自体血清联合重组人表皮生长因子对角膜创面的修复作用
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摘要
目的:探讨自体血清联合重组人表皮生长因子对角膜异物剔除术后角膜创面的修复效果。方法:选取2015-10/2016-03于我院行角膜异物剔除手术的患者92例110眼,随机分为治疗组和对照组,术后对照组患者使用重组人表皮生长因子滴眼液点眼,治疗组患者在对照组的基础上联合使用自体血清滴眼。手术前后,采用AS-OCT观察角膜创面情况。术后评估两组患者的临床疗效及泪液中TNF-α和IL-6的浓度。结果:术后1wk治疗组患者治愈率(96.4%vs 78.2%)和术后2d角膜荧光素染色阴性率(98.2%vs 83.6%)均明显高于对照组,泪液中TNF-α和IL-6(51.47±7.83、5.29±1.67ng/L)浓度均明显低于对照组(143.62±18.12、13.95±3.44ng/L)。术后治疗组患者角膜上皮愈合时间(1.4±0.6d)较对照组(2.2±1.3d)明显缩短。术后1wk,AS-OCT图像显示治疗组修复后的角膜基质形态更加接近术前正常水平。结论:自体血清联合重组人表皮生长因子对角膜异物剔除术后角膜创面的修复效果显著,可以明显缩短角膜创面愈合时间,减轻炎症反应,对角膜基质具有良好的修复功能。
AIM: To investigate the efficacy of autologous serum combined with recombinant human epidermal growth factor in repairing of corneal defect after corneal foreign body eliminating operation.METHODS: Totally 92 patients with corneal foreign body(110 affected eyes) as the research object in our hospital from October 2015 to March 2016. All the patients were divided into the treatment group and the control group according to the random number table. There was no significant difference between the two groups in age, sex and disease course. Both groups received corneal foreign body elimination by slit lamp. The treatment group was given eye drops containing epidermal growth factor combined autologous serum and tobramycin after surgery, while the control group was only administrated with epidermal growth factor and tobramycin. Treatment effects were compared 1 wk after treatment.RESULTS: One week after the treatment, the cure rate in the treatment group(96.4%) was much higher than that in the control group(78.2%). Two days after treatment, the fluorescein staining in the treatment group was 98.2%, it was higher than that in the control group(83.6%). The concentration of TNF-α and IL-6 of the treatment group was lower than that in the control group. One week after the treatment, AS-OCT images showed that the repair of corneal matrix in the treatment group was closer to the preoperative normal level.CONCLUSION: The treatment effect that AS combined rhEGF is much better than that only usde rhEGF, shortened healing time of corneal epithelial wound. It is more effective and security to treat traumatic corneal epithelial defect, better repair function to corneal matrix.
AIM: To investigate the efficacy of autologous serum combined with recombinant human epidermal growth factor in repairing of corneal defect after corneal foreign body eliminating operation.METHODS: Totally 92 patients with corneal foreign body(110 affected eyes) as the research object in our hospital from October 2015 to March 2016. All the patients were divided into the treatment group and the control group according to the random number table. There was no significant difference between the two groups in age, sex and disease course. Both groups received corneal foreign body elimination by slit lamp. The treatment group was given eye drops containing epidermal growth factor combined autologous serum and tobramycin after surgery, while the control group was only administrated with epidermal growth factor and tobramycin. Treatment effects were compared 1 wk after treatment.RESULTS: One week after the treatment, the cure rate in the treatment group(96.4%) was much higher than that in the control group(78.2%). Two days after treatment, the fluorescein staining in the treatment group was 98.2%, it was higher than that in the control group(83.6%). The concentration of TNF-α and IL-6 of the treatment group was lower than that in the control group. One week after the treatment, AS-OCT images showed that the repair of corneal matrix in the treatment group was closer to the preoperative normal level.CONCLUSION: The treatment effect that AS combined rhEGF is much better than that only usde rhEGF, shortened healing time of corneal epithelial wound. It is more effective and security to treat traumatic corneal epithelial defect, better repair function to corneal matrix.
