新生血管性青光眼闭角期患者房水内细胞因子的变化  

Changes of cytokines in the aqueous humor of neovascular glaucoma at the angle-closure stage

作　　者：洪颖[1] 陈旭豪 吴倩如 宋思佳 张纯[1] Hong Ying;Chen Xuhao;Wu Qianru;Song Sijia;Zhang Chun(Department of Ophthalmology,Peking University Third Hospital,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve,Beijing 100191,China)

机构地区：[1]北京大学第三医院眼科眼部神经损伤的重建保护与康复北京市重点实验室,北京100191

出　　处：《中华眼科杂志》2022年第1期14-21,共8页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金(81670851)。

摘　　要：目的评估新生血管性青光眼(NVG)闭角期患者房水内细胞因子浓度的变化并分析其与复发的关系。方法前瞻性病例对照研究。收集2018年9月至2019年9月就诊于北京大学第三医院眼科的32例(32只眼)NVG闭角期患者(NVG组),所有患者均接受包含抗血管内皮生长因子(VEGF)药物注射、小梁切除术和全视网膜光凝在内的三联序贯治疗并随访至少12个月。NVG组患者在抗VEGF药物注射前、小梁切除术前及NVG复发时收集房水标本,采用流式点阵免疫发光法检测VEGF、白细胞介素(IL)、趋化因子等45种细胞因子的浓度。选取25例增生型糖尿病视网膜病变(PDR)患者(PDR组)和24例年龄相关性白内障患者(白内障组)作为疾病对照组。细胞因子浓度以M(Q1,Q3)表示,NVG组与疾病对照组间细胞因子浓度比较采用非参数Kruskal-Wallis H检验;NVG复发与未复发患者间细胞因子浓度比较采用Mann-Whitney U检验。结果NVG组年龄(60±11)岁,男性22例,女性10例;年龄和性别分布与两个疾病对照组相比差异均无统计学意义(均P>0.05)。NVG组在抗VEGF治疗前、小梁切除术前、复发时房水中VEGF浓度分别为2151.3(1433.1,4280.0)、655.4(287.3,836.3)、2003.4(1603.1,2468.9)ng/L,抗VEGF治疗前和复发时均高于PDR组[453.8(189.9,595.8)ng/L]和白内障组[143.5(112.7,269.8)ng/L],差异均有统计学意义(均P<0.05)。NVG组在抗VEGF治疗前房水中细胞程序性死亡蛋白-配体1(PD-L1)浓度[38.9(22.4,50.6)ng/L]高于PDR组[12.0(6.3,20.1)ng/L]和白内障组[14.6(11.4,19.3)ng/L];CX3C型趋化因子配体1(fractalkine)浓度[242.7(189.0,306.7)ng/L]高于PDR组[131.1(119.1,157.6)ng/L]和白内障组[116.7(10.2,135.9)ng/L];IL-7浓度[18.0(12.0,32.7)ng/L]高于PDR组[7.7(2.0,10.8)ng/L]和白内障组[3.3(1.9,6.8)ng/L];嗜酸粒细胞趋化因子(eotaxin)浓度[84.0(52.4,122.7)ng/L]高于PDR组[26.6(17.1,72.3)ng/L]和白内障组[7.1(5.6,14.8)ng/L];肿瘤坏死因子相关凋亡诱导配体(TRAIL)浓度[3.6(2.Objective To evaluate the concentration of cytokines in the aqueous humor of neovascular glaucoma(NVG)patients at the angle-closure stage in different treatment periods and its relationship with recurrence.Methods A prospective case-control study.Angle-closure stage NVG patients who came to Peking University Third Hospital from September 2018 to September 2019 were enrolled and followed-up for at least 12 months.Patients received triple sequential therapy,including anti-vascular endothelium growth factor(VEGF)injection,trabeculectomy,and panretinal photocoagulation.The aqueous humor before anti-VEGF treatment,before trabeculectomy,and during recurrence was collected.Multiplex bead immunoassay was applied to measure the concentration of 45 cytokines including VEGF,interleukin(IL),and chemokine.The relevant data were compared with the values of 25 proliferative diabetic retinopathy(PDR)patients and 24 age-related cataract patients undergoing phacoemulsification as controls.The concentration of cytokines was presented as M(Q1,Q3).The nonparametric Kruskal-Wallis H test was applied to compare the cytokine concentration between the NVG group and controls.The difference between the recurrence and non-recurrence groups was compared with the Mann-Whitney U test.Results The average age of NVG patients was(60±11)years,and there were 22 males and 10 females.No significant differences were found in age and gender between the NVG group and the two control groups(both P>0.05).The median concentrations of VEGF in the NVG group before anti-VEGF treatment,before trabeculectomy,and after recurrence were 2151.3(1433.1,4280.0)ng/L,655.4(287.3,836.3)ng/L and 2003.4(1603.1,2468.9)ng/L respectively.The concentrations of VEGF before anti-VEGF treatment and after recurrence in the NVG group were significantly higher than the PDR group[453.8(189.9,595.8)ng/L]and the cataract group[143.5(112.7,269.8)ng/L](all P<0.05).The median concentration of programmed cell death protein ligand 1(PD-L1)was 38.9(22.4,50.6)ng/L before anti-VEGF treatment

关 键 词：青光眼 新生血管性 血管内皮生长因子A 细胞因子类 生物标记 眼房水 

分 类 号：R775[医药卫生—眼科]