温度敏感型富血小板血浆凝胶治疗角膜碱烧伤的实验研究

Thermo-sensitive platelet-rich plasma gels in treatment of corneal alkali burns

目的观察温度敏感型富小板血浆凝胶治疗角膜碱烧伤的效果。方法通过制作兔角膜碱烧伤模型,抽取实验动物自体血,离心获得富血小板血浆,以泊洛沙姆407为基质配制成温度敏感型富血小板血浆凝胶。然后将实验兔随机分成4组,分别给予生理盐水、凝胶空白基质、自体富血小板血浆和温度敏感型富血小板血浆凝胶滴眼。采用裂隙灯观察各组模型眼经过治疗后的角膜炎症反应和角膜溃疡,分别对实验眼的角膜炎症和角膜溃疡进行评分,HE染色观察角膜组织病理变化。结果实验最终获得的温度敏感型富血小板血浆凝胶经泪液稀释后的胶凝温度为34℃,接近眼表平均温度,血小板计数平均值为1016.54×109L-1,p H值为7.0,眼部刺激试验无不良反应。模型眼给药治疗14 d后,裂隙灯下见生理盐水对照组和凝胶空白基质组角膜混浊、水肿,上皮缺损,溃疡明显,角膜炎症和角膜溃疡评分差异均无统计学意义(均为P>0.05);自体富血小板血浆组和温度敏感型富血小板血浆凝胶组角膜上皮完整,角膜基质仍水肿、混浊,周边角膜清亮,透过角膜可见部分虹膜,与生理盐水对照组相比,两组角膜炎症和角膜溃疡评分差异均有显著统计学意义(均为P<0.01);而温度敏感型富血小板血浆凝胶组与自体富血小板血浆组相比,角膜透明性好转,且新生血管少,两者角膜炎症和角膜溃疡评分差异均有显著统计学意义(均为P<0.01)。HE染色病理学检查显示,生理盐水对照组和凝胶空白基质组角膜处于炎症和溃疡期,自体富血小板血浆组角膜处于修复中期,温度敏感型富血小板血浆凝胶组角膜处于修复后期。结论温度敏感型富血小板血浆凝胶作为一种新型眼用凝胶制剂,其角膜修复作用明显优于自体富血小板血浆。

Objective To observe the effects of thermo-sensitive platelet-rich plasma gels in the treatment of corneal alkali burns. Methods The corneal alkali burn model was established on the right eyes of 20 white rabbits. The blood of the rabbits was drawn and centrifuged,then the autologous platelet-rich plasma was made. Thermo-sensitive platelet-rich plasma gels was made from autologous platelet-rich plasma with poloxamer407. The model rabbits were divided randomly into 4 groups： Normal saline solution group,blank matrix gel group,autologous platelet-rich plasma group and thermo-sensitive platelet-rich plasma gels group.The inflammatory reaction and corneal ulcer area were examined under the slit lamp and scored based on Ando＇S and Trousdale＇s criteria after treatment. Histopathological examination of corneas was performed by HE staining. Results The gelling temperature that we needed was 340 C after the thermo-sensitive platelet-rich plasma gels diluted with tears,closing to the ocular surface temperature. The average count of platelet was 1016. 54 × 10^9L（- 1）,the pH value was 7. 0,and the eye stimulation test was normal. At 14 days after experiment,corneal edema,opacification,epithelial defect and ulcer were seen in the normal saline solution group and blank matrix gel group,there was no significant difference in the scores of inflammatory and corneal ulcer between the two groups（ all P〈 0. 05）. The ulcer healing,epithelial integrity,peripheral corneal shining brilliantly and the portion of iris through the cornea were seen under the slit lamp in both autologous platelet-rich plasma group and thermo-sensitive platelet-rich plasma gels group,but the latter was better,the score of the inflammatory and corneal ulcer were significant difference not only compared with the normal saline solution（ all P 0. 01）,but also between themselves（ all P 〈0. 01）. Histopathological examination showedthat the corneas of the normal saline solution group and blank matrix gel group were in the stage of inflammation and ulcers,the autologous platelet-rich plasma group were in the stage of medium-term repair,and the thermo-sensitive platelet-rich plasma gels group in the stage of repair later. Conclusion As a new type of eye ophthalmic gels,the corneal repair effects of the thermo-sensitive platelet-rich plasma gels are better than those of the autologous platelet-rich plasma.