引文
1李洁,张健梅,黄蒂.重组人表皮生长因子滴眼液治疗角膜异物伤的临床观察.中华医院感染学杂志2012;22(1):76
2 Holland S,Morck D,Schultz C. Treatment of corneal defects with delayed re-epithelization with a medical device/drug delivery system for epidermal growth factor. Clin Exp Ophthalmol 2012;40(7):662-668
3刘治容,张悦,吴峥峥,等.高浓度自体血清滴眼治疗眼表疾病.国际眼科杂志2012;12(6):1111-1113
4中华医学会眼科学分会角膜病学组.我国角膜上皮损伤临床诊治专家共识(2016年).中华眼科杂志 2016;9(52):644-648
5陈虹丽,严晨曦,傅瑶.干细胞在角膜修复中的作用.中华实验眼科杂志 2018;11(36):883-886
6张安民,周爱意,左冰.陕西省汉中地区眼外伤临床分析.国际眼科杂志 2006;6(4):959-960
7孙凤海,许美玲,贾健. 海洋石油渤海地区角膜异物伤1021例调查分析.眼外伤职业眼病杂志 2007;29(9):726-727
8张改玲.手术显微镜下角膜异物剔除100例报告.眼外伤职业眼病杂志 2005;27(3):48-49
9 Quinto GG,Campos M,Behrens A. Autologous serum for ocular surface diseases. Arq Bras Oftalmol 2008;71(6):47-54
10曲忻,郝继龙.自体血清在眼表疾病治疗中的价值.中国实用眼科杂志 2005;23(10):1011-1014
11 Geerling G,Unterlauft JD,Kasper K,et al. Autologous serum and alternative blood products for the treatment of ocular surface disorders. Ophthalmologe 2008;105(7):623-631
12 Tsuboto K,Goto E,Shimmura S,et al. Treatment of persistent corneal epithelial defect by autologous serum application. Ophthalmology 1999;106(10):1984-1989
13周媛,邹新蓉,祝肇荣.自体血清治疗持续性角膜上皮缺损的临床分析.眼外伤职业眼病杂志2010;32(12):888-890
14 Liu L,Hartwig D,Harloff S,et al. An optimised protocol for the production autologous serum eyedrops. Graefes Arch Clin Exp Ophthalmol 2005;243(7):706-714
15 Ali TK,Gibbons A,Cartes C. Use of Autologous Serum Tears for the Treatment of Ocular Surface Disease from Patients with Systemic Autoimmune Diseases. Am J Ophthalmol 2018;189:65-70
16 Jeng BH,Dupps WJ Jr. Autologous serum 50% eyedrops in the treatment of persistent corneal epithelial defects. Cornea 2009;28(10):1104-1108
17梁伟亮,关仕嫦,关卫文,等.自体血清治疗严重眼化学烧伤的临床研究.眼科新进展2007;27(6):450-451
18 Rush SW,Han DY,Rush RB. Optical coherence tomography-guided transepithelial phototherapeutic keratectomy for the treatment of anterior corneal scarring. Am J Ophthalmol 2013;156(6):1088-1094
19祁媛媛,张立军,董贺,等. 前节OCT辅助准分子激光治疗性角膜切削术治疗真菌性角膜溃疡. 眼科新进展2017;37(3):263-266
2 Holland S,Morck D,Schultz C. Treatment of corneal defects with delayed re-epithelization with a medical device/drug delivery system for epidermal growth factor. Clin Exp Ophthalmol 2012;40(7):662-668
3刘治容,张悦,吴峥峥,等.高浓度自体血清滴眼治疗眼表疾病.国际眼科杂志2012;12(6):1111-1113
4中华医学会眼科学分会角膜病学组.我国角膜上皮损伤临床诊治专家共识(2016年).中华眼科杂志 2016;9(52):644-648
5陈虹丽,严晨曦,傅瑶.干细胞在角膜修复中的作用.中华实验眼科杂志 2018;11(36):883-886
6张安民,周爱意,左冰.陕西省汉中地区眼外伤临床分析.国际眼科杂志 2006;6(4):959-960
7孙凤海,许美玲,贾健. 海洋石油渤海地区角膜异物伤1021例调查分析.眼外伤职业眼病杂志 2007;29(9):726-727
8张改玲.手术显微镜下角膜异物剔除100例报告.眼外伤职业眼病杂志 2005;27(3):48-49
9 Quinto GG,Campos M,Behrens A. Autologous serum for ocular surface diseases. Arq Bras Oftalmol 2008;71(6):47-54
10曲忻,郝继龙.自体血清在眼表疾病治疗中的价值.中国实用眼科杂志 2005;23(10):1011-1014
11 Geerling G,Unterlauft JD,Kasper K,et al. Autologous serum and alternative blood products for the treatment of ocular surface disorders. Ophthalmologe 2008;105(7):623-631
12 Tsuboto K,Goto E,Shimmura S,et al. Treatment of persistent corneal epithelial defect by autologous serum application. Ophthalmology 1999;106(10):1984-1989
13周媛,邹新蓉,祝肇荣.自体血清治疗持续性角膜上皮缺损的临床分析.眼外伤职业眼病杂志2010;32(12):888-890
14 Liu L,Hartwig D,Harloff S,et al. An optimised protocol for the production autologous serum eyedrops. Graefes Arch Clin Exp Ophthalmol 2005;243(7):706-714
15 Ali TK,Gibbons A,Cartes C. Use of Autologous Serum Tears for the Treatment of Ocular Surface Disease from Patients with Systemic Autoimmune Diseases. Am J Ophthalmol 2018;189:65-70
16 Jeng BH,Dupps WJ Jr. Autologous serum 50% eyedrops in the treatment of persistent corneal epithelial defects. Cornea 2009;28(10):1104-1108
17梁伟亮,关仕嫦,关卫文,等.自体血清治疗严重眼化学烧伤的临床研究.眼科新进展2007;27(6):450-451
18 Rush SW,Han DY,Rush RB. Optical coherence tomography-guided transepithelial phototherapeutic keratectomy for the treatment of anterior corneal scarring. Am J Ophthalmol 2013;156(6):1088-1094
19祁媛媛,张立军,董贺,等. 前节OCT辅助准分子激光治疗性角膜切削术治疗真菌性角膜溃疡. 眼科新进展2017;37(3):263-266
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