【作者】 张楠；

【导师】 宋耕；

【作者基本信息】 河北医科大学 ， 眼科学， 2017， 硕士

【摘要】 目的:1观察本研究中葡萄膜炎患者的临床特点、治疗效果、视力预后、并发症以及诊治过程中存在的问题。2检测IL-16和IL-32在正常人及前葡萄膜炎患者血清中的表达情况,比较组间IL-16和IL-32表达水平有无明显差异,分别分析它们与疾病之间的相关性。3检测IL-16和IL-32在前葡萄膜炎活动期及稳定期患者血清中的表达情况,比较其表达水平有无差异,并检测IL-16和IL-32在前葡萄膜炎患者治疗前后血清中的表达情况,比较治疗前后有无明显差异,进一步分析它们与疾病的关系。4探讨IL-16和IL-32在前葡萄膜炎发病中的作用,寻找治疗前葡萄膜炎的新方法和新药物。方法:1收集自2015年1月至2017年1月于河北医科大学第一医院就诊的各类葡萄膜炎患者85例,其中男45例,女40例,平均发病年龄(41.25±16.83),发病年龄范围为7-70岁,详细记录他们的全身情况、眼病史以及临床诊疗情况。同期收集非葡萄膜炎患者40例作为正常对照组,其中男22例,女18例,平均年龄(42.33±12.68)。所有对照者排除葡萄膜炎病史,既往身体健康,近期未服用过抗生素、糖皮质激素、非甾体类激素和免疫抑制剂。2采集40例前葡萄膜炎实验组患者及40例正常对照组患者外周静脉血标本4-6ml,离心后提取血清,然后应用双抗体夹心法酶联免疫吸附试验(ELISA),来检测IL-16和IL-32在实验组及正常对照组血清中的表达情况,并对实验组及正常对照组行血沉(Erythrocyte Sedimentation Rate,ESR)、类风湿因子(Rheumatoid factor,RF)、C反应蛋白(C-Reactive protein,CRP)、抗链“O”等检查,分别将所得检测结果进行统计学分析。结果:1本研究85例葡萄膜炎患者中,21-45岁患者最多,发病年龄范围为7-70岁,男女比例为1.125:1。其中单眼发病患者67例,双眼同时受累的患者有18例。按解剖部位来看前葡萄膜炎(64例)最多,其次全葡萄膜炎13例,中间葡萄膜炎及后葡萄膜炎各4例,根据病程来分急性葡萄膜炎患者(61例)最多,慢性葡萄膜炎患者5例,复发性葡萄膜炎患者19例,其中伴有强直性脊柱炎的患者为7例,伴有vogt-小柳-原田(vkh)综合征的有6例(7.9%),伴有behcet病的为5例,合并fuchs综合征4例。本研究85例研究对象中有31例出现白内障、青光眼或眼压升高、虹膜粘连等并发症,大部分患者经过及时的积极的药物治疗后视力都有所提高。2前葡萄膜炎组患者血清中il-16和il-32的浓度分别为196.42(140.77,263.26)和265.67(214.51,342.82);正常对照组血清il-16和il-32的浓度分别为82.68(49.03,115.38)和86.19(51.57,154.28)。前葡萄膜炎组血清il-16浓度与正常对照组比较差异有统计学意义(p=0.003),前葡萄膜炎组血清il-32浓度与正常对照组比较差异也有统计学意义(p=0.008)。3前葡萄膜炎活动期患者血清il-16水平209.55(152.89,277.40)较稳定期水平97.19(57.92,123.17)升高,差异有统计学意义(p=0.000);活动期患者血清il-32水平278.98(222.12,346.80)较稳定期患者95.48(68.26,167.64)升高,差异有统计学意义(p=0.024)。4前葡萄膜炎患者治疗后血清il-16水平84.55(51.39,127.04)较治疗前水平196.42(140.77,263.26)显著降低,差异有统计学意义(p=0.004);并且前葡萄膜炎治疗后血清il-32水平88.98(52.17,165.43)较治疗前水平265.67(214.51,342.82)也显著降低,差异也有统计学意义(p=0.000)。5用spearman相关分别分析il-16和il-32与前葡萄膜炎疾病的相关性,结果显示il-16与疾病呈正相关(spearman相关系数r=0.671,p=0.000),il-32也与前葡萄膜炎呈正相关(spearman相关系数r=0.963,p=0.000)。il-16与il-32之间呈正相关(spearman相关系数r=0.383,p=0.009)。6前葡萄膜炎组患者esr、rf、crp、抗链“o”检测结果分别是24.50(15.50,36.50)、6.30(4.85,9.80)、64.10(11.30,113.10)和4.80(4.02,5.47);正常对照组esr、rf、crp、抗链“o”检测结果分别为15.60(6.90,27.70)、4.52(3.07,8.35)、47.50(8.10,95.80)和3.43(2.65,4.12)。前葡萄膜炎组患者ESR水平较正常对照组升高,差异有统计学意义(P=0.004)。两组患者之间RF、CRP、抗链“O”水平差异无统计学意义(RF:P=0.645;CRP:P=0.053;抗链“O”:P=0.620)。7用Spearman相关分别分析IL-16、IL-32与前葡萄膜炎组患者年龄、ESR、RF、CRP和抗链“O”的相关性,结果未发现血清IL-16、IL-32与年龄、ESR、RF、CRP和抗链“O”的相关性(P>0.05)。结论:1本研究中发现葡萄膜炎在中青年人群中发病多见,前葡萄膜炎为临床常见类型,白内障和青光眼或眼压升高为常见并发症,大部分患者视力预后较好,少数出现视力损害。2前葡萄膜炎组患者血清IL-16、IL-32水平分别与正常对照组比较明显升高;IL-16、IL-32分别与疾病呈正相关,证实了IL-16、IL-32是前葡萄膜炎中重要的细胞因子,表明IL-16、IL-32参与了前葡萄膜炎的发病。3前葡萄膜炎活动期患者血清IL-16、IL-32水平较稳定期水平明显升高,证实了IL-16、IL-32与前葡萄膜炎的活动有关。4前葡萄膜炎患者治疗后血清IL-16、IL-32水平较治疗前水平明显降低,更进一步证实了IL-16、IL-32参与了前葡萄膜炎的发生发展。5血清中IL-16和IL-32之间呈正相关,认为其分别或协同参与了前葡萄膜炎的发生和演进。更多还原

【Abstract】 Objective:1 To observe the clinical characters,effects of treatment,prognosis of visual acuity,complications and the problems in the treatment the various types of uveitis patients.2 To detect the expression of IL-16 and IL-32 in serum of normal human serum and anterior uveitis patients,and to compare the expression levels of IL-16 and IL-32 between the two groups,and to analyze the relationship between IL-16 and IL-32 correlation.3 To detect the levels of IL-16 and IL-32 in activity patients and stable patients with anterior uveitis,to compare