110例穿透性角膜移植术后排斥反应危险因素分析
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摘要
目的探讨穿透性角膜移植术后发生排斥反应的危险因素。方法对2014年1月至2017年6月进行的穿透性角膜移植术后排斥反应发生情况进行回顾性分析,总结免疫排斥反应发生的时间、可能的原因及预后等。结果 110眼中发生免疫排斥反应34眼,其中原发病为圆锥角膜3眼,角膜变性3眼,各种角膜感染后所致角膜白斑19眼,大疱性角膜炎1眼,角移排斥2眼,其他6眼。排斥反应发生的时间与发生率同受体性别、供受体性别差异及受体糖尿病病史密切相关。结论受体性别、供受体性别差异、受体糖尿病病史是穿透性角膜移植术后排斥反应的高危因素。
Objective To investigate the risk factors of rejection reaction after corneal penetrating keratoplasty.Methods A retrospective analysis was curried out in rejection reaction occurrence situation after corneal penetrating keratoplasty from January 2014 to June 2017.The onset time of immune rejection reaction,possible causes and prognosis were summarized.Results Among 110 eyes,the immune rejection reaction occurred in 34 eyes,keratoconus occurred in 3 eyes,corneal degeneration in 3 eyes,albugo after corneal infections in 19 eyes,corneal endothelium dysfunction in 1 eye,heat and chemical injury in 2 eyes,and others in 6 eyes.The occurrence time of rejection reaction and occurrence rate were closely correlated with the receptor sex,sex difference between donor and receptor and diabetes history of receptor.Conclusion The receptor gender,donor gender and diabetes history of receptor are the high risk factors of rejection reaction after DCD keratoplasty.
Objective To investigate the risk factors of rejection reaction after corneal penetrating keratoplasty.Methods A retrospective analysis was curried out in rejection reaction occurrence situation after corneal penetrating keratoplasty from January 2014 to June 2017.The onset time of immune rejection reaction,possible causes and prognosis were summarized.Results Among 110 eyes,the immune rejection reaction occurred in 34 eyes,keratoconus occurred in 3 eyes,corneal degeneration in 3 eyes,albugo after corneal infections in 19 eyes,corneal endothelium dysfunction in 1 eye,heat and chemical injury in 2 eyes,and others in 6 eyes.The occurrence time of rejection reaction and occurrence rate were closely correlated with the receptor sex,sex difference between donor and receptor and diabetes history of receptor.Conclusion The receptor gender,donor gender and diabetes history of receptor are the high risk factors of rejection reaction after DCD keratoplasty.
引文
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[12]BACHMANN B,TAYLOR R S,CURSIEFEN C.Corneal neovascularization as a risk factor for graft failure and rejection after keratoplasty:an evidence-based meta analysis[J].Ophthalmology,2010,117(8):1300-1305.
[13]MAGUIRE M G,STARK W J,GOTTSCH J D,et al.Risk-factors for corneal graft failure and rejection in the collaborative corneal transplantation studies[J].Ophthalmology,1994,101(9):1536-1547.
[2]潘志强,梁庆丰.重视角膜移植手术的供体材料问题[J].中华眼科杂志,2016,52(9):641-643.
[3]GUILBERT E,BULLET J,SANDALI O,et al.Longterm rejection incidence and reversibility after penetrating and lamellar keratoplasty[J].Am J Ophthalmol,2013,155(3):311-315.
[4]PEDERSEN I B,IVARSEN A,HJORTDAL J,et al.Graft rejection and failure following endothelial keratoplasty(DSAEK)and penetrating keratoplasty for secondary endothelial failure[J].Acta Ophthalmologica,2015,93(2):172-177.
[5]朱斌良,刘景棠,张长宁.103例穿透角膜移植术后排斥反应的临床分析[J].中国实用眼科杂志,1995,13(2):79-81.
[6]BACHMANN B,TAYLOR R S,CURSIEFEN C.Corneal neovascularization as a risk factor for graft failure and rejection after keratoplasty an Evidence-Based meta-analysis[J].Ophthalmology,2010,117(7):1242-1300.
[7]WHITSETT C F,STULTING R D.The distribution of HLA antigens on human corneal tissue[J].Invest Ophthalmol Vis Sci,1984,25(5):519-524.
[8]PALAY D A,KANGAS T A,STULTING R D,et al.The effects of donor age on the outcome of penetrating keratoplasty in adults[J].Ophthalmology,1997,104(10):1576-1579.
[9]TRIGUI A,SMAUUI M,MASMOUDI J,et al.Corneal graft rejection:donor and receiver implication[J].J Fr Ophthalmol,2005,28:631-634.
[10]STULTING R D,SUGAR A,BECK R,et al.Effect of donor and recipient factors on corneal graft rejection[J].Cornea,2012,31(10):1141-1147.
[11]ANSHU A,LIM L S,HTOON H M,et al.Postoperative risk factors in uencing corneal graft survival in the Singapore Corneal Transplant Study[J].Am J Ophthalmol,2011,151(4):442-448.
[12]BACHMANN B,TAYLOR R S,CURSIEFEN C.Corneal neovascularization as a risk factor for graft failure and rejection after keratoplasty:an evidence-based meta analysis[J].Ophthalmology,2010,117(8):1300-1305.
[13]MAGUIRE M G,STARK W J,GOTTSCH J D,et al.Risk-factors for corneal graft failure and rejection in the collaborative corneal transplantation studies[J].Ophthalmology,1994,101(9):1536-1547.