透明质酸钠预防兔眼眶软组织粘连形成的研究

Empirical study on prevention adhesion of rabbit orbital soft tissue by sodium hyaluronate

目的探讨透明质酸钠对眼眶软组织粘连的预防作用和机制。方法成年家兔10只,左右眼分别为实验眼和对照眼。在上直肌与对应眼眶骨膜间人为制造创伤,实验组在创面间涂抹透明质酸钠凝胶,对照组不予处理。于术后1周肉眼观察两组粘连情况,行病理学评分和转化生长因子(TGF-β)免疫组织化学染色。结果粘连程度评分为对照组4分者5眼,3分者3眼,2分者2眼;实验组4分者0眼,3分者2眼,2分者2眼,1分者5眼,两组差异有统计学意义(u=61.5,P<0.01)。炎症反应程度评分为对照组4分者4眼,3分者4眼,2分者2眼;实验组4分者0眼,3分者1眼,2分者5眼,1分者4眼,两组差异有统计学意义(u=64,P<0.01)。成纤维母细胞数量实验组明显低于对照组,差异有统计学意义(u=55,P<0.01)。TGF-β免疫组织化学染色结果显示对照组染色呈强阳性,实验组呈弱阳性。结论透明质酸钠可以促进内皮细胞生长,抑制成纤维细胞生长,减少胶原纤维的合成,有效抑制兔眶损伤后粘连的发生。

Objective This study was to observe the result and mechanism of preventing postoperation adhesion after trauma of orbit tissue by sodium hyaluronate. Methods Twenty eyes of 10 white rabbits were included in this study. The injury was made between superior rectus and corresponding periosteum by surgery and the superior rectus and periosteum was scratched for 10 times respectively,and then the sodium hyaluronate was used topically in the left eye of each rabbit, and the normal right eyes were in control group. One week after operation, adhesion degree in injury tissue was examined by mass examination, pathologic score and immunohistochemistry stain by TGF-β. Results According to the Rydell-Balazes adhesion criteria,2 eyes showed the 3 score,5 eyes for 2 score and 4 eyes for 1 score in the experimental group,while 5 eyes for 4 score,3 eyes for 3 score,2 eyes for 2 score in the control group,indicating a statistically significant difference in adhesion degree between these two groups（ u = 64 ,P 〈 0.01 ）. Based on the Nussbaum pathological score, 1 eye presented the higher inflammation score, and 4 eyes showed the middle score in examination group. However, the highest inflammatory score was seen in the control group, showing the 4 score in 4 eyes,3 score in 4 eyes and 2 score in 2 eyes. The number of fibroblasts in the experimental group was less than that in the control group. The result of immunohistochemistry showed that strong positive reaction was found in the sheet of the experimental group,while weakly positive reaction was in the control group. Conclusion Sodium hyaluronate can prevent adhesion after trauma in the rabbit orbit effectively by promoting the growth of epithelium, inhibiting the growth of fibroblast and decreasing the synthesis of collagen fibrils.