the differences.And To detect the expression before and after treatment in serum of anterior uveitis patients,to compare the differences and to analyze the relationship between the cytokines.4 To explore the role of IL-16 and IL-32 in the pathogenesis of anterior uveitis,to find new ways to treat anterior uveitis.Method:1 Collected 85 patients with various types of uveitis from January 2015 to January 2017 in First Hospital Hebei Medical University,there were 45 cases of male and 40 cases of female,the mean age was(41.25±16.83),and the age of patients ranged from 7 to 70 years old,to record their general condition,eye history and clinical diagnosis and treatment.Forty cases of non-uveitis patients were collected as the normal control group,there were 22 cases of male and 18 cases of female,the mean age was(42.33±12.68).All controls were excluded the history of uveitis and other diseases,all were not taking antibiotics,corticosteroids or other immune inhibitors recently.2 The peripheral blood samples 4-6 ml of 40 cases of uveitis patients and40 controls were collected,centrifuged after the extraction of serum,and thenuse double antibody sandwich enzyme-linked immunosorbent assay(ELISA)to detect IL-16 and IL-32 in the experiment group and normal control group.And the experimental group and the normal control group were examed with ESR,RF,CRP,and Anti-chain "O".Finally,the clinical and examination data of patients with anterior uveitis were analyzed statistically.Results:1 In this study,uveitis is more common in the 21-45 years old people,the age of patients ranged from 7 to 70 years old,male to female ratio of 1.125:1.Of which 67 cases is monocular eye disease while 18 cases with both eyes.According to the anatomical site,the anterior uveitis(64 cases)is the most,followed by the whole uveitis in 13 cases,intermediate uveitis and posterior uveitis in 4 cases.According to the course of the disease,acute uveitis patients(61 cases)is most,5 patients with chronic uveitis,19 patients with recurrent uveitis,7 patients with AS(ankylosing spondylitis),6 patients with VKH(Vogt-Koyanagi-Haradasyndrome)(7.9%),5 patients with Behcet’s disease,and 4 patients with Fuchs syndrome.In this study,there were 31 cases of cataract,glaucoma or intraocular pressure,iridosis and other complications,but most of the patients were significantly improved in visual acuity after a timely positive treatment.2 The concentrations of IL-16 and IL-32 in the patients with anterior uveitis were 196.42(140.77,263.26)and 265.67(214.51,342.82)respectively.The concentrations of IL-16 and IL-32 in the normal control group were82.68(49.03,115.38)and 86.19(51.57,154.28).The concentration of IL-16 in the anterior uveitis group was significantly different from that in the normal control group(P=0.003).There was also a significant difference between the pre-uveitis group and the normal control group(P=0.008).3 Serum levels of IL-16 209.55(152.89,277.40)were significantly higher in activity patients than stable patients with anterior uveitis 77.19(37.92,103.17),the difference was statistically significant(P=0.000).Patients in activity with IL-32 levels 278.98(222.12,346.80)were significantly higher than