Nd:YAG激光联合平阳霉素治疗眼眶静脉畸形的病理改变初步观察  

Histopathological and immunohistochemical studies of orbital venous malformations after pingyangmicin and Nd:YAG laser local treatment

作　　者：李瑾[1] 林明[1] 贾仁兵[1] 黄筱玲[1] 范先群[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院眼科,200011

出　　处：《眼科》2011年第4期274-278,共5页Ophthalmology in China

基　　金：上海市重点学科(S30205);上海市科委重点课题资助项目(10JC1409100);上海市科委自然基金(11ZR1420000);上海市卫生局面上项目(2010242)

摘　　要：目的研究眼眶静脉畸形经平阳霉素联合激光治疗后的组织病理变化并探讨两者联合治疗作用的机制。设计实验研究。研究对象19例非扩张型眼眶静脉畸形病理标本。方法 19例非扩张型眼眶静脉畸形病例中,11例行单纯手术切除,为对照组。8例瘤体注射平阳霉素1.6～8.0 mg,7天后Nd:YAG激光术中照射静脉畸形病灶(能量密度为60～100 J/cm2),然后手术切除,为联合治疗组。两组手术后标本均行HE染色观察内皮损伤并计分,行免疫组化染色观察基质金属蛋白酶(MMP-9)、血管内皮生长因子(VEGF)、α平滑肌肌动蛋白(α-SMA)的表达。主要指标MMP-9和α-SMA的表达水平。结果从联合治疗组的标本可观察到瘤体血管内皮细胞损伤、血栓形成和管腔闭塞表现,两组静脉管壁及内皮细胞损伤计分比较有显著性差异(P=0.044)。两组病例标本细胞中均有不同程度MMP-9和α-SMA表达,其中联合治疗组MMP-9(P=0.001)和α-SMA(P=0.024)表达水平低于对照组。结论 Nd:YAG激光与平阳霉素联合应用治疗眼眶静脉畸形的机制可能是通过损伤瘤体血管内皮和中膜,同时与下调MMP-9和α-SMA的表达水平有关。Objective To study the pathological changes of orbital venous malformations after pingyangmicin and Nd：YAG laser local treatment and its mechanism. Design Experimental study. Participants Pathological specimens of 19 patients with nondistensible orbital venous malformations. Methods Eight patients with nondistensible orbital venous malformations were treated with 1.6-8.0 mg pingyangmicin injection. After 7 days, the venous malformation lesions were treated by Nd： YAG laser irradiation with the energy density of 60-100 J/cm^2, then been fully removed. 11 patients were treated by surgical resection alone. The histopathologieal examination was performed. Main Outcome Measures The expression of matrix metalloproteinase-9（MMP-9） and alpha-smooth muscle actin （ct-SMA） in immunohistoehemieal technique. Results For 8 patients treated with pingyangmicin and Nd：YAG laser, the pathological changes such as narrow lumens, endomembrane swelling, the cellular edema of vascular endothelial cells, and mural thrombosis can be observed. The scoring of blood vessel impairment was significantly higher than that of the surgery alone group （P=0.044）. And the expression of MMP-9 and α-SMA was significantly lower than that of the surgery alone group （P=0.001, 0.024）. Conclusions There are signs of endomembrane and mid layer injury of orbital venous malformations after pingyangmicin combined with Nd：YAG laser treatment. The lower expression of MMP-9 and α-SMA is relevant to combined treatment.

关 键 词：眼眶静脉畸形/组织病理学 平阳霉素 Nd:YAG激光治疗术 

分 类 号：R965[医药卫生—药理学]