新鲜羊膜移植重建结膜眼表后的印迹细胞学研究  

Impression Cytology after Fresh Amniotic Membrane Transplantation for Conjunctival Surface Reconstruction

作　　者：周世有[1] 袁进[1] 许丽英[1] 陈家祺[1] 

机构地区：[1]中山大学中山眼科中心∥眼科学国家重点实验室,广东广州510060

出　　处：《中山大学学报（医学科学版）》2008年第5期570-574,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2007B031002010);中山大学临床医学研究"5010"计划(2007034)

摘　　要：【目的】确定静止期结膜眼表重建术后新鲜羊膜上皮在眼表的存活时间及其影响因素,以期探讨羊膜上皮在新鲜羊膜移植重建眼表的相关作用机制。【方法】选择临床连续病例共29例。其中复发翼状胬肉8例8只眼,蚕蚀性角膜溃疡8例8只眼,轻中度睑球粘连13例13只眼。按常规方法行新鲜羊膜移植,移植后不同时间复诊时进行羊膜表面的印迹细胞学检查,手术前后进行泪液分泌量的测定。【结果】翼状胬肉和蚕蚀性角膜溃疡患者、3例陈旧性热烧伤患者泪液分泌试验正常,在这些病例的新鲜羊膜植片表面术后3个月印迹细胞学尚不能找到呈PAS阳性的杯状细胞,但术后4月可见。在陈旧性碱烧伤眼中,2/8眼泪液分泌功能正常,在术后2月时可见杯状细胞。另有6眼陈旧性碱烧伤和2眼Stevens-Jonhson综合征患者泪液分泌减少,在术后2周有6/8眼、1月时有2/8眼可在羊膜植片表面找到杯状细胞。同步的临床观察显示:新鲜羊膜植片术后荧光素染色一直呈阴性,但2周左右则部分少许染色,术后3周以后染色一直呈阴性。【结论】新鲜羊膜上皮细胞在泪液分泌功能不同和移植床微环境不同的静止期结膜眼表存活的时间不同。在泪液分泌功能正常和移植床微环境良好者可存活3个月左右,在干眼症和化学伤患者中存活时间大大缩短。[Objective] To investigate the life span of amniotic epithelium on the reconstructed ocular surfaces at the stage of quiescence by fresh amniotic membrane. [Methods] Impression cytology and tear secretion was performed at different check-point time postoperatively after fresh amniotic membrane transplantation for conjunctival surface reconstruction after pterygium excision,conjunctival excision and symblepharon lysis. [Results] On the surfaces of fresh amniotic grafts in21 eyes with normal tear secretion （all eyes with pterygium and Mooren＇s ulcer, 5 eyes with thermal and chemical eye burns） after transplantation, PAS positive goblet cells did not appear up to 3 months but no more than 4 months in 19 eyes of them,but found in another 2 eyes with chemical burns at 2 months postoperatively. On those eyes with dry eye,6 of 8 eyes can be found goblet cells at 2 weeks postoperatively, but another 2 eyes at 1 months after surgery. The simultaneous clinical observation also showed that fresh anmiotic grafts presented negative fluorescent staining on the eyes with normal tear film, but a few spot staining during the 2nd week after transplantation at those eyes with dry eye. [Conclusion] Fresh amniotic epithelial cells may keep alive up to 3 months on the ocular surfaces with normal tear film and quiescent environment and their life span maybe markedly shortened on that kind of ocular surfaces with dry eye or active inflammation.

关 键 词：羊膜移植 眼表重建 印迹细胞 

分 类 号：R77[医药卫生—眼科]