健康兔眼角膜移植术后植片衰竭与疱疹病毒感染的关系

Association between herpes virus infection and primary graft failure after PKP in naive rabbits

目的:探讨移植术后植片衰竭(PGF)与疱疹病毒感染的关系。方法:建立兔角膜疱疹病毒潜伏感染模型,实验分为健康兔移植潜伏感染供体角膜(A组)和潜伏感染兔移植健康供体角膜(B组)两组,行单眼穿透性角膜移植,A组健康兔7眼移植潜伏感染供体角膜,B组潜伏感染兔7眼移植供体健康角膜,分别于术后3、5、7、14和28d裂隙灯显微镜观察角膜,同时采集角膜拭子,应用多重PCR检测单纯疱疹病毒1型(HSV-1)、单纯疱疹病毒2型(HSV-2)、巨细胞病毒(CMV)和水痘带状疱疹病毒(VZV)核酸,以PCR阳性结果判定存在病毒感染。结果:A组2眼(2/7,28.6%)分别在术后5和28d发生角膜PGF,多重PCR检测角膜拭子、角膜植片,受体角膜边缘及三叉神经节分别为HSV-1和VZV阳性,未检测到HSV-2和CMV;A组其余5眼(5/7,71.4%)和B组7眼(7/7,100%)角膜植片透明,角膜拭子多重PCR结果均为阴性。结论:供体角膜疱疹病毒感染是引起穿透性角膜移植术后PGF的主要因素,其中HSV-1和VZV更易感染兔角膜,潜伏感染的病毒可以因手术刺激被活化,感染复发引起PGF。

Objective To investigate the association between herpes virus infection and primary graft failure （PGF） after penetrating keratoplasty （PKP） in naive rabbits. Methods Animal model of herpes virus latency was established in rabbit eyes. PKP was performed in only one eye in two groups. In group A, seven naive rabbit eyes received latent donor, while seven latent rabbit eyes received naive donor in group B. The cornea was observed with slit lamp at 3, 5, 7, 14 and 28 d after PKP respectively. Cornea swabs were taken and detected for DNA of four viruses, including herpes simplex type 1 （HSV-1）, herpes simplex virus type 2 （HSV-2）, cytomegalovirus （CMV） and varicella-zoster virus （VZV） by multiplex PCR. Results Two eyes in group A （2/5, 28. 6%） were suffered PGF at 5 and 28 d after PKP, respectively. HSV-1 and VZV DNAs were detected by multiplex PCR from cornea swabs, grafts, rims and trigeminal ganglions （TGs）, but HSV 2 and CMV were not detected. The cornea graft of remain 5 eyes in group A （5/7, 71.4%） and 7 eyes in group B （7/7, 100%） were clear until 28 d after PtZP. The multiplex PCR results of cornea swabs were negative. Conclusion The herpes virus infection of cornea donor is the main factor of PGF after PKP. Compare to HSV-2 and CMV, the rabbit cornea is more easily infected by HSV-1 and VZV. The latent viruses in donor can be reactivated by PKP, and PGF is probably caused by VZV besides HSV-1.