穿透性角膜移植术后内皮型免疫排斥反应的临床研究

Clinical study on the endothelial immune rejection after penetrating keratoplasty

目的探讨穿透性角膜移植术(PKP)后内皮型免疫排斥反应发生的动态变化,及对角膜植片透明性的影响。方法对1994年1月至1998年12月在我院行PKP术并有完整记录的患者648例(648只眼),男444例(444只眼)、女204例(204只眼)进行随访,统计术后05、1、3、6、9、12、18、24、36、48个月等10个不同时间内皮型免疫排斥的发生率,以及植片混浊的发生率,比较两者动态变化的相关性,制成动态变化曲线,并对术前的病因与术后内皮型免疫排斥反应发生之间的关系进行分析。结果植片混浊与内皮型免疫排斥反应密切相关(线性相关回归分析,P<001);术后3年,内皮型免疫排斥反应的发生率仍有一定比例。术前不同病因及炎性背景的眼病,因内皮型免疫排斥反应发生率不同,而影响植片透明性。结论PKP术后,植片的透明性主要受内皮型免疫排斥反应的影响,二者密切相关;各种角膜疾病因炎性反应不同,其内皮型免疫排斥反应的发生率也不同,重视术后患者的长期随访,对维持术后角膜植片的透明性,保证手术成功率有重要意义。(中华眼科杂志,2005,41145149)

Objective To study the relationship between the grafts transparency and the endothelial immune rejection at different periods after penetrating keratoplasty (PKP). Methods A following-up was performed on patients received PKP in Shandong Eye Institute and Hospital between January 1994 and December 1998. A total of 648 cases (648 eyes) were involved in this study, including 444 males (444 eyes) and 204 females (204 eyes). The incidence of endothelial immune rejection and grafts opacification at the time point of 0.5, 1, 3, 6, 9, 12, 18, 24, 36 and 48 months postoperatively was collected. We made two curves to study the relationship between transparence of grafts and endothelial rejection. Relationship between the endothelial immune rejection and the types of corneal diseases before the operation was also analyzed. Results There was a significant relationship between grafts opacification and the endothelial immune rejection (linear regression and simple correlation, P<0.01). The rate of rejection decreased after 3 years postoperatively. Inflammatory background was an important factor for the occurrence of endothelial immune rejection and graft opacification. Conclusions After PKP, endothelial immune rejection is the critical factor for affecting the grafts transparency. Long-term follow-up of the patients is important for the maintaining of transparency of grafts and to obtain a successful result of the operation. ( Chin J Ophthalmol, 2005,41:145-149)