【作者】 徐金华；

【导师】 王育良；

【作者基本信息】 南京中医药大学 ， 中西医结合临床， 2008， 博士

【摘要】 本课题从动物实验和调查研究两方面诣在探讨人工光环境对视系统及生殖内分泌节律的影响,以及中药调周法对眼及生殖内分泌节律的保护与调整作用。目的通过动物实验探讨人工光环境对大鼠眼部形态和功能以及生殖内分泌节律的影响,并观察复方中药制剂对眼及生殖内分泌节律的保护与调整作用。同时通过社会调查探讨不同光环境对人屈光状态、生育情况的影响。方法实验研究部分:健康无任何眼病SD大鼠45只,随机分成3组,每组15只,对照组饲养在正常昼夜交替节律的环境中,接受自然界全光谱自然光线的照射,实验组分为模型组和中药组,饲养在光照控制箱内,接受人工光源循环照射,设定每目光照明(早6:00至晚24:00)、暗(晚24:00至早6:00)循环交替时间为18h/6h,同时中药组予以复方中药制剂灌胃。大鼠性成熟后,于动情周期前半期予以补阴方灌胃,动情周期后半期予以补阳方灌胃,实验第4月时,对各组大鼠行眼常规检查、视觉电生理检查、视网膜病理组织学检查、视网膜过氧化物以及抗氧化酶活性分析测定。阴道涂片确定大鼠处于动情间期,检测雌二醇含量。对使用实验光源进行光学参数测定。社会调查部分:我们选取新疆维吾尔自治区伊犁哈萨克自治州哈萨克族人群进行社会调查研究。生活在牧区的哈萨克族人仍保持以自然光照为主的生活方式,人工光源照明时间很短;而城市哈萨克族人主要以人工光源照明为主,光照时间延长,这样同一种族的两组人群,处于不同的光环境,而原有的民族习惯基本不变,恰好符合了我们观察目标。我们于2005年11月至2006年11月随机调查成年哈萨克族人427例(828眼),年龄40-60岁,其中牧区哈萨克族人279例(546眼),城市哈萨克居民148例(282眼),性别不限,职业不限,因其它眼病而影响视力者不作为本次调查对象。对所有调查对象进行眼部检查,包括常规检查、裸眼视力检查、屈光状态检查,问卷调查,包括询问其户外活动时间、睡眠时间、照明时间以及照明光源类型、生育数量等。结果实验研究部分:各组SD大鼠眼部大体组织结构未见明显差异。对照组视觉电生理检查波形较为典型,分化性好,模型组波形不典型,F-ERG与对照组比较Rod-R潜时延长,Max-R a,b波振幅显著下降,下降幅度分别为:54.26%,65.35%,b波潜时延长,Cone-R a,b波振幅下降,幅度分别为35.76%,38.46%,Ops OS值、30Hz Flicker N1-P1振幅下降,与对照组比较差异有显著性。F-VEP与对照组比较振幅降低,差异有显著性。中药组引出的波形与模型组较为相似,F-ERG与对照组比较Rod-R潜时延长,Max-R a,b波振幅显著下降,b波潜时延长,Cone-R a,b波振幅下降,Ops OS值、30Hz Flicker N1-P1振幅下降,与对照组比较差异有显著性。F-VEP与对照组比较振幅降低,差异有显著性。中药组与模型组比较Max-R b波波幅高,差异有显著性。对照组HE染色光镜观察见视网膜各层间分界清晰,内、外核层细胞核密集,胞核排列整齐规则,外核层约10～12个胞核厚度,内核层约4～5个胞核厚度,内丛状层疏松、网状,比外丛状层厚,神经节细胞核大,淡染,散在分部在神经纤维层内。模型组HE染色光镜下见视网膜普遍萎缩变薄,层次不清,层数减少,感光细胞内、外节结构消失,外核层和内核层分界不清,核层数减少,共约3～5个胞核厚度,核深染,排列紊乱,外丛状层消失,内丛状层变薄,神经节细胞水肿,稀疏,排列紊乱,神经纤维层水肿,变薄。中药组HE染色光镜下所见与模型组相类似。对照组大鼠视网膜MDA含量低,SOD活性高,与实验组有明显差异。中药组SOD活性比模型组高(P＜0.05)。对照组和用药组大鼠相对比较安静,实验组表现为比较惊觉,躁动不安,实验第4个月时于生殖间期检测各组血中雌激素含量,模型组大鼠血雌激素含量显著高于对照组、中药组。目光灯频闪大,稳定性差,紫外区的辐射非常明显。白炽灯发光亮度比较稳定,没有探测到紫外辐射区。社会调查部分:城市哈萨克族人裸眼视力分布相对比较均匀,其中19%(54眼)视力为0.4-0.5,21%(59眼)视力为0.6-0.8,18%(50眼)视力为1.0以上者。而牧区哈萨克族人裸眼视力分布呈明显特点,主要集中在0.6以上,其中25%(137眼)视力为0.6-0.8,59%(319眼)视力在1.0以上。二组人群裸眼视力=1.0者,人群分布有显著性差异。城市哈萨克族人屈光度相对较多分布在平光和-4.0之间,而牧区哈萨克族人屈光度分布呈集中趋势,主要集中在≤+2.0D和≤-2.0D之间,其中45%(242眼)为平光,32%(168眼)为≤+2.0D,18%(101眼)为≤-2.0D。二组人群屈光度为=+2.0-平光和=-3.0以上者,人群分布有显著性差异。城市哈萨克族人主要在室内活动,日光灯为主要的照明光源,71%(105例)人工光源照射超过6小时。牧区哈萨克族人主要在室外活动,以自然界全光谱自然光照明为主,75%(210例)户外活动时间超过9小时以上,87%(242例)室内人工光源照明时间仅为1-3小时,白炽灯为主要照明光源。城市哈萨克居民生育数量少。结论日光灯、白炽灯低强度人工光源长时间循环照射大鼠,对视网膜组织结构、视功能有一定影响,考虑与视网膜脂质过氧化有关,中药可能对视网膜内层具有一定的保护作用,但尚需通过大样本资料进一步深入研究加以证实。同时中药对调整大鼠生物节律紊乱有一定的作用,为临床上规范健康照明提供依据。光环境的变化可能是引起近视发病率增高的重要因素之一,有关发病机制还需进一步探讨,也许可为临床上预防近视提供新途径。人工光环境可能影响哈萨克族人生殖功能,尚需通过大样本资料进一步深入研究加以证实。作为近距离照明,传统的白炽灯对人眼损伤相对较小。更多还原

【Abstract】 This topic studied the effects of low intensity artificial light on eye and on biothythm, the intervention role of traditional Chinese medicine to light damage to eye and biothythm disorder.Objective:To study of artificial light on the eye and biothythm and traditional Chinese medicine intervention function by rats experiment.To study the effect of different light environment on refractive error and reproductive condition.Methods:The