吲哚菁绿在眼科的应用

吲哚菁绿造影技术对眼底疾病的诊断有很大的作用。随着高速数字造影技术的出现 ,吲哚菁绿造影技术更为成熟 ,可用来指导激光治疗 ,及用于眼科手术的组织染色。本文综述了吲哚菁绿造影技术应用概况及进展 ,并分析了存在的问题及前景。     

吲哚菁绿的合成

吲哚菁绿（indocyanine green，1）是一种全合成的三羧花青系诊断试剂，又称靛青绿，1955年由美国柯达实验室研发，1956年Fox等首先将其应用于肝功能及循环功能检查，1970年以后广泛应用于眼科血管造影。     

吲哚青绿血管造影在眼球钝挫伤中的作用

眼球钝挫伤后，视网膜的后极部及周边部可发生各种损伤。眼底荧光血管造影（FFA）可以提示血-视网膜屏障有无破坏，然而眼球钝挫伤患者眼底镜及荧光血管造影可无脉络膜的异常表现。近年来国内外学者应用吲哚青绿血管造影“indocyanine green angiography，ICGA）可清楚地显示脉络膜血管的循环过程。笔者应用共焦激光视网膜一脉络膜同步血管造影技术，对68例患者进行FFA和ICGA的检查，现报告如下。     

荧光素钠和吲哚青绿混合造影剂不良反应的临床观察

目的　对荧光素、吲哚青绿混合同步眼底血管造影的安全性作出评价。方法　观察 688例行眼底血管造影术病人的不良反应发生情况。结果　 688例行FFA/ICGA造影的病人中 ,出现不良反应 83例(12 0 % ) ,恶心为 3 7例 (5 3 7% ) ,鼻咽不适为 2 8例 (4 0 6% ) ;～ 2 0岁年龄组不良反应的发生率明显低于其他年龄组 (P <0 0 5) ;不良反应发生与性别、有无过敏史无关 (P <0 0 5)。结论　在目前尚无有效预测方法的情况下 ,可以不必做过敏试验直接进行荧光造影     

吲哚青绿在白内障手术中前囊膜染色与切口愈合的临床观察

目的评价吲哚青绿晶状体前囊膜染色在连续环形撕囊中的有效性及其对术后角膜切口愈合的安全性。方法125例（125只眼）白内障患者随机分为2组观察组（吲哚青绿染色组）61只眼,对照组（空白组）64只眼。观察组采用吲哚青绿溶液前囊膜染色,对照组采用平衡盐灌注液作对比。结果观察组连续环形撕囊成功率96.72%,对照组连续环形撕囊成功率68.75%,2组差异有统计学意义（P〈0.05）;术后1d,3d,7d,1月,3月2组患者中连续环形撕囊成功者切口的透明角膜隧道的混浊程度：2组差异无统计学意义（P〉0.05）。结论吲哚青绿晶状体前囊膜染色能提高连续环形撕囊成功率,也不影响角膜切口的初期愈合过程。     

单侧渗出型老年性黄斑变性对侧眼的吲哚青绿血管造影特征

目的 探讨单侧渗出型老年性黄斑变性(AMD)对侧眼吲哚青绿血管造影(ICGA)特征。方法 分析34例经ICGA确诊的单眼渗出型AMD患者对侧34只眼的荧光素眼底血管造影(FFA)及ICGA图像资料。结果 单眼AMD患者对侧眼分别有中晚期后极部簇状强荧光点、强荧光斑、斑片状强弱相间的荧光图像，以及脉络膜灌注不良等几种异常荧光形态。玻璃膜疣在ICGA和FFA上显示强荧光、弱荧少．和正常荧光3种表现；玻璃膜疣在FFA呈强荧光，ICGA一直为弱荧光有18只眼。ICGA中晚期后极部见簇状分布的强荧光点5只眼；中晚期出现1个或多个强荧光斑6只眼；脉络膜灌注不良7只眼。结论 一眼发生渗出型AMD，ICGA检查有助于发现对侧眼是否有病变、病变程度，以及判断预后。     

