异种表面角膜镜片术与泪液前列腺素E_2含量的变化

Human Xenogeneic Epikeratophakia and Its Related Prostaglandin E 2 Variation in Tears

目的对正常人和异种表面角膜镜片术（ｅｐｉｋｅｒａｔｏｐｈａｋｉａ，ＥＫＰ）后患者泪液前列腺素Ｅ２（ＰｒｏｓｔａｇｌａｎｄｉｎＥ２，ＰＧＥ２）含量的变化进行了测定，以评价异种ＥＫＰ与免疫反应之间的关系。方法对９例９眼施行了异种（恒河猴）ＥＫＰ，术前及术后１、３、７、１４、３０和６０天分别对９例患者的泪液ＰＧＥ２含量进行放免测定，随机选择１０名健康志愿者作为对照。结果异种ＥＫＰ术后泪液ＰＧＥ２含量显著增加，术后第２周达最高水平，为２７．２９μｇ／Ｌ，比正常对照组高出３．１倍，随后逐渐下降，但术后２个月仍高于术前水平。结论作者认为异种ＥＰＫ能诱导ＰＧＥ２的释放，进而导致免疫反应。术后ＰＧＥ２含量的早期变化可能是手术炎症与免疫应答的综合结果，而后期则与异种镜片抗原持续刺激单核—巨噬细胞释放ＰＧＥ２有关。术后早期局部应用类固醇激素和环氧酶抑制剂如消炎痛有利于减少ＰＧＥ２的释放从而抑制排斥反应的发生。

ObjectiveTo evaluate the relationship between xenogeneic epikeratophakia(EKP) and the immune reaction,the prostaglandin E 2 (PGE 2) levels in tears both the normal and the patients undergone xenogeneic EKP were investigated.Methods5 men(5 eyes) and 4 women (4 eyes) underwent Xenogeneic EKP using monkey lenticules.The tears of 9 patients were examined before surgery and at 1,3,7,14,30 and 60 d after the surgery with radioimmunoassay.10 randomly selected volunteers were taken as controls.ResultsXenogeneic EKP resulted in a statistically significant ( P <0.01)increase in tears PGE 2 and reached to the peak of an average level of 27.29 μg/L at 2 wk postoperatively,which represented a 3.1 fold rise compared to control.Then it declined gradually,but was markedly more than the preoperative at 2 months after the surgery.ConclusionThe authors demonstrated the tears PGE 2 levels after xenogeneic EKP.The early PGE 2 variation could be a complex effect of postoperative inflammation and immune response,and the later could be related with PGE 2 released by monocyte macrophage that was continually stimulated by monkey lenticule.The results of this study suggest that the surgery induce release of PGE 2 and furtherly create the immune reaction.Topical corticosteroid and cyclooxygenase inhibitors,such as indocin early after xenogeneic EKP can reduce the PGE 2 releasing and inhibit the rejection.