增殖性玻璃体视网膜病变中的纤溶酶原
Plasminogen in proliferative vitreoretinal disorders.
作者信息
Esser P, Heimann K, Bartz-Schmidt K U, Walter P, Krott R, Weller M
机构信息
Department of Vitreoretinal Surgery, University Eye Clinic Cologne, Germany.
出版信息
Br J Ophthalmol. 1997 Jul;81(7):590-4. doi: 10.1136/bjo.81.7.590.
OBJECTIVE
Intravitreal fibrin formation is a frequent observation after vitrectomy performed for a variety of vitreoretinal disorders including proliferative vitreoretinopathy (PVR), proliferative diabetic retinopathy (PDR), and endophthalmitis. Plasminogen activators (PA) have been used for the management of this postoperative complication. This approach requires the presence of plasminogen, the substrate for PA mediated fibrinolysis, in the vitreal cavity.
METHODS
Quantification of plasminogen in the vitreous of 60 patients with PVR, PDR, and macular pucker was performed by streptokinase mediated activation using a chromogenic substrate. The presence of immunoreactive plasminogen was confirmed by immunoblot analysis of vitreal proteins and immunocytochemistry of surgically removed epiretinal membranes.
RESULTS
Plasminogen levels were dramatically increased in the vitreous of PVR and PDR patients compared with macular pucker patients and normal controls. Staining for plasminogen in epiretinal membranes was confined to the extracellular matrix. Predominant staining of perivascular areas in PDR specimens indicated that breakdown of the blood-retinal barrier is an important source of intravitreal plasminogen in that condition.
CONCLUSION
Plasminogen may play a role in traction membrane formation in PVR and PDR. Our biochemical analysis of presurgical vitreous indicates that there may be abundant substrate for PA mediated fibrinolysis in the vitreous cavity after vitrectomy.
目的
在针对包括增生性玻璃体视网膜病变（PVR）、增生性糖尿病视网膜病变（PDR）和眼内炎在内的各种玻璃体视网膜疾病进行玻璃体切除术后，玻璃体内纤维蛋白形成是常见现象。纤溶酶原激活剂（PA）已被用于处理这种术后并发症。这种方法要求玻璃体腔内存在纤溶酶原，即PA介导的纤维蛋白溶解的底物。
方法
采用发色底物通过链激酶介导的激活对60例PVR、PDR和黄斑皱襞患者的玻璃体中的纤溶酶原进行定量。通过对玻璃体蛋白的免疫印迹分析和手术切除的视网膜前膜的免疫细胞化学，证实了免疫反应性纤溶酶原的存在。
结果
与黄斑皱襞患者和正常对照相比，PVR和PDR患者玻璃体中的纤溶酶原水平显著升高。视网膜前膜中纤溶酶原的染色局限于细胞外基质。PDR标本中血管周围区域的主要染色表明，在这种情况下，血视网膜屏障的破坏是玻璃体内纤溶酶原的重要来源。
结论
纤溶酶原可能在PVR和PDR的牵引膜形成中起作用。我们对术前玻璃体的生化分析表明，玻璃体切除术后玻璃体腔内可能存在大量PA介导的纤维蛋白溶解的底物。
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