patients with glaucoma.
The mechanism of 4.NGF's optic nerve protection may be related to its effect on ET/NO.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R775

【引证文献】