甲泼尼龙冲击治疗视神经损伤的效果及时效关系

Effect and effect-time relation of methylprednisolone pulse therapy on optic nerve injury

目的观察甲泼尼龙(methylprednisolone,MP)治疗视神经损伤的效果及时效关系。方法 144只Wistar大鼠,随机分为正常对照组、损伤对照组、6个MP治疗组。后7组制作视神经损伤模型,6个MP治疗组分别在伤后2h、4h、6h、8h、12h、24h应用MP治疗,首次30.0mg·kg-1尾静脉注射,以后按5.4mg·kg-1·h-1给药,直至伤后48h。伤后4d、7d和14d:光镜下观察各组视神经和视网膜的组织病理学变化、视网膜神经节细胞(retinal ganglion cell,RGC)计数、观察F-VEP波形变化。结果与损伤对照组比较,伤后6h、24h应用MP治疗组伤后4d、7d、14d视神经和视网膜的病理损害均较轻;伤后2h、4h、6h、8h、12h应用MP治疗组伤后4d、7d和14dRGC计数分别为28.87±1.23、25.54±2.62、21.37±2.30,28.60±1.46、24.60±1.84、20.60±2.31,27.34±1.41、25.34±1.80、20.50±1.93,27.40±1.47、22.07±1.34、16.82±1.11,27.64±1.59、22.16±1.02、16.77±1.20,均显著高于损伤对照组(25.14±1.42、19.14±1.43、12.14±1.55),差异均有统计学意义(均为P<0.05),伤后24h应用MP治疗组伤后4d和7d RGC计数为25.16±1.14、19.20±1.07,与损伤对照组比较,差异均无统计学意义(均为P>0.05),14d(14.21±1.13)高于损伤对照组,差异有统计学意义(P<0.05)。伤后2h、4h、6h、8h和12h应用MP治疗组伤后4d、7d和14dP波潜伏期延迟和波幅降低,与正常对照组比较,差异均有统计学意义(均为P<0.05);伤后2h、4h和6h应用MP治疗组伤后7d和14d与伤后8h、12h、24h应用MP治疗组比较,差异均有统计学意义(均为P<0.05)。结论视神经损伤后12h内开始给予MP冲击治疗,可以明显减轻视神经损伤程度和促进恢复,6h内开始治疗效果更好,24h仍有效。

Objective To observe the effect and time-effect relation of methylprednisolone（MP） pulse therapy on optic nerve injury.Methods One hundred and forty-four Wistar rats were randomly divided into normal control group,injury control group and six MP treatment groups.The optic nerve injury models were made with vascular clamp in last seven groups.Treatment groups were given with MP through intravenous injection at 2 hours,4 hours,6 hours,8 hours,12 hours and 24 hours after injury.First dose was 30.0 mg·kg-1,and then 5.4 mg·kg-1·h-1 for 48 hours.The histopathological changes of retina and optic nerve in each group,retinal ganglion cells（RGC） counting,and flash visual evoked potential（F-VEP）were observed at 4 days,7 days and 14 days after injury.Results Compared with injury control group,the pathological lesions of optic nerve and retina were slight at 4 days,7 days and 14 days in treatment group of 6 hours and 24 hours.RGC counting in the treat groups of 2 hours at 4 days,7 days and 14 days were 28.87±1.23,25.54±2.62,21.37±2.30,respectively,in the treatment group of 4 hours were 28.60±1.46,24.60±1.84,20.60±2.31,respectively,in the treatment group of 6 hours were 27.34±1.41,25.34±1.80,20.50±1.93,respectively,in the treatment group of 8 hours were 27.40±1.47,22.07±1.34,16.82±1.11,respectively,in the treatment group of 12 hours were 27.64±1.59,22.16±1.02 and 16.77±1.20,respectively,and these were all higher than that in injury control group（25.14±1.42,19.14±1.43,12.14±1.55）,there were statistical differences（all P0.05）.RGC counting in the treat group of 24 hours at 4 days and 7days were 25.16±1.14 and 19.20±1.07,and there was no statistical difference compared with injury control group（all P0.05）,but there was statistical difference at 14 days（14.21±1.13） compared with injury control group（P0.05）.The P wave latency delay and amplitude depression in the treatment groups of 2 hours,4 hours,6 hours,8 hours and 12 hours at 4 days,7 days and 14 days were slighter than that in injury control group,there were statistical differences（all P0.05）,there were also statistical differences at 7 days and 14 days between the treatment groups of 2 hours,4 hours,6 hours and the treatment groups of 8 hours,12 hours and 24 hours（all P0.05）.Conclusion MP pulse therapy on optic nerve injury is very effective within 12 hours,which can obviously reduce the pathological damage and promote functional recovery.The MP therapeutic efficacy is better within 6 hours,still effective within 24 hours.