those in stable patients 80.48(48.26,147.64),with a statisticallysignificant difference(P=0.024).4 The concentrations of IL-16 and IL-32 in patients with anterior uveitis after treatment serum were 84.55(51.39,127.04)and 88.98(52.17,165.43)respectively.The concentrations of IL-16 and IL-32 in the group before the treatment were 196.42(140.77,263.26)and 265.67(214.51,342.82)respectively.The concentration of IL-16 in the anterior uveitis after treatment group was significantly different from that in the group before the treatment(P=0.004).There was also a significant difference between the pre-uveitis after treatment group and the group before the treatment(P=0.000).5 The correlation between IL-16 and IL-32 and pre-uveitis was analyzed by Spearman correlation.The results showed that IL-16 was positively correlated with disease(Spearman correlation coefficient r=0.671,P=0.000),IL-32 also positive correlation with anterior uveitis(Spearman correlation coefficient r=0.963,P=0.000).There was a positive correlation between IL-16 and IL-32(Spearman correlation coefficient r= 0.383,P=0.009).6 In the anterior uveitis group,the expression of ESR,RF,CRP and anti-chain "O" were 24.5(15.50,36.50),6.30(4.85,9.80),64.10(11.30,113.10)and 4.80(4.02,5.47).The levels of ESR,RF,CRP and anti-chain "O" in the normal control group were 15.60(6.90,27.70),4.52(3.07,8.35),47.50(8.10,95.80),and 3.43(2.65,4.12).The level of ESR in the patients with the anterior uveitis was higher than that in the normal control group,there was also a significant difference between the two group(P=0.004).There was no significant difference in RF,CRP and anti-chain "O" levels between the two groups(RF:P=0.645;CRP: P=0.053;P=0.620).7 The correlation of IL-16 and IL-32 with age,ESR,RF,CRP and anti-chain "O" in patients with anterior uveitis were analyzed by Spearman correlation.The results showed that serum IL-16,IL-32 were not correlated with age,ESR,RF,CRP and anti-chain "O"(P>0.05).Conclusion:1 In this study,we found that the uveitis occurs in young and middle-aged,more common in anterior uveitis,cataracts or glaucoma is acommon complication of pre-uveitis.After treatment,the majority of patients visual acuity is well,a few vision did not change.2 The level of serum IL-16,IL-32 in the patients with anterior uveitis was significantly higher than that in the normal control group,and IL-16,IL-32 was positively correlated with the disease.It is suggesting that IL-16,IL-32 was an important cytokine in the anterior uveitis,indicating that IL-16 involved in the anterior uveitis disease.3 Serum levels of IL-16 and IL-32 in patients with activity pre-uveitis were significantly higher than those in stable stage.It is indicating that IL-16 and IL-32 related to the acute course of anterior uveitis.4 The level of IL-16 of after treatment pre-uveitis was significantly reduced,the level of IL-32 of after treatment pre-uveitis was significantly reduced,it was a more powerfully suggested that IL-16 and IL-32 involved in the anterior uveitis disease.5 There is a positive correlation between the level of IL-16 and IL-32 in serum of uveitis,suggesting that IL-16 and IL-32 participated in the development of uveitis.更多还原