【摘要】 目的 探讨原发性开角型青光眼(POAG)患者房水中促红细胞生成素(EPO)、信号素3A(Sema3A)、转化生长因子β1(TGF-β1)与视网膜纤维层厚度、视野缺损的相关性。方法 前瞻性病例对照研究。选取2019年6月至2020年6月期间来我院就诊的POAG患者156例(156只眼)作为观察组，并选取同期进行白内障手术的78例(78只眼)作为对照组。根据POAG患者视野平均缺损程度将患者分为A组55只眼、B组66只眼和C组35只眼。采用相干光层析成像术(OCT)术测量患者视网膜纤维层厚度，使用一次性无菌注射器取房水标本，采用酶联免疫吸附试验检测房水中EPO,采用Western blot法检测房水中信号素3A(semaphorin 3A,Sema3A)水平，采用酶联免疫双抗体夹心法检测房水中TGF-β1水平。分析房水中EPO、Sema3A、TGF-β1水平变化与POAG患者视网膜纤维层厚度、视野缺损的关系。结果 观察组患者眼压、视野平均缺损、杯盘比显著高于对照组(P<0.05)。观察组患者房水中EPO、Sema3A、TGF-β1水平高于对照组，且观察组中B组和C组房水中EPO、GF-β1水平高于A组，组间比较差异具有统计学意义(P<0.05)。观察组患者视网膜纤维层厚度显著低于对照组，且观察组中B组和C组视网膜纤维层厚度低于A组，组间比较差异具有统计学意义(P<0.05);观察组患者视野平均缺损程度显著高于对照组，且观察组中B组和C组视野平均缺损程度显著高于A组，组间比较差异具有统计学意义(P<0.05)。Pearson相关性分析结果显示，房水中EPO水平与视网膜纤维层厚度呈负相关关系(r=-0.348,P<0.05),与视野缺损程度呈正相关关系(r=0.518,P<0.05);房水中Sema3A水平与视网膜纤维层厚度呈负相关关系(r=-0.426,P<0.05),与视野缺损程度呈正相关关系(r=0.629,P<0.05);房水中TGF-β1水平与视网膜纤维层厚度呈负相关关系(r-0.457,P<0.05),与视野缺损程度呈正相关关系(r=0.532,P<0.05)。结论 POAG患者房水中EPO、Sema3A、TGF-β1水平与视野缺损加重、视网膜纤维层厚度变薄密切相关，可为POAG预防病情进展提供参考依据。更多还原

【Abstract】 Objective To explore and analyze the relationship between erythropoietin(EPO), semaphorin 3A(Sema3A), transforming growth factor β1(TGF-β1), retinal fibrous layer thickness and visual field defects in aqueous humor of primary open-angle glaucoma.Methods Prospective case-control study.A total of 156 patients with primary open-angle glaucoma who visited our hospital from June 2019 to June 2020 were selected as the observation group, and 78 eyes who underwent cataract surgery during the same period were selected as the control group. The patients were divided into group A 55 eyes, group B 66 eyes and group C 35 eyes according to the mean visual field defect degree of primary open Angle glaucoma. Retinal fiber thickness was measured by optical coherence tomography, aqueous humor samples were collected with disposable sterile syringes, and Erythropoietin(EPO) in aqueous humor was detected by elisa. Western blot was used to detect the level of Semaphorin 3A(Sema3A) in aqueous aqueous solution, and elisa was used to detect the level of transforming growth factor-β1(TGF-β1) in aqueous aqueous solution. To analyze the relationship between EPO, Sema3A, TGF-β1 levels and retinal fiber thickness and visual field defect in patients with primary open-angle glaucoma.Results There was no significant difference in gender, age, eye axis and other data between the two groups(P>0.05), and they were comparable; while the intraocular pressure, average visual field defect, and cup-to-disk ratio of the observation group were significantly higher than those of the control group, and the difference was statistically significant Significance(P<0.05). The EPO level in the aqueous humor of the observation group was significantly higher than that of the control group, and the EPO level in the aqueous humor of the observation group group B and C group was higher than that of the group A, and the difference between the groups was statistically significant(P<0.05). The levels of Sema3A and TGF-β1 were significantly lower than those of the control group, and the levels of Sema3A and TGF-β1 in the aqueous humor of groups B and C in the observation group were significantly lower than those of group A, and the difference between groups was statistically significant(P<0.05). The thickness of the retinal fiber layer in the observation group was significantly lower than that in the control group, and the thickness of the retinal fiber layer in groups B and C in the observation group was lower than that in the group A, and the difference between the groups was statistically significant(P<0.05). The degree of defect was significantly higher than that of the control group, and the average defect degree of the visual field in groups B and C in the observation group was significantly higher than that in group A, and the difference between the groups was statistically significant(P<0.05). The results of Pearson correlation analysis showed that the EPO level in the aqueous humor was negatively correlated with the thickness of the retinal fiber layer(r=-0.348, P<0.05), and was positively correlated with the degree of visual field defect(r=0.518, P<0.05). The level of Sema3A was negatively correlated with retinal fiber layer thickness(r=-0.426, P<0.05), and positively correlated with the degree of visual field defect rr=0.629, P<0.05); the level of TGF-β1 in aqueous humor was associated with retinal fiber layer thickness It was negatively correlated(r=-0.457, P<0.05), and positively correlated with the degree of visual field defect(r=0.532, P<0.05).Conclusions The EPO, Sema3A and TGF-β1 levels in the aquifers of patients with primary open-angle glaucoma gradually increased, and the retinal fiber layer gradually became thinner, and the visual field defect gradually worsened.更多还原