first part:This experiment planed to simulate light environment of the human ordinary room.The SD rats were exposed to low intensity artificial light intermittently for a long time,daylight lamp and the incandescent lamp as experiment lamp.SD rats 45 without any eye diseases were divides into 3 groups randomly,each group of 15.The control group were exposed to natural light.Experimental group were divided into model group and traditional Chinese medicine group.Two experimental group were exposed to artificial light(light:dark=18:6h) which imitated indoor light of human.The rats of medicine group were given traditional Chinese medicine to fill the stomach according to rat reproductive period.After four months, routine inspection,F-ERG and F-VEP,retina histo-pathology inspection,estrogen content were carded throught to every group.Optical parameter was measured to daylight lamp and the incandescent lamp.The second part:We selected the Xinjiang Uigur Autonomous Region Yili kazak to conduct the social investigation research. Kazak who lived in the pastoral area still maintained traditional life style.Most of them used natural illumination.The artificial illumination time was very short.But the city Kazak illuminated mainly by the artificial light.The illumination time were longer than pastoral Kazak.Two groups of Kazak lived in the different light environment,but the original national custom was invariable.So two groups exactly conformed to us to observe the goal.From November,2005 to November,2006,We investigated grown-up Kazak 427 cases(828 eyes),the age 40-60 year old.The pastoral Kazak were 279 cases(546 eyes),the city Kazak 148 cases(282 eyes).There was no limit to occupation and sex.Anyone whose eye disease affected the vision were excluded.All objects were inspected,including the routine inspection,vision and refractive inspection,questionnaire survey. Results:The first part:The eye tissue profile of each group had not seen the obvious difference.ERG and VEP of control group were more typical,but experiment group’s were not.In model group,Latent period of Rod-R were prolonged.The amplitude of a-wave and b-wave of Max-R decreased by 54.26%and 65.35%respectively.The amplitude of a-wave and b-wave of Cone-R decreased by 35.76%and38.46% respectively.The amplitude of OS of Ops and N1-P1 of 30Hz Flicker decreased too. The amplitude of ERG in model group were lower than that in control group(P＜0.05).The amplitude of F-VEP in model group were lower than that in the control group(P＜0.05).ERG and VEP of medicine group were similar to model group,and b-wave of Max-R,Cone-R,Ops OS值、30Hz Flicker N1-P1 were lower than that of control group(P＜0.05).The amplitude of F-VEP were lower than that of control group(P＜0.05).The amplitude of b-wave of Max-R in medicine group were higher than model group.Retina was normal in the control group.The cell arrangement of the control group