羊膜联合角膜缘干细胞移植治疗眼表疾病的临床研究

Amniotic Membrane Combined with Keratolimbal Stem Cells Autograft Transplantation in The Treatment of Ocular surface Disease

目的:探讨羊膜联合角膜缘干细胞移植治疗眼表疾病的临床效果。方法:选择有手术指征的各种眼表疾病病例300例,均为单眼患病。随机分为治疗组(A组),对照组(B组),每组150例(150)眼。A组为治疗组,行羊膜联合角膜缘干细胞移植术,其中复发性翼状胬肉50例,单纯翼状胬肉50例,其他眼表疾病(包括眼化学伤、热烧伤、眼表肿瘤、睑球粘连)50例;B组为对照组,行自体角膜缘上皮移植术,其中单纯翼状胬肉80例,复发翼状胬肉40例,其他眼表疾病(包括眼化学伤、热烧伤、眼表肿瘤、睑球粘连)30例。随访6～24个月,评价两组术后1 d3、d、1周,1、2、3、6、12、24个月的眼表上皮修复时间、炎症反应、新生血管、视力等。结果:角膜缘干细胞联合羊膜移植(A组)与自体角膜缘移植(B组)分别为(3.1±0.2)d和(3.3±0.5)d,应用配对u检验(u=4.5486,P<0.01),认为两组有统计学意义。A组3例(3眼)复发,复发率为2%,B组11例复发,复发率为7.33%,经χ2检验,(χ2=4.7952,P=0.0285,P<0.05),说明两组有统计学意义。186眼(62%)术后视力提高,两组比较(χ2=99.8302.P=0.0000,P<0.05),认为两组有统计学意义。结论:角膜缘干细胞为病灶角膜提供了健康干细胞来源,恢复了角结膜屏障功能。人羊膜本身无抗原性,术后不发生免疫排斥反应且具有抗炎、抑制新生血管及纤维化作用、在伤口愈合中起促进作用。相对于角膜缘干细胞而言,羊膜起着角膜上皮生长移行支架物的作用。因此用羊膜联合角膜缘干细胞移植是一种有效的治疗眼表疾病的手段。

Objective：To investigate the clinical effects of amniotic membrane combined with keratolimbal stem cells autograft rtansplantation in the treatment of the ocular surface diseases.Methods： 300 cases（72 males and 78 females） with ocular surface disease aged 18-62 years,randomly divided into two groups（n=150 eyes）：The amniontic membrane combined with keratolimbal stem cell autograft transplantation group（Group A）,including 50 eyes of 50 patients with recurrent pterygium,50 eyes of 50 patients with simple pterysium and 50 eyes of 50 patients with other ocular surface diseases（including chemical or thermal injuries,tumour on eyeball surface and symblepharon） and the limbal stem cell autologous transplantation group（Group B）,including 80 eyes of 80 patients with simle petrygium,40 eyes of 40 patients with recurrent ptergium and 30 eyes of 30 patients with other ocular surface disease（including chemical or thermal burn and tumour on eyeball surface and symblepharon）.the age was 18-62 years odl.The postoperative recovering time of corneal epithelium,inflammation reaction,neovascularization,visual acuity,the recurrent rate were evaluated.The post-operative follow up period was 24 months.Results：The postoperative recovering time of corneal epithelium takes 3.1±0.2 days in group A and 3.3±0.5 days in group B respectively.The recurrcnt rate was 2.00% in group A and 7.33% in group B respectively,Best corrected visual cauity improved in 186 eyes（62%）,inluding group A had 135 eyes and group B had 51 eyes.Between the two groups,there were significant difference in the postoperative recovering time of corneal epithelium,the recurrent rate and visual acuity promotion.Conclusion： Limball stem cells provide a healthy source of stem cells for the cornea focus and restore effective barrier function Human amniotic membrane has antibacterial,antiangiogenic,anti-inflanmmatory,and antifibroblastic properties.Amniotic membrane can provide a possible support material for corneal epithelial migration,It is effective to use amniotic membrane combined with keratolimabl stem cells autograft transplantation in the treatment of ocular surface diseases.