更昔洛韦不同用药方式对实验性视网膜坏死的治疗效果

Therapeutic effects of ganciclovir with different injection methods on experimental retinal necrosis

目的观察更昔洛韦（GCV）不同给药途径治疗实验性急性视网膜坏死（ARN）的疗效。方法用单纯疱疹病毒（HSV-1，COS株）感染41只青紫蓝兔的右眼，建立ARN动物模型。建模后24、72h，分别用GCV以玻璃体腔注射（10只眼）、静脉注射（11只眼）以及玻璃体腔注射联合静脉注射（10只眼）3种方式对ARN动物进行治疗，另设GCV联合氟美松玻璃体腔注射组（6只眼）和未进行任何治疗的单纯模型对照组（4只眼）。GCV玻璃体腔注射剂量为800μg，静脉注射剂量为5mg／kg体重。根据视网膜病变分级标准，在注射后1～21d观察和记录视网膜坏死分级，对比观察不同用药时间、不同用药方式组之间以及不同用药方式组与单纯模型对照组视网膜坏死分级的差异。结果单纯模型对照组视网膜坏死分级为3．8级。建模后24h进，彳治疗者，玻璃体腔注射、玻璃体腔注射联合静脉注射、GCV联合氟美松玻璃体腔注射、静脉注射组视网膜坏死分级分别为0．2、0．4、0．8、2．2级，前3组与静脉注射组视网膜坏死分级比较，差异有统计学意义（P=0．003，0．011，0．045），但前3组之间比较，差异无统计学意义（P=0．881，0．054，0．107）；建模后72h进行治疗者，4种给药方法治疗后病变都在1．4级以上，组间相互比较，差异无统计学意义（P=0．214）。结论GCV玻璃体腔注射能有效降低实验性ARN视网膜坏死分级；玻璃体腔注射联合静脉注射、GCV联合氟美松玻璃体腔注射与单纯GCV玻璃体腔注射比较，视网膜坏死分级无明显差异。

Objective To observe the therapeutic effects of ganciclovir （GCV） with different injection methods on experimental acute retinal necrosis （ARN）. Methods The right eyes of 41 pigmented rabbits were infected by herpes simplex virus （HSV-1） （COS strain） to establish ARN animal model. After 24 and 72 hours, GCV was given by intravitreal injection （10 eyes）, intravenous injection （11 eyes） and the intravitreal ＋ intravenous injection （10 eyes）; intravitreal injection of GCV and dexamethasone （6 eyes） was also included. Four eyes were not treated as the control. The dosage of GCV in intravitreal and intravenous injection was 800 μg and 5 mg/kg weight, respectively. Retina necrosis was observed and the grade was recorded 1-21 days after injection according to the grade standard of retinopathy. The maximum grades of retinal necrosis in different groups were compared. Results The grade of retinal necosis was 3.8 in the control group, and 0.2, 0.4, 0. 8, and 2.2 in intravitreal injection, intravitreal ＋intravenous injection, intravitreal injection with GCV and dexamethasone, and intravenous injection, respectively, 24 hours after the model was set up. The effects of the first 3 groups were obviously better than the last group （P=0. 003, 0. 011, 0. 045）; while the difference among the first 3 groups were not significant （P=0. 881,0. 054,0. 107）. Seventy two hours after the model was set up, the grades of retinal necrosis were above 1.4 in 4 groups, and the differences among the 4 groups were not apparent （P= 0. 214）. Conclusions In the animal model of ARN, intravitreal injection with GCV can effectively decrease the grade of retinal necrosis. The difference among intravitreal injection, intravitreal＋ intravenous injection, intravitreal injection with GCV and dexamethasone, and intravenous injection is not significant.