Avastin在增生型糖尿病视网膜病变手术中的应用及作用机制  

Application of avastin in vitrectomy for proliferative diabetic retinopathy and its mechanism

作　　者：王祥硅[1] 李永平[1] 李石毅[1] 李永浩[1] 张静琳[1] 黄新华[1] 吕林[1] 

机构地区：[1]中山大学中山眼科中心眼科学国家重点实验室,广州510060

出　　处：《中华实验眼科杂志》2011年第1期53-57,共5页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目（30672277）

摘　　要：背景研究表明avastin辅助玻璃体手术治疗严重增生型糖尿病视网膜病变（PDR）能减少手术并发症，降低手术难度，可能与avastin抑制新生血管的形成有关，但缺乏组织病理学证据。目的探讨玻璃体腔注射avastin辅助的玻璃体手术治疗严重PDR减少手术并发症的可能机制。方法病例对照研究。收集严重PDR患者24例24眼，按照手术方式将患者分为单纯手术组10例10眼，单纯进行玻璃体切割术；avastin＋手术组14例14眼，行玻璃体手术前2周一次性玻璃体腔注射25g/L avastin0．06ml。收集术中剥离的视网膜前膜行苏木精一伊红染色，观察组织病理学改变。应用免疫组织化学染色法检测CD34在新生血管内皮细胞中的表达，比较2组患者视网膜前膜新生血管的密度及单细胞新生血管密度。结果单纯手术组与avastin＋手术组患者的人口基线特征和眼部基线特衙比较差异均无统计学意义（P〉0．05）。单纯手术组视网膜＋＋＋级新生血管者10眼，avastin＋手术组为1眼，二者比较差异有统计学意义（P〈0．01）。组织病理学结果表明，单纯手术组增生膜内可见较多散在的毛细血管型新生血管，多数由单个血管内皮细胞构成管腔，部分区域可见较多出血；avastin＋手术组增生膜玻璃样变的成分增多，新生的毛细血管明显减少或消失。免疫组织化学检测证实，新生血管内皮细胞中CD34均呈强阳性表达，avastin＋手术组400倍镜下每个视野新生血管密度为（15．40±7．42）个，单纯手术组为（8．00±3．80）个，差异有统计学意义（Z=-4．102，P〈0．01）；avastin＋手术组单细胞新生血管密度为（1．88±1．71）个，单纯手术组为（0．45±0．56）个，差异有统计学意义（Z=-4．137，P〈0．01）。结论Avastin可抑制增生膜新生血管芽的形成，阻断新生血管的发生，减轻视网膜水肿，这可能是其辅助玻璃Background Researches demonstrated that avastin-assisted vitrectomy for serious proliferative diabetic retinopathy can decrease intra-operation complication and bring down difficulty of surgery. It is speculated that this is associated with suppression of avastin on neovascularization. However,the evidence of its pathology is lack. Objective The aim of this study was to evaluate the application and mechanism of avastin in vitrectomy for severe proliferative diabetic retinopathy. Methods Twenty-four eyes from consecutive 24 patients with vitrectomy for severe proliferative diabetic retinopathy were enrolled in this study. Fourteen eyes received an intravitreal injection of 0.06 ml avastin（ 1.5 rag） 14 days prior to vitreetomy,and the other 10 eyes underwent only vitreetomy without avastin injection as controls. Preretinal membranes were collected during vitreetomy for histopathologic examination by hemotoxylin and eosin staining. The differences in the density of the neovessels and micro-neovessels between the two groups were observed by detecting the expression of CD34 in vessel endothelial cells using immunohistochenfistry. Written informed consent was obtained from each patient before surgery. Results No statistically significant differences were found in the demography and eye manifestations between only vitrectomy group and avastin ＋ vitrectomy group（P〉0. 05）. The ncovessels with grade three was in 10 eyes in only vitrectomy group and 1 eye in avastin＋ vitrectomy group （ P 〈 0.01 ）. More capillary-like neovaseularization with single vascular endothelial cells, obvious hemorrhage and inflammatory ceils infiltration were observed on preretinal membranes in vitreetomy group. However,there were less hemorrhage,cellular components and few capillary-like neovaseularization but more hyaline degeneration of fibrous tissue were observed in avastin＋vitreetomy group under the light microscope. Immunoehemistry revealed that CD34 was positively expressed in vascular endothelial cells on preretinal me

关 键 词：糖尿病视网膜病变 AVASTIN 增生膜 新生血管 

分 类 号：R774.12[医药卫生—眼科] R988.1[医药卫生—临床医学]