摘要
目的探讨小牛血去蛋白提取物对原发性翼状胬肉切除术后早期修复的促进作用。方法前瞻性随机对照试验。2016年3至5月间在厦门大学附属厦门眼科中心确诊为单眼原发性翼状胬肉的患者,住院治疗并进行患眼翼状胬肉切除联合自体结膜移植术,采用随机数字表法按照术后用药随机分为4个组:空白对照组、小牛血去蛋白提取物组、羧甲基纤维素钠组和重组人表皮生长因子组。在术前和术后1、2、3、7、14d对所有患者分别行简式McGill疼痛问卷评估、裂隙灯检查及角膜荧光素钠染色、非接触式眼压、裸眼与矫正视力及球结膜充血程度并作统计分析。采用方差分析对年龄、角膜上皮缺损面积、疼痛程度和球结膜充血程度进行组间比较,采用卡方检验对性别分布及手术前后视力变化的分布进行组间比较。结果研究实际纳入患者共114例,其中男性43例,女性71例,年龄(48.9±12.5)岁。术后各组McGill疼痛评分均逐渐下降。术后2d时,小牛血去蛋白提取物组、空白对照组、羧甲基纤维素钠组和重组人表皮生长因子组患者McGill总分分别为(1.42±0.67)、(2.21±0.88)、(1.93±1.08)和(1.77±1.18)分;术后3d时则分别为(1.32±0.54)、(1.93±0.72)、(1.79±0.87)和(1.52±0.77)分,差异具有统计学意义(2d,F=3.436,P=0.019;3d,F=4.047,P=0.009),其中小牛血去蛋白提取物组的分值显著低于滴用羧甲基纤维素钠组,差异具有统计学意义(2d,P=0.047;3d,P=0.017)。术后2d时,小牛血去蛋白提取物组、空白对照组、羧甲基纤维素钠组和重组人表皮生长因子组患者的上皮缺损面积百分比分别为8.6%±1.9%、11.7%±1.7%、11.5%±1.9%和10.4%±1.8%;术后3d时分别为4.5%±2.2%、9.2%±2.4%、7.4%±2.5%和5.9%±2.3%,差异具有统计学意义(2d,F=17.17,P<0.001;3d,F=21.46,P<0.001)。其中,术后2d时小牛血去蛋白提取物组的上皮缺损面积百分比低于其他3个组(P<0.01),术后3d时,小牛血去蛋白提取物组上皮缺损面积百分比低于空白对照组和羧甲基纤维素钠组(P<0.001),但与重组人表皮生长因子组的差异无统计学意义(P>0.05)。各时间点各组术后视力发生变化的患者数量的差异均无统计学意义(P>0.05)。各组手术前后的眼压、球结膜充血程度的差异均无统计学意义(P>0.05)。结论原发性翼状胬肉切除术后早期应用小牛血去蛋白提取物滴眼液,具有较快减轻疼痛,加速角膜上皮修复的作用。
Objective To investigate the effect of deproteinized calf blood extract eye drops on early postoperative recovery in primary pterygium patients. Methods This is a prospective randomized controlled study. Patients diagnosed with primary pterygium in single eye at affiliated Xiamen Eye Center of Xiamen University during March 2016 to May 2016 were enrolled. After Pterygium excision with autologous conjunctival transplantation, patients were randomly assigned into four groups by a random number table, treated with anti-inflammaroty drugs only (control group) or combined with the following agents: deproteinized calf blood extract eye drops (DCBE group), carboxymethylcellulose sodium eye drops (CMC group), and recombinant human epidermal growth factor eye drops (rEGF group). Short-form McGill pain questionnaire, slit lamp and corneal fluorescein sodium staining, non-contact intraocular pressure, uncorrected visual acuity (UCVA) and best corrected visual acquity (BCVA) as well as redness score of bulbar conjunctiva were performed before surgery (d0) and on day 1 (d1), day 2 (d2), day 3 (d3), day 7 (d7) and day 14 (d14) after surgery. Results One hundred and fourteen patients including 43 males and 71 females, aged (48.9±12.5) years, were eventually included in this study. The McGill scores gradually decreased after surgery in all groups. On d2, the McGill score in DCBE group, control group, CMC group and rEGF group was (1.42±0.67), (2.21±0.88), (1.93±1.08) and (1.77±1.18), respectively;On d3, the score was (1.32±0.54), (1.93±0.72), (1.79±0.87) and (1.52±0.77), respectively. On d2 and d3, statistical difference was recorded among groups (d2, F=3.43, P=0.019;d3, F=4.047, P=0.009), and the McGill score of DCBE group was significantly lower than that of CMC group (d2, P=0.047, d3, P=0.017). On d2, the percentage of corneal epithelium defect in DCBE group, control group, CMC group and rEGF group was 8.6%±1.9%, 11.7%±1.7%, 11.5%±1.9% and 10.4%±1.8%, respectively;On d3, the percentage was 4.5%±2.2%, 9.2%±2.4%, 7.4%±2.5% and 5.9%±2.3%, respectively. On d2 and d3, statistical difference of corneal epithelium defect percentage was recorded among groups (d2, F=17.17, P<0.001;d3, F=21.4, P<0.001). On d2, the percentage of corneal epithelium defect in DCBE group was significantly lower than the other three groups (P<0.01);On d3, the percentage of corneal epithelium defect in DCBE group was significantly lower than control group and CMC group (P<0.001), while no difference was found between DCBE group and rEGF group (P>0.05). However, no statistical differences were recorded in the number of patients with vision improvement among the groups (P>0.05). The intraocular pressure remained stable. No differences in the conjunctival redness score were found among the groups after surgery (P>0.05). Conclusion Our data demonstrated the efficacy of deproteinized calf blood extract eye drops on the postoperative management in patients with primary patients, with faster pain relief and promoted epithelium recovery.
作者
林志荣
吴护平
谢智文
罗顺荣
方颉
闫蕾
刘昭升
董诺
商旭敏
Lin Zhirong;Wu Huping;Xie Zhiwen;Luo Shunrong;Fang Xie;Yah Lei;Liu Zhaosheng;Dong Nuo;Shang Xumin(Department of Ocular Surface and Corneal Diseases,the Affiliated Xiamen Eye Center of Xiamen University, Xiamen 361001,China)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2019年第2期134-140,共7页
Chinese Journal of Ophthalmology
基金
国家自然科学基金(81570816,81570815)
福建省自然科学基金(20149002,2015D013)
福建省医学创新课题项目(2014-CXB-50)
厦门市科技局重大科技创新平台项目(2013S0226).
关键词
翼状胬肉
血蛋白质类
眼药水
Pterygium
Blood proteins
Ophthalmic solutions
