疏肝通窍法对青光眼视神经损害大鼠视网膜神经节细胞凋亡及视网膜、视神经超微结构的影响  

A Study to Determine if the Traditional Chinese Medicine Used to Soothe the Liver and Unblock the Orifices can Protect Retinal Ganglion Cells,the Ultrastructure of Retina and Optic Nerve in Rats from Damage by Glaucoma

作　　者：樊晓瑞[1,2] 孙河[2] 庞国龙[3] Xiaorui Fan;He Sun;Guolong Pang(Heilongjiang University of Chinese Medicine,Haerbin 150040,China;Department of Ophthalmology,First Affiliated Hospital of Heilongjiang University of Chinese Medicine,Haerbin 150040,China;Department of Ophthalmology,Taian City Central Hospital,Taian 271000,China)

机构地区：[1]黑龙江中医药大学,哈尔滨150040 [2]黑龙江中医药大学附属第一医院眼科,哈尔滨150040 [3]山东省泰安市中心医院眼科,271000

出　　处：《中华眼视光学与视觉科学杂志》2018年第8期461-468,共8页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：国家自然科学基金面上项目(81173305)。

摘　　要：目的:通过观察视网膜神经节细胞(RGCs)计数和视网膜、视神经超微结构及形态学变化,研究疏肝通窍法保护高眼压损害的视神经的作用机制,为开发保护青光眼视神经的有效中药方剂提供参考。方法:实验研究。以SD大鼠为实验动物,右眼前房注射复方卡波姆溶液建立慢性高眼压模型(90只)。将不同时间窗(1周、2周、3周)的慢性高眼压大鼠模型分别分为模型组(5只)、阴性对照组(5只)、阳性对照组(5只)、低剂量通窍明目4号治疗组(低剂量治疗组)(10gkg-1d-1,5只)、中剂量治疗组(20gkg-1d-1,5只)和高剂量治疗组(40gkg-1d-1,5只),以具有疏肝通窍作用的通窍明目4号灌胃为干预手段,运用CMIAS系列数码医学图像分析系统观察RGCs计数,电镜观察视网膜、视神经超微结构,采用one-wayANOVA法和LSD法进行数据分析。结果:①RGCs计数:随着高眼压持续的时间延长,RGCs计数逐渐减少(F=87.67、29.69、33.38、38.03、33.67、23.36,P<0.001),经药物治疗后,高眼压持续1周、2周和3周各组的高中剂量治疗组RGCs的存活量明显增加,与阴性对照组和阳性对照组比较差异均有统计学意义(P<0.001)。②模型组和阴性对照组视网膜结构排列紊乱,厚度变薄,空泡变性,细胞萎缩坏死,各治疗组视网膜的结构紊乱减轻,各层厚度略增加,空泡变性减少,细胞萎缩程度减轻。③模型组和阴性对照组视神经轴突排列紊乱,密度降低,微丝溶解,空泡样变,细胞器肿胀破坏,髓鞘变性,各治疗组视神经髓鞘的水肿程度减轻,髓索的变性有所修复,线粒体的水肿程度也减轻。结论:通窍明目4号可以改善高眼压大鼠模型RGCs生存的微环境,保护未受损的细胞,修复轻度受损的RGCs,延缓或阻止部分受损细胞的下行性改变,减少高眼压大鼠模型RGCs的凋亡。疏肝通窍法对青光眼视神经损害具有保护作用。Objective:To study the effectiveness of a traditional Chinese medicine(TCM)used for soothing the liver and unblocking the orifices to determine if it can protect the optic nerve from high intraocular pressure in glaucoma by observing retinal ganglion cell(RGCs)counts and the ultrastructure and morphological changes of the retina and optic nerve in rats;to develop an effective TCM prescription to protect the optic nerve from glaucoma.Methods:In this experimental study,the 4th formula TCM prescriptions for unblocking the orifices to improve vision is based on the therapeutic principles of soothing the liver and unblocking the orifices.In this research study,90 SD rats were used as experimental animals.Chronic high intraocular pressure(IOP)was established in rat models by injecting carbomer solution into the anterior chamber of the right eyes.The models were first divided into 3 groups based on different IOP time frame windows(1 week,2 weeks,3 weeks).Then each IOP group was divided into a model group(non-treated,5 rats),negative control group(5 rats),positive control group(treated with a neurotrophic solution,5 rats),low-dose treatment group(treated with 10 gkg-1d-1 4th formula for blocking orifices,5 rats),middle-dose treatment group(20 gkg-1d-1,5 rats)and high-dose treatment group(40 gkg-1d-1,5 rats).The rats in the treatment groups were given TCM prescriptions by intragastric administration.RGC counts were observed by a CMIAS series digital medical image analysis system.The ultrastructure of the retina and optic nerve was observed by electron microscopy.The data were analyzed by one-way ANOVA and LSD methods.Results:1.RGC counts gradually reduced along with the duration of high intraocular pressure(F=87.67,29.69,33.38,38.03,33.67,23.36,all P<0.001).Comparing the high-and middle-dose treatment groups with the positive and negative control groups(IOP at 1 week,2 weeks,3 weeks),the survival of RGCs significantly increased with the oral administration of the 4th formula for unblocking the orifices t

关 键 词：青光眼 视神经保护 疏肝通窍法 视网膜神经节细胞 超微结构 

分 类 号：R285.5[医药卫生—中药学]