结膜下注射丝裂霉素C的抗瘢痕化效果和安全性研究  

Anti-scars and safety of subconjunctival injection of mitomycin C

作　　者：刘翠娟[1] 周震[2] 王大博[1] 李元伟[1] 

机构地区：[1]青岛大学附属医院眼科,山东省青岛市266000 [2]青岛大学附属医院重症医学科,山东省青岛市266000

出　　处：《眼科新进展》2015年第8期708-712,共5页Recent Advances in Ophthalmology

摘　　要：目的 研究结膜下注射丝裂霉素C（mitomycin C,MMC）对兔眼瘢痕化模型的抗瘢痕化效果及对兔眼局部组织的毒副作用,探讨其作为青光眼滤过性手术后抗瘢痕形成辅助用药的可行性及有效性。方法 取18只健康成年新西兰大白兔,随机分为3组,分别为A组、B组和C组,每组12眼,建立实验性瘢痕化模型。A组术后3 d结膜下注射0.4 g·L-1的MMC 0.3 m L,B组术中巩膜瓣下放置浸泡0.4 g·L-1MMC的棉片5 min,C组术后3 d结膜下注射生理盐水（normal saline,NS）0.3 m L。应用结膜印迹细胞学检查观察结膜损伤情况。分别于术后7 d、14 d、28 d分批处死实验兔,摘出眼球,应用免疫组织化学染色检查观察成纤维细胞增殖细胞核抗原（proliferation cell nuclear antigen,PCNA）的表达情况,应用光镜观察手术部位的病理改变。结果术后3组均未出现结膜伤口渗漏,A组、B组角膜上皮点状缺损于术后1周消失,C组无角膜上皮点状缺损。结膜印迹细胞学检查显示A组和B组结膜印迹细胞分级均为2~3级,C组为2级。术后7 d、14 d、28 d光镜下,C组手术区球结膜下炎性细胞、纤维细胞、新生毛细血管增多,纤维组织增生较A组和B组显著。免疫组织化学染色结果显示,术后7 d,A组、B组、C组每高倍视野PCNA阳性细胞计数分别为（12.83±2.08）个、（14.37±3.76）个、（28.12±6.74）个;术后14 d,3组PCNA阳性细胞计数分别为（13.81±1.53）个、（16.28±3.78）个、（25.67±4.45）个;术后28 d,3组PCNA阳性细胞计数分别为（11.96±1.45）个、（13.07±2.04）个、（17.69±3.11）个;相应时间点,A组、B组PCNA阳性细胞计数均较C组少（均为P=0.000）,但A组与B组间差异均无统计学意义（均为P〉0.05）。结论 结膜下注射MMC能有效抑制手术后术区的瘢痕化,与术中常规应用MMC相比,其对结膜的损伤程度无明显差异,对其进一步研究有望为青光眼滤过手术后抗瘢痕化提供一种使用方�Objective To observe the anti-scarring effects and local organization toxicities of subconjunctival injection of mitomycin C （MMC） on the scarring model of rabbit eyes, and explore the feasibility and effectiveness as a support drug after glauco- ma filtration surgery. Methods Eighteen healthy adult New Zealand white rabbits were randomly divided into three groups：Group A, group B and group C, 12 eyes in each group ,the experimental scarring model was established. Group A was given subconjunc- tival injection of 0.4 g L-1 MMC at 3 days after operation, and group B intraoperative subscleral flap placed 0.4 g L -± MMC cotton for 5 minutes, group C subconjunctival in- jection of normal saline （ N S） at 3 days after operation. Conjunctival imprint cytology was used to observe the conjunctival injury. At 7 days, 14 days and 28 days after opera- tion, the rabbits were sacrificed respectively, and eyeballs were excised. Immunohisto- chemistry was used to observe fibroblast proliferation cell nuclear antigen （PCNA） expression, and light microscope was used to study the pathological changes of surgical area. Results After operation of the three groups, there was no corneal edema and conjunctival wound leakage. Mild corneal spot epithelial defect of group A and group B disappeared after 1 week, corneal spot epithelial defect of group C did not happen. Conjunctival impression cytology showed group A and B were 2-3 level, and group C was 2 level. At 7 days, 14 days and 28 days after operation,optical microscope showed that in- flanmmtory cells, fibroblasts, new blood capillaries and fibrous tissue proliferation below conjunctival increased significantly in group C than that in group A and B. Immunohis- tochenical staining showed that PCNA-positive cell counts of 3 groups were 12. 83 ±2.08,14.37 ±3.76,28. 12 ± 6.74 respectively at 7 days after operation; 13.81 ±1.53, 16.28 ± 3.78,25.67 ± 4.45 respectively at 14 days after operation; 11.96 ± 1.45,13.07 ±2.04,17.6± 3. 11 respectively at 14 days after

关 键 词：丝裂霉素C 结膜下注射 成纤维细胞增殖细胞核抗原 瘢痕化模型 青光眼滤过性手术 兔 

分 类 号：R772.21[医药卫生—眼科]