外伤性睫状体脱离的临床研究及睫状上腔渗液中炎性因子的实验研究

发布时间：2019-01-19 14:05

【摘要】：目的：探讨眼前节光学相干断层扫描(AS-OCT)与眼超声生物显微镜(UBM)在诊断睫状体脱离中的临床应用价值,为丰富及优化临床检查选择提供依据。评价一种新的改良睫状体缝合复位术与传统的睫状体缝合复位术治疗外伤性睫状体脱离的临床效果,为优化手术方案提供依据。检测外伤性睫状体脱离患者睫状体上腔渗液中interleukin-6(IL-6)、tumor necrosis factor-alpha(TNF-α)的含量,探讨其在睫状体脱离发生发展中的作用,为临床治疗促使睫状体脱离复位提供思路。方法： 1临床病例对照研究。外伤性睫状体脱离病人30例入组,每个病例均采用房角镜、UBM和AS-OCT三项检查,其中任意一项检查发现睫状体脱离即可确诊。比较UBM和AS-OCT诊断睫状体脱离的阳性率,应用SPSS配对χ2检验进行统计分析,探讨其不同机制及优劣。 2临床随机对照研究。行手术治疗的外伤性睫状体分离患者23例,随机分为2组。传统组11例,改良组12例,传统组行传统睫状体脱离缝合复位术,改良组行改良的睫状体缝合复位术。比较两组术后睫状体复位情况、眼压及视力,进行统计分析,评价疗效。注意两组临床资料的匹配情况。统计方法采用SPSS16.0统计软件,术前术后两组睫状体脱离情况的比较采用四格表资料的确切概率法(Fisher's exact test),术前术后两组眼压、视力对比采用配对资料t检验。两组间术后睫状体复位情况、眼压、视力比较分别四格表资料的确切概率法(Fisher's exact test)和独立样本t检验。 3实验研究。于天津市眼科医院住院行手术治疗并成功取得检测样本的外伤性睫状体脱离患者12例,取其睫状体上腔渗液作为实验组,取其自身血清作为对照组,应用酶联免疫吸附试验法检测两组的interleukin-6(IL-6)、tumor necrosis factor-alpha(TNF-α)含量,应用SPSS统计软件计量资料配对t检验进行统计学分析。结果： 1房角镜组、UBM组、AS-OCT组三组检查睫状体脱离阳性率分别为63.33%、100%、60%,其中UBM检查组与房角镜组、AS-OCT组相比差异均具有统计学意义(P值分别为0.001、0.000,均0.05),而房角镜组与AS-OCT组比较差异无统计学意义(P值=1.000,0.05)。 2传统睫状体缝合复位组中11例有10例一次手术复位成功,改良睫状体缝合复位组中12例全部一次手术复位成功,两组术前术后比较差异均有统计学意义(P0.05),两组复位率分别为90.9%(10/11)、100%(12/12),两组间复位率比较差异无统计学意义(P0.05)。两组术后眼压较术前均有明显回升,差异均有统计学意义。传统睫状体缝合复位组及改良睫状体缝合复位组术前平均眼压分别为6.45±1.58mmHg、6.78±1.43mmHg,术后两组平均眼压均有回升,分别达到了13.35±2.08mmHg、14.57±2.96mmHg,两组术前术后差异比较具有统计学意义(传统组t=-12.34,P0.01；改良组t=-11.85,P0.01),但两组间术后2周眼压值比较差异无统计学意义(t=-1.17,P0.05)。传统睫状体缝合复位组及改良睫状体缝合复位组术前视力分别为0.25±0.21、0.29±0.23,术后2周分别为0.42±0.26、0.45±0.21,其中视力0.3者分别达到了63.6%、66.6%,与术前比较差异具有统计学意义(传统组t=-5.27,P0.01；改良组t=-5.89,P0.01)。两组间术后2周视力比较差异无统计学意义(P0.05)。 3本组睫状体脱离患者IL-6的含量在睫状体上腔渗液和自体血清中分别为70.25±58.64pg/ml、6.29±1.25pg/ml,TNF-α的含量在睫状体上腔渗液和自体血清中分别为18.59±5.75pg/ml、8.93±1.82pg/ml。睫状体脱离患者的睫状体上腔渗液中IL-6、TNF-α的含量均高于自体血清中IL-6、TNF-α的含量,差异均有统计学意义(P0.05)。结论：眼前节OCT与UBM比较并无明显诊断优势,但其为非接触式检查,为睫状体脱离提供了新的检查手段,尤其是对于一些不适于房角镜和UBM等需行接触式检查的患者及对检查过程中舒适度要求比较高的患者；传统的睫状体缝合复位术和改良的睫状体缝合复位术均能有效复位睫状体,眼压、视力等指标均有改善,取得了良好的效果,但改良术式较传统术式操作相对简化,费时更少,应用范围更宽,效果确切。外伤性睫状体脱离患者睫状体上腔渗液中IL-6与TNF-α的含量均高于自身血清中的含量,提示两者可能参与了睫状体上腔渗液形成发展的过程,在其中发挥了作用,为防治睫状体脱离提供了新的思路和切入点。
[Abstract]:Objective: To study the clinical application value of the anterior segment optical coherence tomography (AS-OCT) and the ocular ultrasound biomicroscope (UBM) in the diagnosis of the detachment of the ciliary body and to provide the basis for enriching and optimizing the selection of clinical examination. To evaluate the clinical effect of a new method of improved ciliary body suture reduction and traditional ciliary body suture reduction in the treatment of traumatic cyclodialysis, and to provide the basis for the optimization of the operation plan. The content of interleukin-6 (IL-6), tumornecrosis factor-alpha (TNF-1) in the ciliary body of the patients with traumatic ciliary body detachment was examined, and its role in the development of the detachment of the ciliary body was discussed. square Method: 1 Clinical case pair According to the study, 30 cases of traumatic cyclodialysis patients were enrolled in the group, and each case was examined by gonioscope, UBM and AS-OCT, and any one of them found that the ciliary body was separated. The positive rate of the detachment of the ciliary body was compared with that of the UBM and AS-OCT, and the statistical analysis was carried out by using the SPSS. clinical follow-up machine-controlled study: 23 cases of traumatic cyclodialysis patients treated with operation and follow-up The machine was divided into 2 groups, 11 in the traditional group, 12 in the modified group, the traditional group of the traditional group and the traditional group, and the modified group was used for the improvement of the ciliary body. The reduction of the ciliary body, the intraocular pressure and the visual acuity of the two groups after operation were compared. Evaluation of curative effect. Take care of two groups of clinical data The statistical method was based on the statistical software of SPSS16. 