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目的观察多克隆睫状神经营养因子(CNTF)抗体对肉毒毒素(BTX)注射眼外肌后引起的神经末梢萌芽的抑制作用及对肌肉的影响。设计实验性研究。研究对象20只新西兰大白兔。方法随机取10只兔,左上直肌作为空白对照(1组),右上直肌直视下注射A型肉毒毒素(BTXA)2.5U(3组),14天后全麻下取出双上直肌标本;另外10只兔左上直肌注射生理盐水对照(2组),右上直肌注射BTXA 2.5U后第4天,将50μl CNTF抗体一次性注射到右眼上直肌(4组),14天后取出双上直肌标本。标本行电镜观察、乙酰胆碱酯酶染色及Bielschowsky神经末梢银染法显示神经末稍萌芽,使用Leica显微镜成像系统计数及测量。主要指标眼外肌有萌芽终板数、平均萌芽总长度及电镜超微结构变化。结果眼外肌有萌芽终板数和平均萌芽总长度,1组分别为5.75%和10.53μm;2组为6.11%和11.16μm;3组为84.04%和170.71μm;4组为54.77%和68.12μm;差异均有统计学意义(P均=0.000)。电镜超微结构观察显示:3组肌肉明显萎缩,肌纤维和神经结构无明显改变;而再注射CNTF抗体4组,可见部分肌丝断裂融解,变性的肌细胞坏死崩解成细胞碎片,引起部分肌肉不可逆性破坏,而神经髓鞘及运动终板结构无明显改变。结论多克隆CNTF抗体可以抑制BTX诱发的神经萌芽,引起局部肌肉不可逆性破坏,从而可能延长肌麻痹恢复的时间,提示多克隆CNTF抗体可能延长BTX的肌麻痹作用。
Objective To observe the inhibitory effect of polyclonal ciliary neurotrophic factor (CNTF) antibody on the germination of nerve endings caused by injection of botulinum toxin (BTX) into the extraocular muscle and its effect on muscle. Design experimental research. Study objects 20 New Zealand white rabbits. Methods Ten rabbits were randomly selected from the left upper rectus muscle as a control group (group 1). The upper right rectus muscle was injected with 2.5 U of BTXA (group 3) under direct vision. After 14 days, the double upper rectus The other 10 rabbits were injected saline into the left superior rectus muscle (group 2), the right upper rectus muscle injected with 2.5 U of BTXA for 4 days, and 50 μl of CNTF antibody was injected into the right upper rectus muscle (group 4) Remove the double upper rectus muscle specimen. Specimens underwent electron microscopy, acetylcholinesterase staining and Bielschowsky nerve endings silver staining showed end buds, the use of Leica microscopy imaging system and measurement. The main indicators of extraocular muscle bud end of the number of the average total length of germination and electron microscopy changes in ultrastructure. Results The extraocular muscle had the number of sprouting endplates and the average total length of germination, with the rates of 5.75% and 10.53μm in group 1, 6.11% and 11.16μm in group 2, 84.04% and 170.71μm in group 3, 54.77% and 68.12 in group 4 μm; the differences were statistically significant (P = 0.000). Electron microscopy showed that there was a significant atrophy of muscle in group 3 and no obvious change in the structure of muscle fibers and nerves. However, after re-injection of CNTF antibody in 4 groups, some myofilaments ruptured and melted, degeneration of myocyte necrosis disintegrated into cellular debris, causing some muscle Irreversible damage, while the structure of nerve myelin and motor end plate no significant change. CONCLUSION: Polyclonal anti-CNTF antibody can inhibit BTX-induced neural germ and cause irreversible destruction of local muscles, which may prolong recovery time of muscular paralysis, suggesting that polyclonal CNTF antibody may prolong the muscle paralysis of BTX.