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学科主题: 眼科学
题名:
孔源性视网膜脱离患者黄斑微结构改变与玻璃体细胞因子、视功能相关性研究
作者: 晏红改
答辩日期: 2016-05-17
导师: 杨柳
专业: 眼科学
授予单位: 北京大学
授予地点: 北京大学第一临床医学院
学位: 博士
关键词: 孔源性视网膜脱离 ; 椭圆体带 ; 外界膜 ; 相干光断层扫描 ; 细胞因子
其他题名: The study of vitreous cytokines, retinal structures and BCVA in patients with rhegmatogenous retinal detachment
分类号: R774.1
摘要:


目的:测定孔源性视网膜脱离患者玻璃体中细胞因子改变;观察患者术后不同随访时间的视网膜微结构改变及其与视功能的关系;研究细胞因子与术后黄斑微结构改变的相关关系。
方法:这是一项前瞻性研究。我们选取诊断为视网膜脱离并行玻璃体切除手术的患者作为研究组,无视网膜脱离的黄斑裂孔、黄斑前膜、玻璃体黄斑牵拉综合征的患者作为对照组。两组患者均于术中留取玻璃体,用CBA检测方法进行细胞因子检测。检测细胞因子包括IL-1β、IL-2、IL-6、IL-8、IL-10、IL-12、TNF-α、IFN-γ、VEGF、MCP-1。对研究组进行术后随访并进行常规眼科检查和EDI-OCT检查。监测指标主要为术后1周、1月、3月、6月的BCVA和EDI-OCT,并对EDI-OCT进行视网膜神经上皮层、外核层、脉络膜厚度测量,观察椭圆体带、外界膜断裂情况,黄斑水肿、黄斑前膜的发生概率。最后,我们将患者的玻璃体细胞因子、黄斑微结构改变进行相关性分析。该研究采用独立样本t检验和配对样本t检验进行两组间比较,运用Pearson和 Spearman相关性检验进行相关性分析。
结果:研究组为62例63只眼(男性32人,女性30人,平均年龄54.3±14.2岁),对照组为29例29只眼(男性7人,女性22人,平均年龄64.0±7.7岁)。研究组、对照组玻璃体中细胞因子水平,结果为IL-1β(0.54±0.80
pg/mL,0.42±0.47 pg/mL,P=0.441)、IFN-γ(0.47±0.51 pg/mL,0.38±0.45 pg/mL,P=0.42)、IL-2(2.25±2.5 pg/mL,1.88±1.84 pg/mL,P=0.470)、IL-6(516.5±2399.7 pg/mL,22.8±53.2 pg/mL,P=0.272)、IL-10(0.53±0.53 pg/mL,0.39±0.43 pg/mL,
P=0.216)两组相比差异无显著性,但研究组均较对照组升高。VEGF(39.8±63.1pg/mL,4.4±5.9pg/mL ,P=0.000)、MCP-1(2238.8±1827.7pg/mL,572.9±576.2pg/mL,P=0.000)、IL-8(53.3±86.9pg/mL,7.3±12.5pg/mL,P=0.000)、IL-12(7.6±8.6pg/mL,3.5±3.7pg/mL,P=0.002)研究组测量值高于对照组,差异存在显著性(P<0.05)。
参与术后随访的患者共31例32只眼(男性15人,女性16人,平均年龄51.1±15.7岁)。术后视力(logMAR)呈现明显好转趋势(1周0.95,1月0.78,3月0.73,6月0.66)。对随访视力进行两两比较,除了1月与3月之间差异不显著,其余均呈显著性差异。黄斑中心凹下神经上皮层厚度、外核层厚度在术后1周(122.8±111.8μm,79.1±76.7μm)至3月(163.3±133.1μm,108.7±120.4μm)的随访过程中逐渐增厚,术后6月时稍有下降(159.50±99.26μm,99.22±74.89μm)。而脉络膜厚度在随访中变化不明显(1周186.1μm,1月181.6μm,3月182.9 μm,6月182.3μm)。椭圆体带及外界膜随着随访时间的延长其断裂的发生率明显下降(1周68.8%,53.1%;1月65.6%,46.9%;3月56.3%,40.6%;6月50.0%,37.5%),各不同随访时期,椭圆体带及外界膜断裂情况与患者视力恢复呈显著相关关系。椭圆体带及外界膜均完整的患者有较好的术后视力。我们将随访患者分为未累及黄斑组和累及黄斑组,未累及黄斑组术后视力明显优于累及黄斑组,在术后1周和1月时差异显著(1周:0.55±0.4,1.11±0.72,P=0.035;1月:0.41±0.52,0.93±0.62,P=0.036)。
另外,我们对患者玻璃体腔细胞因子水平与其术后恢复过程中的神经上皮层、外核层、脉络膜层厚度进行相关性研究,结果显示IL-2水平与黄斑中心凹下视网膜神经上皮层、外核层厚度存在相关关系(神经上皮层:r=0.398,P=0.024;外核层r=0.394,P=0.026)。视网膜脱离未累及黄斑组和累及黄斑组的各细胞因子比较中,未累及黄斑组中有较低的VEGF水平,且两组差异显著(6.0±8.2 pg/mL,41.9±55.3 pg/mL, P=0.006)。
结论:孔源性视网膜脱离患者玻璃体中VEGF、MCP-1、IL-8、IL-12水平上调;视网膜神经上皮层厚度与外核层厚度随着随访时间延长可逐渐变厚,在术后3月时厚度最大,且其厚度改变趋势与黄斑水肿发生率的趋势相一致;椭圆体带、外界膜的完整性以及视网膜脱离是否累及黄斑区均是是影响患者术后视力恢复的关键因素。IL-2与神经上皮层和外核层厚度存在相关性。视网膜脱离累及黄斑区的患者玻璃体中存在较高水平VEGF。