原田病药物治疗后不同时期的吲哚青绿眼底血管造影观察

原田(Harada)病是伴有皮肤及神经系统异常、原发于脉络膜血管继发于色素上皮的双侧内源性葡萄膜炎。急性期典型病例容易诊断,但是在药物治疗后有些脉络膜的炎症虽然仍然存在,但是由于此时视力的恢复及脉络膜炎症病变的隐蔽,而视网膜则表现正常,FFA也表现正常,所以易被误认为Harada已经治疗痊愈,但是ICGA却能够发现有些病例脉络膜仍然有     

吲哚菁绿染色在白内障环形撕囊术中的应用

目的 探讨0.5%吲哚菁绿溶液前囊膜染色在白内障环形撕囊术中的临床应用效果.方法 60例白内障患者,随机分为两组,每组30例.观察组采用0.5%吲哚菁绿溶液前囊膜染色.采用粘弹剂下染色法,应用撕囊镊完成连续环形撕囊操作.对照组不做染色,应用撕囊镊连续环形撕囊.结果 观察组有28眼撕囊成功,成功率93.3%;对照组有20...     

注射用吲哚菁绿致过敏性休克1例

病例：患者,女,38岁。因“丙肝病史6年,再发肝功能异常4天”,于2013年8月12日入院治疗,诊断为慢性丙型病毒性肝炎,肝硬化。既往史：1996年行剖腹产手术,当时曾输血治疗;2013年5月因“肺炎”住院治疗,期间发现重度贫血,曾输血治疗,未进一步检查。     

吲哚青绿染色联合全氟丙烷填充治疗对高度近视黄斑裂孔视网膜脱离患者预后及黄斑区结构的影响

目的 探讨吲哚青绿染色联合全氟丙烷(C3F8)填充治疗对高度近视黄斑裂孔视网膜脱离患者预后及黄斑区结构的影响.方法 选取医院2015年8月至2018年8月收治的高度近视黄斑裂孔视网膜脱离患者90例,随机分为对照组和观察组,各45例.对照组患者仅予术后玻璃体腔注射C3F8填充治疗,观察组患者予吲哚青绿染色联合C3F8填充...     

Hepatic Blood Flow Measurements and Indocyanine Green Kinetics in a Chronic Dog Model

The objective of this study was to compare hepatic blood flow measurements using ultrasonic flow probes and ICG in a conscious dog model and to evaluate whether ICG can be used to estimate relative change in hepatic blood flow. Seven mongrel dogs (3 M, 4 F, BW = 21 ± 1.8 kg, Hct = 0.39 ± 0.05) were used in the study. Catheters were surgically inserted into carotid artery and portal, hepatic and jugular vein. Transit-time ultrasonic flow probes were implanted around the portal vein and hepatic artery. After two weeks of recovery, a single i.v. bolus dose of ICG (0.5 mg/kg) was administered to each dog. The disposition profiles for ICG in the four catheters were measured for 15 minutes and the hepatic blood flow reading from the probes recorded. Jugular vein ICG blood clearance (Cl = 5.9 ± 1.1 ml/min/kg) was low compared to the electronically measured hepatic blood flow rate (Q = 27.8 ± 9.1 ml/min/kg). Extraction ratios (E = 0.15 ± 0.05) estimated using data from the inlet and the outlet of the liver were consistent with the clearance values, suggesting that ICG is not highly extracted by dog livers. Three dogs were used in experiments where liver blood flow was increased by food intake. Consistent with characteristics of low extraction ratio drugs, ICG was insensitive to blood flow changes while there was an overall increase in electronically measured liver blood flow of 30%. Therefore, ICG is a poor indicator of hepatic blood flow and the present dog model permits continuous and reliable measurements of hepatic blood flow and can be a useful tool in studying the effects of hepatic hemodynamics on pharmacokinetics.     

