先天性晶状体半脱位患者手术前后眼房水细胞因子的定量分析

Quantitative analysis of cytokines in aqueous humor of patients with congenital dislocated lens before and after surgery

目的 探讨先天性晶状体半脱位患者手术前后房水中白细胞介素(IL)及肿瘤坏死因子(TNF)等细胞因子的变化情况及其与术后炎症反应的关系。方法 回顾性分析2011年6月至2012年6月首都医科大学附属北京同仁医院眼科26例(52只眼)行晶状体摘除术+人工晶状体植入+晶状体囊袋张力环(CTR)植入术患者的临床资料。根据CTR的移位情况,将患者分为两组,第1组(术后2~5 d组)12例(24只眼)患者CTR轻度移位,术后2~5 d行巩膜缝合固定术;第2组(术后30 d组)14例(28只眼)患者CTR重度移位,术后约1个月行巩膜缝合固定术。术前取术眼房水标本,置于-80℃深低温冰箱冻存,采用流式细胞术微球阵列法测定出房水中各细胞因子的含量。术眼房水中各细胞因子的浓度等计量数据,采用均数±标准差(x珋±s)表示,手术前后两样本均数的比较采用配对t检验。结果 在术后2~5 d患者组中,术前房水标本中的IL-6含量为(4 347.11±5 506.90)pg/L,明显低于术后的(101 420.60±43 120.69)pg/L,手术前后比较差异有统计学意义(t=20.27,P=0.001);术前房水标本中的IL-1β、IL-2、IL-4、IL-5、IL-10、IFN-γ及TNF-α含量分别为(148.36±114.96)pg/L、(106.80±53.19)pg/L、(32.67±17.97)pg/L、(72.93±40.65)pg/L、(105.43±53.36)pg/L、(126.21±80.52)pg/L及(80.36±53.29)pg/L,术后分别为(152.36±88.58)pg/L、(124.31±78.55)pg/L、(66.66±35.61)pg/L、(50.81±18.30)pg/L、(201.37±133.11)pg/L、(60.66±40.03)pg/L及(49.94±35.59)pg/L,手术前后上述各种细胞因子含量比较,差异无统计学意义(t=0.561,1.087,2.412,6.929,5.396,6.327,5.886;P=0.468,0.318,0.146,0.062,0.059,0.057,0.055)。在术后1个月患者组中,术前房水标本中的IL-6含量为(3 605.28±4 255.05)pg/L,明显低于术后的(77 401.52±16 120.2)pg/L,手术前后比较差异有统计学意义(t=11.56,P=0.003);术前房水标本中IL-1β、IL-2、IL-4、IL-5、IL-10、IFN-γ及TNF-α的含量分别为(150.25±118.65)pg/L、(135.31±73.16)pg/L、(46.08±19.60)pg/L、(83.97±35.56)pg/L、(143.24±62.51)pg/L、(159.48±70.60)pg/L及(79.31±44.49)pg/L,术后含量分别为(136.88±187.48)pg/L、(114.41±85.30)pg/L、(58.09±33.74)pg/L、(57.41±42.60)pg/L、(128.08±87.09)pg/L、(103.18±70.57)pg/L及(79.14±64.22)pg/L,手术前后上述各种细胞因子含量比较,差异无统计学意义(t=0.103,0.898,2.498,0.367,0.132,0.894,0.102;P=0.751,0.354,0.128,0.367,0.132,0.894,0.102)。结论 IL-6可能是晶状体摘除术后炎症反应机制中的重要细胞因子之一。

Objective To discuss the relationship between the change of cytokines including terleukin( IL) , tumor necrosis factor ( TNF ) , interferon ( IFN ) ect.in aqueous humor of patients with congenital dislocated lens before and after surgery and the postoperative inflammation.Methods Twenty-six cases (52 eyes) with congenital dislocated lens undertaken Phaco+IOL+capsulartensionring ( CTR) surgery from June 2011 to June 2012 in Department of Ophthalmology, TongRen Hospital were retrospectively analyzed.Patients were divided into Group A 12 cases (24 eyes) and group B 14 cases (28 eyes).In group A,CTR shift modestly after surgery,the dislocated CTR was sutured to sclera 2-5 days postoperatively.In group B,CTR shift seriously after surgery,the dislocated CTR was sutured to sclera 30 days postoperatively. Aqueous humor samples were taken by anterior chamber puncture before and after surgery ( 2-5 days postoperatively in group A and 30 days postoperatively in group B) .Specimens of aqueous humor were frozen at -80℃.The densities of IL-1β,IL-2,IL-4,IL-5,IL-6,IL-10,TNF-αand IFN-γwere determined by flow cytometry bead array method.Paired-samples ttest was used in this study.Results In group A, IL-6 was (4 347±5 506)pg/L before surgery and (101 420.60±43 120.69)pg/L after surgery.The difference was statistically significant (t=20.27,P=0.001); before operation IL-1β,IL-2,IL-4,IL-5,IL-10,IFN-γ,TNF-α′s content were (148.36 ±114.96) pg/L,(106.80 ±53.19) pg/L, (32.67 ±17.97) pg/L, (72.93 ± 40.65)pg/L,(105.43±53.36)pg/L, (126.21±80.52)pg/L, (80.36±53.29)pg/L vs postoperation (152.36±88.58)pg/L, (124.31±78.55)pg/L, (66.66 ±35.61)pg/L, (50.81±18.30)pg/L, (201.37±133.11)pg/L,(60.66±40.03)pg/L,(49.94±35.59)pg/L,the difference was not statistically significant(t=0.561,1.087,2.412,6.929,5.396,6.327,5.886;P=0.468,0.318,0.146,0.062,0.059, 0.057,0.055).In group B,IL-6 was (3 605.28 ±4 255.05) pg/L before surgery and (7 7401.52 ± 16 120.2)pg/L after surgery.The difference was also statistically significant (t=11.56,P=0.003);before operation IL-1β,IL-2,IL-4,IL-5,IL-10,IFN-γ,TNF-α′s content were (150.25±118.65)pg/L,(135.31± 73.16)pg/L,(46.08±19.60)pg/L,(83.97±35.56)pg/L,(143.24±62.51)pg/L,(159.48± 70.60)pg/L,( 79.31 ±44.49 ) pg/L vs postoperation were ( 136.88 ±187.48 ) pg/L, ( 114.41 ± 85.30)pg/L,( 58.09 ±33.7 ) pg/L, ( 457.41 ±42.60 ) pg/L, ( 128.08±87.09 ) pg/L, ( 103.18 ± 70.57)pg/L,(79.14±64.22)pg/L,the difference was no statistically significant (t=0.103,0.898,2.498, 0.367,0.132,0.894,0.102;P=0.751,0.354,0.128,0.367,0.132,0.894,0.102).Conclusions IL-6 may be one of the most important cytokines in postoperative inflammatory response of dislocated cataract surgery.