英文摘要:


Purpose: To evaluate the vitreous cytokines in patients with rhegmatogenous retinal detachment. To observe the retinal microstructure changes and the relationship between BCVA and retinal microstructures. To study the relationship between cytokines and retinal changes.
Methods: This was a prospective study. Patients who were diagnosed with rhegmatogenous retinal detachment were in the study group. Patients who were diagnosed with macular hole, epiretinal membrane, or vitreomacular traction syndrome were in the control group. We got the vitreous body during the operation and CBA was performed for detecting the vitreous cytokines. IL-1β、IL-2、IL-6、IL-8、IL-10、IL-12、TNF-α、IFN-γ、VEGF、MCP-1 were included. The patients in the study groups were returned for regular follow-up examinations after surgery 1 week, 1 month, 3 months, 6 months. The BCVA and EDI-OCT were taken during the follow-up. We measured the thickness of neuroretina, outer nuclear layer, choroidal thickness and observed the ellipsoid zone, external limiting membrane, macular edema, epiretinal membrane. Finally, we studied the relationship between cytokines and retinal changes. We used Independent samples t-test, Pearson and Spearman for statistical methods.
Results: Sixty-three eyes from 62 patients (30 women and 32 men, mean age 54.3 ± 14.2 years) were in the study group, Twenty-nine eyes from 29 patients (22 women and 7 men, mean age 64.0 ± 7.7 years) were in the control group. The cytokines IL-1β(0.54±0.80pg/mL,0.42±0.47pg/mL,P=0.441)、IFN-γ
(0.47±0.51pg/mL,0.38±0.45pg/mL,P=0.42)、IL-2(2.25±2.5 pg/mL,1.88±1.84 pg/mL,P=0.470)、IL-6(516.5±2399.7 pg/mL,22.8±53.2 pg/mL,P=0.272)、IL-10(0.53±0.53 pg/mL,0.39±0.43 pg/mL, P=0.216)concentrations in study and control groups were no Significant differences. But the cytokines VEGF(39.8±63.1pg/mL,4.4±5.9pg/mL ,P=0.000)、MCP-1(2238.8±1827.7pg/mL,572.9±576.2pg/mL,P=0.000)、IL-8(53.3±86.9pg/mL,7.3±12.5pg/mL,P=0.000)、IL-12(7.6±8.6pg/mL,3.5±3.7pg/mL,P=0.002)concentrations in study group elevated significantly compared to control group(P<0.05).
Thirty-two eyes from 31 patients were in follow-up(16 women and 15 men, mean age 51.1 ± 15.7 years). The BCVA became better With prolonged follow-up(1 W 0.95, 1M 0.78, 3M 0.73, 6M 0.66). The subfoveal neuroretina and outer nuclear layer were became thicken from 1 week(122.8±111.8μm, 79.1±76.7μm) to 3 months(163.3±133.1μm,108.7±120.4μm), and slight declined in the 6 months(159.50±99.26μm,99.22±74.89μm). But the choroidal thickness was no significant change (1W 186.1μm, 1M 181.6μm,3M 182.9 μm,6M 182.3μm). The fractures of ellipsoid zone, external limiting membrane were declined(1W 68.8%,53.1%;1M 65.6%,46.9%;3M 56.3%,40.6%;6M 50.0%,37.5%)and was correlated with the BCVA. We divided the study group into macular-on and macular-off groups. The BCVA of macular-on group was better than the macular-off group and the comparison was obvious difference in 1 week and 1 month(1W:0.55±0.4,1.11±0.72,P=0.035;1M:0.41±0.52,0.93±0.62,P=0.036).
We also got some other results. IL-2 was associated with the neuroretina and outer nuclear layer(neuroretina:r=0.398,P=0.024;ONL:r=0.394,P=0.026). The VEGF in macular-on group was lower than that in macular-off group(6.0±8.2 pg/mL,41.9±55.3 pg/mL,P=0.006).
Conclusion: VEGF, MCP-1, IL-8, IL-12 in vitreous body of patients with retinal detachment were upregulated. The thickness of neuroretina and outer nuclear layer became gradually thicken, and became thickest in 3 months. The ellipsoid zone, external limiting membrane fractures were influenced the BCVA. IL-2 was
relationship with the neuroretina and outer nuclear layer thickness. The patients with macular-off had High level of VEGF.

语种: 中文
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/125265
Appears in Collections:北京大学第一临床医学院_学位论文

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作者单位: 北京大学第一临床医学院

Recommended Citation:
晏红改. 孔源性视网膜脱离患者黄斑微结构改变与玻璃体细胞因子、视功能相关性研究[D]. 北京大学第一临床医学院. 北京大学. 2016.
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