Thermal Injury Decreases Hepatic Blood Flow and the Intrinsic Clearance of Indocyanine Green in the Rat

The influence of severe thermal injury (full-thickness burns involving 50% of the body surface area) on hepatic blood flow in the rat was assessed using the tricarbocyanine dye indocyanine green (ICG). In a randomized crossover fashion, rats received sequential infusions of ICG through both the femoral vein and the portal vein, allowing the estimation of total hepatic plasma clearance and trans-hepatic extraction of the dye. These two parameters, along with the hematocrit, were used to calculate intrinsic hepatic clearance of ICG and hepatic blood flow. Animals were examined at 0 (control), 0.5, 12, or 24 hr following infliction of scald burns. Hepatic blood flow was decreased significantly by 0.5 hr postburn and remained approximately 20% below normal throughout the remainder of the study. The intrinsic efficiency of the liver in removing ICG from the systemic circulation was also decreased by thermal injury. The potential mechanisms involved in these two physiologic perturbations are discussed.     

Influence of Indocyanine Green on Plasma Disappearance and Biliary Excretion of a Synthetic Thrombin Inhibitor of the 3-Amidinophenyl-alanine Piperazide-type in Rats

Purpose. The pharmacokinetics of a number of synthetic peptidomimetic thrombin inhibitors is determined by extensive hepatic elimination. The objective was to further characterize the disposition in vivo of Pefa 1023, a novel 3-amidinophenylalanine piperazide-type thrombin inhibitor, by influencing the hepatic handling with indocyanine green (ICG), which is actively taken up by the liver. Methods. Pefa 1023 was administered intravenously to bile duct-cannulated rats, either alone or in combination with ICG. The concentrations of Pefa 1023 in blood plasma and bile were measured by a bioassay (thrombin clotting time), concentrations of indocyanine green were measured spectrophotometrically. Results. ICG (10 mg/kg i.v. 15 min prior to or simultaneously with Pefa 1023) markedly influenced the plasma level and biliary excretion rate of the thrombin inhibitor Pefa 1023 given in a dose of 1 mg/kg i.v. The plasma level was more than twice that of the control, the maximum biliary excretion rate about one third and the fraction of dose excreted in bile about two thirds. Conclusions. The anionic dye ICG is able to interfere with the hepatic handling of a cationic, amidinophenylalanine piperazide-type thrombin inhibitor with the consequence of reduced hepatic clearance leading to higher plasma levels and lower biliary excretion of the latter.     

兔眼前段缺血模型的实验研究

目的：观察直肌断腱术后兔眼的组织病理学变化,探讨通过直肌断键术制备兔眼前段缺血模型。方法：新西兰白兔24只,随机平均分为A、B、C三组。各组左眼对照,A组切断右眼上、下、内、外四条直肌;B组切断上、下、内三条直肌;C组切断内、外两条直肌。术后第1、14天,每组分别处死4只兔,迅速摘取眼球,作光镜加电子显微镜的组织病理学检查。结果：裂隙灯检查、组织病理学检查均显示各组左眼未发生明显变化。A、B两组右眼前段自术后第一天,均发生了不同程度的缺血性组织病理学变化,其中A组程度更为严重：角膜缘坏死,炎细胞浸润,虹膜睫状体色素上皮脱落、基质出血水肿等。电子显微镜观察显示虹膜、睫状体相应改变。结论：①切断兔眼三或四条直肌可造成兔眼前节组织缺氧改变。②通过直肌断腱术可以制备ASI模型。     

Effects of Duration of Ischemia and Donor Pretreatment with Methylprednisolone or Its Macromolecular Prodrug on the Disposition of Indocyanine Green in Cold-Preserved Rat Livers

