角膜内皮移植术后早期玻璃酸钠对泪膜及角膜上皮细胞再生的作用  

Application of hyaluronate on tear film and corneal epithelial cells regeneration at the early stage after endothelial keratoplasty

作　　者：彭荣梅[1] 孙彬佳 肖格格[1] 洪晶[1] PENG Rongmei;SUN Binjia;XIAO Gege;HONG Jing(Department of Ophthalmology,Peking University Third Hospital,Key Laboratory of Vision Loss and Restoration,Ministry of Education of Beijing,Beijing 100191,China)

机构地区：[1]北京大学第三医院眼科,北京市视觉损伤与修复教育部重点实验室,北京市100191

出　　处：《眼科新进展》2020年第6期542-546,共5页Recent Advances in Ophthalmology

基　　金：国家自然科学基金资助(编号81800801,31271045)。

摘　　要：目的研究1 g·L^-1和3 g·L^-1玻璃酸钠(hyaluronate,HA)滴眼液对角膜内皮移植术后早期泪膜及角膜上皮细胞再生的作用。方法选择2017年9月至2018年2月在北京大学第三医院行角膜内皮移植术的患者60例(60眼),随机分成1 g·L^-1HA组和3 g·L^-1HA组,每组各30例,观察标准干眼评估问卷(SPEED)评分、结膜角膜染色评分(OSS)、泪膜破裂时间(TBUT)、角膜上皮缺损范围,进行激光共聚焦显微镜检查。比较不同时间点组间、组内各指标差异。结果SPEED评分各时间点两组间比较差异均无统计学意义(均为P>0.05)。组内比较两组组内术后7 d、14 d、28 d均低于前一时间点(均为P=0.000),余相邻时间点两两比较差异均无统计学意义(均为P>0.05)。TBUT术后7 d、14 d、28 d 3 g·L^-1HA组均显著高于1 g·L^-1HA组(均为P<0.05),而术前组间差异不显著;组内比较1 g·L^-1 HA组后一时间点较前一时间点、3 g·L^-1HA组术后7 d较术前均显著延长(均为P<0.05),而3 g·L^-1HA组术后14 d、28 d与前一时间点差异均无统计学意义(均为P>0.05)。OSS评分术前及术后1 d、3 d两组间比较差异均无统计学意义(均为P>0.05),术后7 d、14 d、28 d 3 g·L^-1HA组均显著低于1 g·L^-1HA组(均为P<0.05);组内比较两组术后1 d OSS评分均显著高于术前(均为P=0.000),其余时间点两组均低于前一时间点(均为P=0.000)。角膜上皮缺损范围术后1 d两组间比较差异均无统计学意义(均为P>0.05),术后3 d、7 d两组间比较,以及两组组内与前一时间点比较差异均有统计学意义(均为P<0.05)。角膜基底细胞密度术前、术后28 d两组间比较,以及1 g·L^-1HA组组内术前与术后28 d比较差异均无统计学意义(均为P>0.05),而3 g·L^-1 HA组术后28 d显著低于术前(P=0.002)。结论HA可以有效改善角膜内皮移植术后早期泪膜状态并促进角膜上皮细胞再生,存在浓度依赖性。Objective To investigate the effect of 1 g·L^-1 and 3 g·L^-1 hyaluronate(HA)on tear film and corneal epithelial cells regeneration at the early stage after endothelial keratoplasty.Methods The study was conducted on totally 60 eyes of 60 patients who underwent endothelial keratoplasty(EK)from September 2017 to February 2018 in Peking University Third Hospital.They were randomly divided into 1 g·L^-1 HA group and 3 g·L^-1 HA group,30 cases in each group.The standard dry eye assessment questionnaire(SPEED)score,conjunctival corneal staining score(OSS),breakup time of tear film(TBUT),corneal epithelial defect area were observed,and laser scanning confocal microscopy was performed.The inter-group and intra-group differences of each index were compared at different time points.Results SPEED score No statistical differences were observed at different time points between the two groups(all P>0.05).Intra-group comparison The level at the time was lower than that at the former time point in both two groups for 7 d,14 d and 28 d after operation(all P=0.00),no difference was found at other time points by pairwise comparison(all P>0.05).TBUT There was no significant difference in preoperative TBUT between two groups(P>0.05).TBUT in 3 g·L^-1 HA group was significantly higher than that in 1 g·L^-1 HA group on the 7 d,14 d,28 d after operation(all P<0.05).Intra-group comparison Within 1 g·L^-1 HA group,there was significant prolongation compared with prior time point,and there was significant prolongation on 7 d after operation compared with that before operation for 3 g·L^-1 HA group(all P<0.05),whereas there was no significant prolongation on 14 d and 28 d after operation compared with prior time point in 3 g·L^-1 HA group(both P>0.05).OSS score There was no significant difference between two groups in OSS score before operation,on 1 d and 3 d after operation(all P>0.05),whereas OSS score in 3 g·L^-1 HA group was significant lower than that in 1 g·L^-1 HA group on 7 d,14 d and 28 d after operation(all P<0.05).Intra

关 键 词：玻璃酸钠滴眼液 角膜内皮移植 泪膜破裂时间 角膜基底细胞 上皮缺损修复 

分 类 号：R779.1[医药卫生—眼科]