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背景:采用健康角膜缘干细胞体外培养形成组织工程化角膜上皮,移植于碱烧伤后角膜创面可促进创面的修复愈合。目的:观察组织工程角膜上皮移植治疗角膜碱烧伤的疗效和时机。设计、时间及地点:对比观察动物实验,于2007-07/2008-06在解放军总医院第一附属医院实验动物科完成。材料:新西兰雌性大白兔21只,体质量2.0～2.5kg,随机分为对照组和移植组,其中对照组8只16眼,移植组13只再分为:早期移植组,1d移植组2只4眼、3d移植组3只6眼、6d移植组3只6眼、9d移植组2只4眼;中期移植组,14d移植组3只6眼。方法:取21只兔上方健康角膜缘组织体外培养制备组织工程角膜上皮。21只兔双眼采用1mol/L氢氧化钠制作改良角膜碱烧伤模型,移植组在碱烧伤后早期1,3,6,9d和中期14d行自体或同种异体组织工程角膜上皮移植,对照组烧伤后持续观察4周。主要观察指标:移植组及对照组烧伤后4周内眼表和组织病理学变化。结果:角膜碱烧伤后1周开始出现角膜上皮的大片脱落,2周角膜上皮大片脱落或溃疡发生率达72%,持续至4周,移植组在4周时发生率仅为25%,大多获得完整的角膜上皮;烧伤后早期移植组角膜基质深层炎性细胞浸润和新生血管生长较对照组明显受到抑制,而中期移植组角膜基质层较对照组并无明显差异;4周内异体组织工程角膜上皮移植的免疫排斥反应并不大于自体移植。结论:自体或同种异体组织工程角膜上皮移植可尽快恢复眼表完整性,且烧伤后早期移植效果明显优于中期移植。
BACKGROUND: The cultured corneal limbal stem cells cultured in vitro to form tissue-engineered corneal epithelium and transplanted to corneal wounds after alkali burn can promote wound healing. Objective: To observe the curative effect and timing of corneal epithelial allograft in treating corneal alkali burn. DESIGN, TIME AND SETTING: Observational animal experiments were performed at the Laboratory Animal Section of the First Affiliated Hospital of PLA General Hospital from July 2007 to June 2008. MATERIALS: Twenty-one female New Zealand white rabbits weighing 2.0-2.5 kg were randomly divided into control group and transplantation group, of which 8 in control group and 16 in transplantation group were divided into three groups: early transplantation group, 2-day transplantation group 4 eyes, 3 eyes in 3 days, 3 eyes in 6 days, 6 eyes in 6 days, 2 eyes in 9 days and 6 eyes in 3 days after transplantation. Methods: Twenty-one healthy corneal limbal tissues were cultured in vitro to prepare tissue-engineered corneal epithelium. Twenty-one rabbits were treated with 1mol / L sodium hydroxide to improve corneal alkaline burn model. The autologous or allogenic tissue corneal epithelium was transplanted in the transplantation group at 1, 3, 6, 9 days and 14 days after alkali burn, After 4 weeks of continuous observation. MAIN OUTCOME MEASURES: Changes of ocular surface and histopathology within 4 weeks after burn in transplantation group and control group. Results: Large corneal epithelial detachment started 1 week after corneal alkali burn. The incidence of large corneal epithelial exfoliation or ulcer in 2 weeks reached 72% for 4 weeks. The incidence of corneal epithelial necrosis was only 25% at 4 weeks, most of which were obtained Intact corneal epithelium; deep corneal stromal inflammatory cell infiltration and neovascularization in the early transplantation group were significantly inhibited compared with the control group, but the corneal stroma in the medium transplantation group had no significant difference compared with the control group; within 4 weeks after allogeneic tissue engineering cornea Epithelial graft immune rejection is not greater than autologous transplantation. Conclusion: Autologous or allogeneic tissue engineering corneal epithelial transplantation can restore ocular surface integrity as soon as possible, and the effect of early transplantation after burns is better than that of mid-term transplantation.