PURPOSE: Cold preservation of the liver before transplantation may change uptake and excretory functions of hepatocytes. We hypothesized that an increase in the duration of preservation would result in a progressive decrease in the hepatic uptake and/or biliary excretion of indocyanine green (ICG), which would be attenuated by pharmacologic interventions. METHODS: Donor rats (n = 40) were administered saline (control) or single 5 mg/kg doses of methylprednisolone (MP) or its liver-targeted prodrug (DMP) 2 h prior to liver harvest. Following preservation in cold University of Wisconsin solution for 0, 24, 48, or 72 h, livers were reperfused in a single-pass manner for 30 min in the presence of ICG (approximately 4 microg/ml), followed by 60 min of ICG-free perfusion. The inlet, outlet, and bile concentrations of ICG were measured periodically by high performance liquid chromatography (HPLC), and kinetic parameters were estimated. RESULTS: Effects of duration of preservation: In unpreserved livers, a significant portion of ICG dose (16%) was effluxed from the liver during the washout period. Cold preservation for 24-72 h progressively increased (p < 0.05) the efflux of ICG (>2-fold at 72 h). Similarly, average extraction ratio showed a modest (30-40%) decrease with increasing preservation time (p < 0.05). However, biliary excretion of ICG showed the most sensitivity to the preservation time (14 to >800-fold decline). Effects of pretreatment: DMP caused significant (p < 0.05) increases in biliary ICG levels (>12-fold) and bile flow rates (6-15-fold) of preserved livers. Although MP pretreatment significantly (p < 0.05) increased (6-fold) bile flow rates in 48-h preserved livers, its effects on biliary ICG levels were not significant (p > 0.05). CONCLUSIONS: Biliary excretion of ICG is the most sensitive kinetic parameter to prolonged cold ischemia-reperfusion injury in a rat liver perfusion model. The injury may be significantly attenuated by pharmacologic pretreatment of the liver donors.     

术竭异位安胶囊治疗兔子宫内膜异位症的实验研究

［摘要］目的观察术竭异位安胶囊对兔子宫内膜异位症的治疗作用。方法手术移植法制备兔子宫内膜异位症模型，分为术竭异位安胶囊低、中、高剂量组（分别为1.9， 3.8， 7.6 g&#8226;kg 1），灌胃给药4周。观察异位内膜外观，异位灶生长情况，进行组织形态学检查；放射免疫法测定血清中雌二醇（E2）、孕酮（P）、6 酮 前列环素（6 k PG）、血栓素B2（TXB2）的含量。结果术竭异位安胶囊各剂量组均能使异位内膜包块积液量明显减少，体积变小，生长受到抑制，异位内膜呈萎缩相，内膜变薄，表面上皮变矮，未增生形成腺体，间质细胞小而稀疏；高、中剂量组能显著降低子宫内膜异位症兔的血清E2、P、6 k PG和TXB2水平。结论术竭异位安胶囊对异位内膜具有明显抑制作用，可通过调节激素水平而促使异位内膜萎缩。     

The effect of a single oral dose of ethanol on hepatic blood flow in man

Summary The magnitude and time course of changes in hepatic blood flow following oral ingestion of a single (0.6 g/kg) dose of ethanol was studied using the model compound indocyanine green (ICG).Hepatic blood flow was not significantly different at 40, 90, 150 and 210 minutes following ethanol as compared to baseline values measured 20 and 70 min prior to alcohol ingestion.These results suggest that ethanol, at concentrations commonly associated with social drinking, has minimal effects on liver blood flow and would be expected to contribute little to changes in either the bioavailability or clearance of drugs highly extracted by the liver.     

绿色化学在实验教学中的应用研究

通过对绿色化学理论知识的研究,使教师和学生掌握相关知识,并将绿色化学应用到实验教学中。实验中通过不同方法、多种途径实施绿色化学教育,可以增强学生的环保意识,减少环境的污染,节省资源,对化学学科的发展和人类生活的可持续发展具有重要意义。