穿透性角膜移植术后慢性失功移植片的免疫学研究  

Immunology study of chronic corneal allograft dysfunction after penetrating keratoplasty

作　　者：高华[1,2,3] 王晔[1,2,3] 谢立信[1,2,3] 

机构地区：[1]山东省眼科研究所 [2]山东省眼科医院 [3]青岛眼科医院,青岛266071

出　　处：《眼科》2009年第3期162-165,共4页Ophthalmology in China

基　　金：国家自然科学基金(30700923);山东省自然科学基金(Y2006C89)资助项目

摘　　要：目的检测穿透性角膜移植术后慢性失功移植片的免疫与非免疫相关细胞因子表达的变化,探讨免疫与非免疫因素在角膜植片慢性失功中的作用机制。设计临床实验研究。研究对象分为两组,角膜植片慢性失功(CCAD)组:穿透性角膜移植(PK)术后因CCAD导致移植失败的8例患者的角膜植片;正常对照组:由山东眼库提供的正常角膜供体3只。方法免疫组化法检测两组角膜片免疫相关细胞因子表达,结合患者的临床资料进行综合分析。主要指标角膜中CD4^+、CD8^+、F4/ 80、TGF-β、bFGF、α-SMA的表达。结果免疫组化检测显示正常对照组:角膜各层组织CD4^+、CD8^+、α-SMA、bFGF表达阴性, F4/80角膜基质偶见表达,TGF-β在角膜上皮层有表达。CCAD组:所有角膜植片全层均未见CD4^+及CD8^+T淋巴细胞浸润;5例失功植片基质层F4/80阳性表达,其余3例角膜植片全层表达阴性;所有角膜植片上皮层可见TGF-β阳性表达,基质层内可见TGF-β表达。所有失功角膜片基质层bFGF表达呈弱阳性;所有患者角膜基质内α-SMA表达阳性,后弹力层附近可见较强表达。结论穿透性角膜移植术后慢性失功移植片免疫组化检查未发现支持临床急性免疫排斥反应的证据,抗原递呈细胞及非免疫特异相关细胞因子的异常表达提示免疫与非免疫因素参与了CCAD的发生和发展。Objective To study the expression of immune and non-immune related cytokine in corneal grafts of chronic graft dysfunction after penetrating keratoplasty and reveal the possible mechanism of it. Design Clinical experimental study. Participants Including two groups. In chronic corneal allograft dysfunction （CCAD） group, corneas of 8 patients fulfilling the diagnostic criteria for CCAD who underwent repeated PK operation. Three normal corneas supplied by Shandong provincial eye bank of China were used as control group. Methods The conreal graft were analyzed by immunohistochemical studies. Moreover, the comprehensive analysis was carried out combining the patient＇s clinical data. Main Outcome Measures CD4^＋、CD8^＋, F4/80, TGF-β, bFGF and α-SMA in cornea. Results The results of immnunohistoehemical studies showed that compared with normal corneas, full-thickness corneal grafts of eight corneas which underwent repeated PK operation had no CD4^＋ and CD8^＋ T lymphocyte infiltration. F4/80 positive inflammatory cells were more abundant near the stroma of five corneal grafts which underwent once PK operation. Full-thickness corneal grafts of other three corneas which underwent no immune rejection had no F4/80 positive inflammatory cells. The TGF-β positive inflammatory cells were more abundant near the epithelium and stroma of all corneal grafts. The moderate bFGF positive inflammatory cells were present in stroma of all corneal grafts. The α-SMA positive inflammatory cells were more abundant near stroma and the elastic layer of all corneal grafts. Conclusions After PK operation, the results of immnunohistochemical studies of the corneal graft which underwent CCAD showed that there is no evidence of clinical acute rejection. The abnormal expression of antigen presenting ceils and non-immune cell specific factors suggest that immune or non-immune factors maybe involve in the occurrence and development of CCAD.

关 键 词：角膜植片 慢性失功 免疫因素 非免疫因素 

分 类 号：R779.65[医药卫生—眼科] R656.6[医药卫生—临床医学]