地塞米松联合羊膜匀浆上清液治疗兔角膜碱烧伤的实验研究

发布时间：2019-03-22 18:12

【摘要】： 目的：通过建立兔角膜碱烧伤模型,探讨刮除与保留角膜上皮后,地塞米松联合羊膜匀浆上清液与地塞米松单独用药治疗角膜碱烧伤的疗效差异。方法：24只成年家兔随机分为A、B、C、D四组,每组6只眼,建立右眼角膜碱烧伤模型。A组刮除角膜上皮+地塞米松结膜下注射；B组刮除角膜上皮+地塞米松结膜下注射+羊膜匀浆上清液点眼；C组保留角膜上皮+地塞米松结膜下注射；D组保留角膜上皮+地塞米松结膜下注射+羊膜匀浆上清液点眼。在碱烧伤后不同时点,角膜1%荧光素钠染色,眼前节拍照,计算机图像分析；不同时点制作病理切片,进行光镜及电镜观察。结果： 1、角膜上皮修复率：角膜碱烧伤后,各组角膜上皮逐渐愈合,1d各组角膜上皮修复率比较,差异均有统计学意义(P0.05),B组(0.4632±0.01222)优于A组(0.3925±0.03352),A组优于D组(0.3541±0.01457),D组优于C组(0.3009±0.02575)。3d时B组(0.8143±0.02444)分别与A组(0.7694±0.02181)、C组(0.7025±0.01258)、D组(0.7625±0.03187)比较,差异均有统计学意义(P0.05),B组优于其它各组,C组与A组、D组比较,结果有统计学意义(P0.05),C组角膜上皮愈合较A、D组差,A组与D组比较,差异无统计学意义(P0.05)。7d除A组(0.9620±0.02681)与D组(0.9594±0.02607)比较差异无统计学意义(P0.05)外,其余各组间比较,差异均有统计学意义(P0.05),B组(0.9905±0.01075)优于A、D组,A、D组优于C组(0.9057±0.00853)。 2、光镜检查：碱烧伤后7d,B组角膜上皮约3-4层,细胞形态规则；C组角膜上皮约2-3层,细胞形态异常且排列紊乱,A、D组角膜上皮2-4层,部分细胞排列不规则。碱烧伤后14d,B组角膜基质层胶原纤维排列较A、C、D组整齐,炎胞浸润亦较少；C组与A、D组比较,C组胶原纤维排列紊乱且炎细胞浸润较多；A、D组形态改变相似,胶原纤维排列情况及炎细胞浸润介于B、C组之间。 3、透射电镜检查：碱烧伤后14d,B组角膜上皮细胞形态大致正常,细胞间桥粒数量较多,细胞内线粒体、粗面内质网、高尔基复合体较多,染色质丰富,基质层胶原纤维排列较整齐；C组角膜上皮细胞形态不规则,细胞间隙大,未见桥粒连接,可见大量线粒体固缩或空泡化,可见核旁脂滴,基质层胶原纤维排列紊乱；A、D组介于B、C组之间,可见少量桥粒连接及核旁脂滴。结论： 1、角膜碱烧伤后,早期刮除角膜上皮后再进行药物治疗疗效优于未刮除上皮组。 2、地塞米松联合羊膜匀浆上清液治疗角膜碱烧伤比地塞米松单独用药疗效好。
[Abstract]:Aim: to investigate the therapeutic effect of dexamethasone combined with amniotic membrane homogenate supernatant and dexamethasone alone on corneal alkali burn by establishing rabbit corneal alkali burn model after curettage and preservation of corneal epithelium. Methods: twenty-four adult rabbits were randomly divided into four groups (group A, B, C, D, 6 eyes in each group) to establish corneal alkali burn model in right eye. Group A was given subconjunctival injection of dexamethasone and scraped corneal epithelium. Group B received subconjunctival injection of amniotic membrane homogenate supernatant, group C retained subconjunctival injection of corneal epithelium dexamethasone, and group D retained corneal epithelial dexamethasone subconjunctival injection of amniotic membrane homogenate supernatant. At different time points after alkali burn, the cornea was stained with 1% fluorescein sodium, the anterior segment was photographed and the image was analyzed by computer, the pathological sections were made at different time points and observed by light and electron microscope. Results: 1, corneal epithelial repair rate: after alkali burn, corneal epithelium gradually healed in each group, and there was significant difference in corneal epithelial repair rate in each group on the 1st day (P0.05). Group B (0.4632 卤0.01222) was superior to Group A (0.3925 卤0.03352), A) than Group D (0.3541 卤0.01457), D) better than Group C (0.3009 卤0.02575). On the 3rd day, Group B (0.8143 卤0.02444) was better than Group A (0.7694 卤0.02181). C group (0.7025 卤0.01258), D group (0.7625 卤0.03187), the difference was statistically significant (P0.05), B group was better than other groups, C group and A, D group, the results were statistically significant (P0.05), the results were statistically significant (P0.05). The corneal epithelium healing in group C was worse than that in group A and D, and there was no significant difference between group A and group D (P0.05). There was no significant difference in corneal epithelial healing between group A (0.9620 卤0.02681) and group D (0.9594 卤0.02607) (P0.05) at 7d, except for group A (0.9620 卤0.02681) and group D (0.9594 卤0.02607). The difference among the other groups was statistically significant (P0.05:), B group (0.9905 卤0.01075) was better than A, D group, A, D group was better than C group (0.9057 卤0.00853). 2. Light microscopy: on the 7th day after alkali burn, the corneal epithelium of group B was about 3 and 4 layers, and the morphology of the cells was regular. In group C, the corneal epithelium was about 2 ~ 3 layers, the morphology of the cells was abnormal and the arrangement was disordered. In group A, the corneal epithelium of group D was 2 ~ 4 layers, and some of the cells were arranged irregularly. On the 14th day after alkali burn, collagen fibers in group B were more orderly than those in group A, C, D, and there were fewer inflammatory cells in group C than those in group A and D, and the arrangement of collagen fibers in group C was more irregular than that in group A and D, and the infiltration of inflammatory cells was more in group C than that in group A and D. The morphological changes of group A and D were similar. The arrangement of collagen fibers and infiltration of inflammatory cells in group A and D were between B group and C group. 3. Transmission electron microscopy (TEM): on the 14th day after alkali burn, corneal epithelial cells in group B were almost normal in shape, with a large number of desmosomes, intracellular mitochondria, rough endoplasmic reticulum, Golgi complex and abundant chromatin. The collagen fibers in the matrix layer were arranged neatly. In group C, the corneal epithelial cells were irregular in shape, with large gap, no desmosome junction, a large number of mitochondria pyknosis or vacuolization, lipid droplets around nucleus and disordered arrangement of collagen fibers in the stroma. A, D group was between B group and C group, a small number of desmosome junctions and lipid droplets were observed. Conclusion: 1. After alkali burn of cornea, the curative effect of drug therapy after early curettage of corneal epithelium is better than that of non-curettage group. 2.Dexamethasone combined with amniotic membrane homogenate supernatant was better than dexamethasone alone in the treatment of corneal alkali burn.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.1

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