玻璃体切割术治疗增生性糖尿病视网膜病变中应用曲安奈德的止血作用及其机制

摘要

背景 临床发现玻璃体切割术治疗增生性糖尿病视网膜病变(PDR)术中应用曲安奈德(TA)有止血作用,但其机制并不清楚. 目的 探讨玻璃体切割术治疗PDR过程中眼内应用TA止血的作用机制.方法 采用前瞻性研究设计,于2011-2014年纳入在天津医科大学总医院眼科因PDR接受玻璃体切割术且术中眼内应用TA的患者12例12眼,作为TA组,同期因黄斑前膜或黄斑裂孔接受玻璃体切割术且未用TA的患者共32例32眼作为对照组,两组术眼在玻璃体切割术开始时均采集玻璃体样本0.6 ～0.8 ml.采用ELISA法分别测定TA组和对照组患者玻璃体中尿激酶纤溶酶原激活物(u-PA)、组织纤溶酶原激活物(t-PA)及纤溶酶原激活物抑制剂1(AI-1)含量,比较TA组和对照组术前玻璃体样本中上述指标含量的差异.结果 TA组术眼玻璃体中u-PA、t-PA和PAI-1平均质量浓度分别为25.45、127.44和0.42 ng/ml,对照组分别为22.94、142.37和0.27 ng/ml,TA组术眼玻璃体中u-PA平均质量浓度明显高于对照组,差异有统计学意义(Z=-2.268,P＜0.05),TA组和对照组术眼玻璃体中t-PA和PAI-1平均质量浓度的差异均无统计学意义(Z=-0.092、-1.847,均P＞0.05). 结论 PDR患者玻璃体中u-PA平均质量浓度高,易致眼内出血.玻璃体切割术中眼内应用TA可减少或阻止出血其机制可能与t-PA和u-PA平均质量浓度降低而达到降低出血倾向,并通过增加PAI-1质量浓度而发挥止血作用有关.%Background Clinical work found that triamcinolone acetonide (TA)bleeding during vitrectomy in proliferative diabetic retinopathy (PDR),but its mechanism is not clear.Objective This study was to explore the anastalsis of TA in vitrectomy for PDR.Methods A prospective study was performed.Twelve eyes of 12 patients who received vitrectomy combined with the intraocular use of TA for PDR were in cluded in Tianjin Medical University General Hospital from 2011 to 2014 and served as TA group.Thirty-two eyes of 32 patients who underwent vitrectomy for epimacular membrane or macular hole were enrolled as control group.The vitreous specimens of 0.6 ～0.8 ml was collected during the surgery.The concentrations of urokinase plasminogen activator (u-PA),tissue plasminogen activator (t-PA) and plasminogen activator inhibitors 1 (PAI-1) in vatreous were measured by ELISA.Results The mean contents u-PA,t-PA and PAI-1 in the vatreous were 25.45,127.44 and 0.42 ng/ml respectively in the TA group,and those the mean contents in the control group were 22.94,142.37 and 0.27 ng/ml respectively,shouwing a significant difference between the TA group and the control group (Z=-2.268,P＜0.05).NO significant difference was found in vitreous t-PA and PAI-1 between TA and control groups (Z =-0.092,-1.847,both at P＞0.05).Conclusions Vitreous u-PA content is increased in PDR eyes,which is more likely to lead bleeding.Anastalsis of TA during vitrectomy for PDR may be relatived to decreasing vitreous t-PA and u-PA contents as well as increasing PAI-1 contents.