were clear and orderly by optical microscope.The outer nuclear layer were about 10 to 12 layer thickness,while the inner nuclear layer about 4 to 5.The inner plexiform layer were thicker than outer plexiform layer.The ganglion cell were in nerve fiber layer.The entire retina of the model group atrophied by optical microscope.The cell arrangement of the model group were disorderly.The outer and inner node of photoreceptors disappeared.There was no clear line between outer and inner nuclear layer.The nuclear layer reduced to about 3 to 5 layer thickness.The inner plexiform layer were thinner than that of control group.The ganglion cell and nerve fiber layer were swelled.What to see by optical microscope in medicine group were similar to model group.The control group MDA content were lower than that of two experiment group(P＜0.01).The control group SOD content were higher than that of two experiment group(P＜0.01).The medicine group SOD content were higher than that of model group(P＜0.01).SD rats of control or medicine group were quiet while model group were restless and alarmed.After 4 months,estrogen content in model group were higher than other two groups(P＜0.01).Daylight lamp brightness was not stable and contained much ultraviolet rays,but incandescent lamp was not.The second part:The city Kazak vision were worse.19%(54) the vision is 0.4-0.5,21%(59) the vision 0.6-0.8,18%(50) the vision above 1.0.But the pastoral Kazak vision were better.25%(137) the vision is 0.6-0.8,59%(319) the vision above 1.0.The number whose vision more than 1.0 in pastoral Ka7ak were more than city Kazak(P＜0.05).The city Kazak diopter were between 0D and—4.0D.But the pastoral Kazak diopter mainly concentrated between +2.0D and—2.0D,45%(242) 0D,32%(168)≤+2.0D,18%(101)≤—2.0D.Two groups diopters between +2.0D and 0D or less than 3.0 D have obvious difference.The city Kazak mainly were active in the room.The daylight lamp was the main illumination photosource. 71%(105 cases) the artificial light illuminated more than 6 hours.The pastoral Kazak were active mainly in the outdoor.75%(210 cases) the outdoors activity time were above 9 hours by the natural light illumination.87%(242 cases) the artificial light, main incandescent lamp,illumination time only were 1-3 hour.The number of reproduction were decreased.Conclusion:It suggests that low intensity artificial light can injure retinal function and structure over a long period of time.At same time traditional Chinese medicine is helpful to regulate biothythm disorder.Maybe this medicine can protect retina too. But this opinion needs to discuss further.This research provides experimental basis for the improvement lighting installation.It infers that poor light environment is one of very important reasons to cause refractive error.At same time artifical light environment maybe effect reproductive ability.But this opinion needs to discuss further.更多还原