【作者】 苑晓勇；

【导师】 孙慧敏；

【作者基本信息】 天津医科大学 ， 眼科学， 2002， 硕士

【摘要】 准分子激光PRK手术以其预测性好、稳定性强、安全有效等优点成为一种令人振奋的屈光手术，十余年来逐渐为广大眼科医师和近视散光患者所接受。但作为一种手术，PRK也有其并发症，如屈光回退和Haze形成，尚待进一步解决。而近来采用LASIK屈光手术，此种并发症减少。本文仅选用几种细胞因子研究其PRK术后的变化。 细胞因子是一类具有调节细胞功能的高活性多功能蛋白质多肽分子，其作用已广为众多学者所重视。PRK手术后，角膜创口浸浴在泪液的环境中，已证实，泪液中存在一定量的细胞因子，它们必定参与角膜创口的较为特异的愈合过程，而组织的修复情况直接影响日后的屈光状态。泪液中的细胞因子在PRK术后含量是否有变化，变化有无规律，与患眼屈光状态是否存在联系是本研究关注的问题。 本研究选择EGF、TGF-β₁和IL-1α三种与细胞增殖、组织损伤修复关系较为密切的细胞因子，选用酶联免疫吸附实验（ELISA），检测其在PRK手术前、术后1天、2天、10天、30天泪液中含量的变化，分析其变化规律；选用ABC法和间接免疫荧光法检测此三种细胞因子的主要受体EGF R、TGF-βRI和IL-1RI在角膜上皮细胞的蛋白质水平的表达情况。其结果为： 1．PRK术眼泪液中的EGF在手术前后未检测到明显变化，考虑其功能可能主要与维持细胞稳态有关。 2．泪液中的TGF-β₁，在术后第一天含量较术前下降，自术后第二天开始恢复至术前水平，我们认为此变化的出现与术后第一天细胞增殖移行旺盛有关，进一步分析发现中低度近视患眼术后才有此变化。而且中低度近视患眼泪液中TGF-β₁在术后1天、2天、30天均有低于高度 天津医科大学硕土研究生学位论文 近视患眼的趋势，尽管无统计学差异，我们推断这与高度近视眼手术 切削偏深，基质修复较明显有关。结合国外学者的研究，TGF－p；在 高度近视眼术后含量偏高，可能与Haze和屈光回退率较高有关。 3．泪液中几刁 a在手术前后亦无明显变化，考虑 PRK手术创伤可能尚不I 足以改变 IL－la含量。 4．ABC法和免疫荧光法均证实：近视眼角膜上皮细胞表达此三种受体， 强度依次为 EGF R＞ IL－IRI ＞TGFeR PRK手术后角膜的愈合是一复杂的过程，很多细节至今尚不完全清楚， Haze和屈光回退也是多种因素的综合结果，细胞因子可能仅起一部分作用， 本研究从一个方面进行了探讨，力图寻找其变化的规律，为寻找抑制Haze和 近视回退的方法提供一定的依据。更多还原

【Abstract】 Excimer laser photorefractive keratectomy (PRK) is an exciting refractive surgery for its excellent predictability, stability, effectiveness and safeness. In the past years, it has been accepted by ophthalmic surgeons and patients of myopia and astigmatism. Just like other operations, it possesses some special complications to be resolved, such as myopia regression and haze. With the use of LASIK procedure, such complications are reduced to some extends. Cytokines are a group of active and multi-functional peptides, which have been studied by many scholars. Corneal wound immerses in tears after PRK, where cytokins has been found, they must have effect on the wound healing, then effect the operative results. Whether there are variations of the concentration of cytokines in tears or not, the regularity of variation and the relationship between the concentration and the refractive condition are the questions to be resolved in this research.ELISA method was utilized to measure the concentration of EGF> TGF- P i and IL-1 a in tears before operation, the 1st, 2nd, 10th and 30th day postoperatively, variance analysis was used to treat the data. ABC method and indirect immunofluoreince method was chosen to detect the protein expression of the main receptors from these three kinds of cytokines. The results are as follows:1. EGF in tears remains a constant level before and after operation, maybe the main function of EGF is to maintain the hemogenesis of cells.2. TGF-P i in tears decreased in the 1st day postoperatively, then recovered on the 2nd day, we thought that the variation were related to the cellproliferation, after further analysis we found that the decrease only appeared in moderate and low myopia group. And the concentration of TGF- 3 | in moderate and low myopia group was lower than that of high myopia on the 1st , 2nd and 30th day postoperatively with no significant differences. We postulate that the higher concentration of TGF- 3 i in high myopia may be related to the deeper keratectomy and the more obvious corneal stromal healing. The higher concentration of TGF- 3 i in tears of high myopia may have effect on haze and regression.3. There were no significant differences between pre and postoperative IL-1a in tears, the surgical trauma may not affect the concentration of this kind of cytokine.4. ABC method and immunofluoreince method have all conformed the protein expression of the main receptors of these cytokines, the intensity was EGFR> IL-1R I >TGF3 R I .The healing of the cornea after PRK is a complex procedure, among which many details are still unknown, haze and regression are also the results of many factors. Cytokines may only take part effect. The objective of this research is to find the regularity of the changes of cytokines in tears in order to find the methods to inhibit haze and regression of myopia.更多还原