手术后玻璃体腔再形成液中MMPs的含量测定及意义

Quantitative Analysis on Matrix Metalloproteinases in Intravitreous Regenerated Fluid

【目的】研究玻璃体切割成功平复视网膜脱离术后,玻璃体腔再形成液内基质金属蛋白酶的含量,分析其与视网膜脱离病变的关系,观察术后气-液交换术次数对其的影响。【方法】孔源性视网膜脱离者25只眼,增生性玻璃体视网膜病变(PVR)C3～D2级;合并脉络膜脱离者23只眼,PVRB～C3级。玻璃体切割术中均成功平复视网膜,术后行1～4次徒手气-液交换术,同时获取玻璃体腔再形成液。所获样本MMP-9及MMP-2含量的测定采用明胶酶谱分析法。【结果】两组病人的玻璃体腔再形成液中均有MMP-9及MMP-2的表达:MMP-9及MMP-2的表达与PVR呈显著正相关(r=0.57,P<0.01);MMP-2的活性在伴有严重PVR的RD组患者显著高于无严重PVR的CD组(P<0.05);MMP-9的变化两组间无显著差异(P>0.05)。【结论】玻璃体切割术前RD伴有的PVR程度是影响MMP-9和MMP-2表达的重要因素之一,MMP-9的表达在无严重PVR伴CD的视网膜脱离患者术后玻璃体腔再形成液中只是相对增高;玻璃体切割术后的徒手气-液交换可物理性的减少眼内MMPs的含量;测定玻璃体腔再形成液中MMP-9和MMP-2的活性,可提供检测玻璃体切割术后眼内组织损伤修复状态的途径。

To analyze the concentration of matrix metaUoproteinases （MMPs） in the reformation of intraocular fluid after successful vitrectomy. To discuss the relationship between MMPs and retinopathy,and observe the effect of fluid-gas exchange on MMPs. [Methods] Among 48 eyes with complex retinal detachment, twenty-five eyes were rhegmatogenous retinal detachment （RRD） with proliferative vitreoretinopathy C3～D2, twenty-thee eyes were retinal detachment（RD） with choroidal detachment （CD） with PVR B～C3. All 48 eyes after successful vitrectomy received 1 to 4 fluid-gas exchange in order to prolong the gas tamponade. Meanwhile intravitreous regenerated fluid was obtained. MMP-9 and MMP-2 in all samples were measured by gel zymography. [Results] Both MMP-9 and MMP-2 expression were found in all 124 samples of reproduce vitreous fluid. There were significant relativity between the expression of MMPs and the PVR （r= 0.57, P 〈0.01）. The activities of MMP-2 were higher in the groups of severe PVR （ P 〈0.05）. There were no significant difference of MMP-9 among two groups （ P〉0.05）. In RD with CD group the ratio of MMP-9/ MMP-2 was significantly higher than the other, and it decreased with times of fluid- gas exchange increased. The ratio of the third time was significantly lower than that of the first time. [Conclusion]The PVR degree of RD before vitrectomy was an important factor affecting the expression of MMP-9 and MMP-2 in reformation of intraocular fluid. The expression of MMP-9 was relatively higher in eyes of RD with CD group without PVR. Fluid-gas exchange can physically decrease the expression of MMPs in reformation of intraocular fluid. This suggests a method to detect the repair state of tissues of eyes after vitrectomy through analysis the activities of MMPs in reformation of intraocular fluid.