汉防已甲素抑制兔Epi-LASIK术后上皮下雾状混浊形成的组织病理研究

A histopathologic study of the inibitive effect of tetrandrine on corneal haze after epipolis laser in situ keratomileusis in rabbits

目的 观察汉防已甲素对微型号角膜刀法准分子激光上皮瓣下角膜磨镶术（Epi-lasik）术后角膜上皮下角雾状混浊（Haze）的治疗效果。方法 健康新西兰大耳兔27只,双眼行-10.00D激光切削的Epi-LASIK手术,采用自身对照按眼别随机分3组,分别为阴性对照（negative control,NC）组、汉防已甲素（Tetrandrine,Tet）组、艾氟龙（Fluoromethalone,FML）组,每组18只眼。定期在裂隙灯下对兔Epi-LASIK术后Haze进行分级评估。分别于术后0.5月、1月、2月共3个时间点每组随机选取6眼,取角膜行光镜、透射电镜、胶原纤维染色等方法观察。结果 术后0.5月和1月,Haze分级水平与Ⅲ型胶原表达结果显示：组间比较差异均有统计学意义（P〈0.05）,Tet组和FML组Haze分级水平明显低于NC组（P〈0.01）,但Tet组和FML组相比,差异无统计学意义（P〉0.01）;术后2月组间整体比较差异无统计学意义（P〉0.05）;Ⅰ型胶原在术后各时间点的表达,组间差异均无统计学意义（P〉0.05）;HE染色和透射电镜检测结果发现,各组不同时间点上皮层结构清晰完整,而Tet组和FML组上皮下手术区前基质层增生反应程度明显弱于NC组,提示这两种药物对成纤维细胞的增生均有抑制作用。结论 Tet通过抑制基质层角膜细胞增殖和降低Ⅲ型胶原表达,能有效抑制兔Epi-LASIK术后Haze形成,其疗效与FML相似。

Objective This study was to investigate the therapeutic effect of Terandrine on corneal haze formation arter epipolis laser in situ keratomileusis （Epi-LASIK）. Methods Twenty-seven New Zealand white rabbits were performed bilateral -1 0.00 diopters epi-LASIK, then randomly divided into 3 groups by self- control, NC group, Terandrine group, Fluoromethalone group. And there were eighteen eyes in each group. Corneal haze grade were evaluated by slim light at 0.5-1-and 2 mouth postoperative intervals. Six corneal samples were randomly harvested in each group at different postoperative intervals and then examined by optical and transmission electron microscope and Sirius red dyeing analyses. Results Corneal haze grades and collagen type Ⅲ expression at 0.5-and 1 mouth after surgery were significant different among the groups（P〈0. 05）,Comparing with the NC group,The Corneal haze grade and collagen type Ⅲ expression in Tet and FML groups were apparently lower（P〈0.0 1）,but there was no significant difference between Tet and Fml groups（P〉0. 0 1）.There was no sigrificaet differense.among the there groups at 2 month postoperatively（P〉0.05）.Collagen type Iexpression among the groups were no significant difference too（P〉0.05）.The optical and transmission electron microscope examination discovered that the structure of the epithelial layer in each groupa was intact. And the anterior stromal proliferative reactions between Tet and FML groups were apparently weaker than that in NC groups, which suggested that both medicines have inhibitive effect on corneal haze formation. Concluions Tet has inhibitive effect on corneal haze formation after Epi-LASIL by suppression keratocytyes＇ proliferation and decreasing the expression level of collagen type III, whose efficacy was similar to FML.