發(fā)布時間：2018-08-16 07:26

【摘要】：目的：激光角膜切削術在全世界已有三十余年的發(fā)展歷程，準分子激光原位角膜磨鑲術(LASIK)在我國也有近二十年的發(fā)展，LASIK手術由于手術時間短、恢復時間快、術后疼痛輕、術后反應少、術后安全及穩(wěn)定性強等優(yōu)點，在眼科醫(yī)師中被公認為矯正各種屈光不正理想的，在臨床工作中應用前景最廣的一種手術。而LASIK手術后角膜創(chuàng)傷愈合反應機制是研究預測術后臨床效果的重要環(huán)節(jié)。角膜創(chuàng)傷修復是一個極其復雜而又高度協(xié)調(diào)的過程，此過程基本上可以分為局部的炎癥反應、細胞的增殖分化和組織的修復重建三個互不相同而又相互交錯的階段。在這一過程中涉及了多種生長因子和細胞因子之間的相互作用及相互影響，它們共同參與調(diào)控細胞的遷移、增生、分化、基質(zhì)沉積以及組織塑形等多個反應。各種細胞因子與生長因子的作用貫穿了整個角膜的創(chuàng)傷愈合的全過程形成一個有機的網(wǎng)絡體系。深入探討了解各種細胞因子和生長因子在LASIK術后角膜傷口愈合中的作用，對于理解LASIK術后角膜傷口愈合反應的調(diào)控機制，獲得LASIK術后更好的臨床預后效果具有重大的指導意義。 本試驗通過對LASIK手術前后淚液中與角膜關系密切的肝細胞生長因子（HGF）含量的定量分析，，探討肝細胞生長因子在LASIK手術前后患者淚液中短期內(nèi)濃度變化規(guī)律及它在LASIK術后角膜傷口愈合中的作用。 方法：隨機收集2011年4月至2011年7月于我院行LASIK手術患者30人60眼(男：女比例1：1)的淚液標本，用雙抗體夾心酶聯(lián)免疫吸附法（ELISA法）檢測LASIK術前、術后1天、3天、1周、2周、1個月患者淚液標本中HGF表達量的變化，用統(tǒng)計學方法對不同時間淚液中細胞因子平均濃度進行相關性分析。 結(jié)果：所有患者60只眼在LASIK手術術前至術后1個月的隨訪期間，術后1天（775.42±96.96）pg/ml、3天（612.38±80.72）pg/ml、1周（390.25±121.68）pg/ml、2周（253.52±45.69）pg/ml淚液中的HGF表達量均較術前HGF表達量（199.12±25.46）pg/ml明顯提高(P0．05），特別是術后1天和3天較術前提高顯著（P0．01）。但術后1個月（200.75±31.46）pg/ml與術前比較無統(tǒng)計學差異(P0．05）。 結(jié)論：LASIK術后淚液中HGF含量存在著一個由升高到降至術前水平的短期動態(tài)變化過程，這一結(jié)果提示在LASIK術后淚液中由淚腺和角膜成纖維細胞分泌的HGF含量增加，可能發(fā)揮了對角膜損傷反應中的上調(diào)作用，促進細胞分裂增殖及遷移等生物學效應作用，參與了LASIK術后角膜傷口愈合的早期過程。
[Abstract]:Objective: laser keratectomy has been developed for more than 30 years in the world. Excimer laser in situ keratomileusis (LASIK) has been developed in China for nearly 20 years. It has the advantages of less reaction, better safety and stability after operation. It is recognized as the most widely used surgery in clinical work for the correction of all kinds of ametropia among ophthalmologists. The mechanism of corneal wound healing after LASIK is an important link in predicting the clinical effect. Corneal wound repair is an extremely complex and highly coordinated process, which can be divided into three stages: local inflammatory response, cell proliferation and differentiation, and tissue repair and reconstruction. The interaction and interaction of various growth factors and cytokines are involved in this process, and they are involved in the regulation of cell migration, proliferation, differentiation, matrix deposition and tissue remodeling. The effects of cytokines and growth factors throughout the corneal wound healing process form an organic network system. To understand the role of cytokines and growth factors in corneal wound healing after LASIK is of great significance in understanding the mechanism of corneal wound healing response after LASIK and obtaining a better clinical prognosis after LASIK. The content of hepatocyte growth factor (HGF), which is closely related to cornea, was determined by quantitative analysis before and after LASIK operation. Objective: to investigate the changes of hepatocyte growth factor (HGF) concentration in tear before and after LASIK operation and its role in corneal wound healing after LASIK. Methods: from April 2011 to July 2011, 60 eyes (60 eyes) of 30 patients undergoing LASIK operation in our hospital were randomly collected. Double antibody sandwich enzyme linked immunosorbent assay (ELISA) was used to detect LASIK before operation. The changes of HGF expression in tear samples were analyzed by statistical method. The mean concentrations of cytokines in tears at different times were analyzed by statistical method. Results: 60 eyes of all patients were followed up for 1 month after LASIK operation. The expression of HGF in tears of (775.42 鹵96.96) PG / ml (612.38 鹵80.72) PG / ml for 1 week (390.25 鹵121.68) PG / ml for 2 weeks (253.52 鹵45.69) pg/ml was significantly higher than that for preoperative (199.12 鹵25.46) pg/ml (P0.05), especially on the 1st and 3rd day after operation (P0.01). But 1 month after operation (200.75 鹵31.46) pg/ml had no statistical difference compared with preoperative (P0.05). Conclusion there is a short period of dynamic change of HGF content in tear after W1 LASIK, which indicates that the content of HGF secreted by lacrimal gland and corneal fibroblasts in tear after LASIK is increased. It may play a role in the up-regulation of corneal injury response, promote cell division, proliferation and migration, and participate in the early process of corneal wound healing after LASIK.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R779.63

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