0. The comparison of the two groups of the two groups before and after the operation was the exact probability method of the four-cell table data (Fisher's exact test), and the two groups of IOP and visual acuity were paired before and after the operation. Data t-test. The exact probability method (Fisher's exact test) and independence of the four-cell table data were compared between the two groups. Sample t-test. 3. The experimental study was carried out in 12 cases of traumatic cyclodialysis patients who underwent surgical treatment and successfully obtained the test samples in the hospital of the Eye Hospital of Tianjin, and the internal cavity of the ciliary body was taken as the experimental group, and the self-contained serum was taken as the control group, and the interleukin-The content of 6 (IL-6), tumor necrosis factor-alpha (TNF-1) was measured by SPSS statistical software. to be in series The results showed that the positive rate of the detachment of the ciliary body was 63. 33%, 100% and 60% respectively in the first group, the UBM group and the AS-OCT group, among which the difference of the UBM group and the gonioscope group and the AS-OCT group was statistically significant (P = 0.001, 0, respectively).. 000, 0. 05), while the difference between the gonioscopic group and the AS-OCT group was not statistically significant (P value = 1. 000, 0. 05). 10 of the 11 cases of the traditional ciliary body suture reduction group were successfully reset, 12 of the modified ciliary body suture reduction group were successfully reset, the difference between the two groups was statistically significant (P0.05), and the reduction rates of the two groups were 90.9% (10/ 11), respectively.), 100% (12/ 12), difference between two groups There was no significant difference between the two groups (P0.05). The mean IOP of the two groups was 6.45, 1.58mmHg, 6.78% and 1.43mmHg, respectively. The mean IOP of the two groups recovered after the operation. The difference between the two groups was statistically significant (the traditional group t =-12.34, P0.01; modified group t =-11.85, P0.01), but there was no significant difference in IOP between the two groups (t The pre-operative visual acuity of the traditional ciliary body suture reduction group and the modified ciliary body suture reduction group were 0.25, 0.21, 0.29 and 0.23, respectively. The visual acuity was 0.42, 0.26, 0.45 and 0.21, respectively. The visual acuity of 0.3 was 63.6% and 66.6%, respectively. t =-5.27, P0.01; modified group t =-5.89, P0.01). There was a difference in visual acuity between the two groups. There was no statistical significance (P0.05). The content of IL-6 in the ciliary body was 70. 25, 58. 64pg/ ml, 6.29 and 1.25pg/ ml, respectively, and the content of TNF-1 was 18.59 and 5.75pg/ ml, respectively. The content of IL-6 and TNF-1 in the body of the ciliary body from the patient's ciliary body was higher than that in the autoserum. There was no significant difference between OCT and UBM, but it was non-contact. The present invention provides a new examination method for the detachment of the ciliary body, in particular to a patient which is not suitable for the contact examination of the angle mirror and the UBM or the like and the patients with higher comfort requirements in the examination process, and the traditional ciliary body suture reduction method and the improved ciliary body The suture and reduction method can effectively reset the indexes of the ciliary body, the intraocular pressure, the vision and the like, and has good effect, but the improved operation is relatively simplified compared with the conventional operation type operation. and the content of the IL-6 and the TNF-1 in the cavity of the ciliary body of the patients with the traumatic ciliary body is higher than the content in the serum of the patient, and the two can be involved in the infiltration of the cavity of the ciliary body. The process of formation and development of liquid, in which the effect is played, to prevent
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R773.3

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