结膜松弛症患者泪膜稳定性、杯状细胞及黏蛋白5AC表达的变化  

Changes of tear film stability, goblet cell and mucin 5AC expression in conjunctivochalasis patients

作　　者：项敏泓[1] 贾元玲 周欢明[1] 李青松[1] 王晗敏[1] 张兴儒[1] 陈星星[1] 

机构地区：[1]上海中医药大学附属普陀医院眼科,上海市200062

出　　处：《眼科新进展》2017年第8期759-763,共5页Recent Advances in Ophthalmology

基　　金：上海市卫生及计划生育委员会资助项目(编号:20124108);上海市普陀区自主创新科研基金(编号:2013PTKW009);上海中医药大学预算内项目(编号:2015YSN50)~~

摘　　要：目的检测和观察结膜松弛症患者泪膜稳定性、杯状细胞变化及黏蛋白5AC的表达情况,探讨结膜松弛症的发病机制。方法收集在我院就诊的结膜松弛症患者30例30眼)为结膜松弛症组,另选取单纯老年性白内障手术患者15例(15眼)为正常对照组,对所有入选者进行眼部症状评价[国际眼表面疾病指数(ocular surface disease index,OSDI)积分法]、泪膜破裂时间检测、Schirmer I试验、泪液羊齿状结晶试验,分别对结膜松弛症组和正常对照组的结膜组织标本行HE染色、AB染色、黏蛋白5AC免疫组织化学染色观察,行统计学分析。结果结膜松弛症组OSDI评分为(37.80±8.94),高于正常对照组(11.40±4.08)(P<0.01)。结膜松弛症组泪膜破裂时间为(6.70±2.76)s,低于正常对照组(13.67±3.48)s(P<0.01)。SchirmerⅠ试验结膜松弛症组为(6.23±3.13)mm,明显低于正常对照组(13.40±3.74)mm(P<0.01)。结膜松弛症组患者泪液中羊齿状结晶较正常对照组明显减少(χ~2=14.309,P=0.003)。光镜下结膜松弛症组较正常对照组球结膜厚度变薄,胶原纤维少,弹力纤维缺失,固有层间质淤血水肿,杯状细胞减少,黏蛋白5AC染色阳性细胞数低于正常对照组(χ~2=9.499,P=0.023)。结论结膜松弛症患者泪膜功能受到影响,杯状细胞减少,泪液中羊齿状结晶减少,黏蛋白5AC含量减少,最终导致球结膜过度松弛,出现眼表泪液学异常。Objective To observe the changes of tear film stability,goblet cell and mucin 5AC expression in conjunctivochalasis patients,and explore the mechanism of conjunctivochalasis.Methods Conjunctivochalasis patients （30 cases） and single age-related cataract patients （15 cases） were collected as conjunctivochalasis group and normal control group.Eye symptom assessment （OSDI score）,tear break-up time（BUT）,Schirmer Ⅰ test,tear fern crystallization tests were performed for all the selected persons.Conjunctival rescent-shaped resections were made for all the conjunctivochalasis patients.Conjunctival tissue samples were stained by HE staining,AB staining,mucin 5AC immunohistochemical staining from the conjunctivochalasis group and normal control group respectively,and then statistical analysis was made.Results The OSDI score in the conjunctivochalasis group （37.80±8.94） was significantly higher than that in the normal control group （11.40±4.08） （P〈0.01）.BUT in the conjunctivochalasis group （6.70±2.76）s was significantly lower than that in the normal control group （13.67±3.48）s （P〈0.01）.Schirmer Ⅰ test in the conjunctivochalasis group （6.23±3.13）mm was significantly lower than the normal control group （13.40±3.74）mm （P〈0.01）.Tear ferning crystallization of the conjunctivochalasis group was decreased significantly compared with the normal control group （χ2=14.309,P=0.003）.Light microscopic showed that conjunctival thickness was thinned,collagen fibers were less,elastic fiber was reduced,the lamina propria and interstitial were congestion and edema,the number of goblet cells was significantly reduced,and the positive staining of mucin 5AC staining was significantly lower in the conjunctivochalasis group than in normal control group （χ2=9.499,P=0.023）.Conclusion For patients with conjunctivochalasis,the tear film function is affected,goblet cells are decreased,tear fern crystallization is decreased,mucin 5AC content is decreased,which finally l

关 键 词：结膜松弛症 黏蛋白5AC 泪膜稳定性 结膜 杯状细胞 

分 类 号：R777.3[医药卫生—眼科]