心脏死亡后捐献角膜用作穿透性角膜移植术供体的安全性研究  

Security research of cardiac death donation corneas used as penetrating keratoplasty grafts

作　　者：徐晶[1] 张虹[2] 蒋继贫[3] 徐玲娟[2] 杜建芳[1] 陈敏[1] 马剑晴[2] 李贵刚[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院手术室,中国湖北省武汉市430030 [2]华中科技大学同济医学院附属同济医院眼科,中国湖北省武汉市430030 [3]华中科技大学同济医学院附属同济医院器官移植科,中国湖北省武汉市430030

出　　处：《国际眼科杂志》2015年第2期317-319,共3页International Eye Science

基　　金：国家自然科学基金(No.81200661;81470606);湖北省自然科学基金(No.2010CDB09802)~~

摘　　要：目的：探讨心脏死亡后捐献（donation after cardiac death,DCD）角膜供体行穿透性角膜移植的安全性。方法：按照时间先后顺序,采用DCD供体角膜行穿透性角膜移植术,术后3~4mo检测角膜植片内皮细胞密度及最佳矫正视力。结果：共统计14例26眼DCD角膜供体纳入本研究。供体年龄0.5~61（平均38.3±15.6）岁;死亡原因包括脑外伤9例,心肌梗塞2例,脑干出血2例,呼吸循环衰竭1例。14例DCD捐献者28眼,因2眼暴露性角膜炎用作科学研究,共26眼用于穿透性角膜移植。所有患者手术过程顺利,手术后3~4mo未发生排斥反应,角膜植片保持透明。手术后3~4mo角膜内皮细胞密度794~4 347（平均2 305±827）个/mm2,其中低于1 000个/mm2者1例（3.8%）,1 000~2 000个/mm2者9例（34.6%）,大于2 000个/mm2者16例（61.5%）。26例角膜移植受者年龄20~80（平均40.7±17.1）岁。手术前最佳矫正视力为光感（＋）~0.08（平均0.027±0.024）;手术后3~4mo最佳矫正视力为0.2~0.8（平均0.52±0.182）,两者比较差异有显著统计学意义（t=3.96,P〈0.01）。结论：DCD捐献角膜用作穿透性角膜移植供体具有较高的安全性。To test the safety of using cardiac death donation （ DCD ） corneas for penetrating keratoplasty surgery graft.METHODS：ln chronological order, suing DCD corneas penetrating keratoplasty, corneal endothelial cell density and best corrected visual acuity （ BCVA） were tested 3~4mo after surgery.RESULTS：A total of 14 cases of DCD while 26 corneas were included in this study. Donors age ranged 0. 5 ~61 years, averagely 38. 3 ± 15. 6 years. Causes of death included that 9 cases of traumatic brain injury, 2 cases myocardial infarction, 2 cases brain stem hemorrhage, 1 case of respiratory and circulatory failure. All 26 patients underwent penetrating keratoplasty, no rejection occurred and all grafts were transparent 3 ~ 4mo after surgery. Three to four months after surgery, corneal endothelial cell density ranged 794 ~ 4 347/mm2 , averaged 2 305 ± 827/mm2 , within which was only one case was lower than 1000/mm2 （3. 8%）, while 9 cases ranged from 1000 ~ 2000/mm2 （34. 6%）, 16 cases were higher than 2000/mm2 （61. 5%）. The age of all the 26 receipts were from 20~80 years, mean 40. 7±17. 1 years. BCVA before surgery was light perception positive to 0. 08, with an average 0. 027±0. 024. Three to four months after surgery, BCVA were 0. 2~0. 8, with an average 0. 52± 0. 182 in contrast （t=3. 96, P＆lt;0. 001）.CONCLUSlON：DCD donated corneas could be used for penetrating keratoplasty graft with high security.

关 键 词：心脏死亡后捐献 穿透性角膜移植 角膜内皮细胞 最佳矫正视力 

分 类 号：R779.65[医药卫生—眼科]