上睑下垂患者提上睑肌组织病理学评价和临床相关性研究  

Histopathological evaluation and clinical correlation study of the levator palpebralis muscle in patients with ptosis

作　　者：白蓉 赵瑜 李军 郝红艳 马丹莉 Bai Rong;Zhao Yu;Li Jun;Hao Hongyan;Ma Danli(Department of Ophthalmology,the First People’s Hospital of Lanzhou City,730000,China)

机构地区：[1]兰州市第一人民医院眼科,730000

出　　处：《临床眼科杂志》2022年第2期148-151,共4页Journal of Clinical Ophthalmology

基　　金：甘肃省重点研发计划-社会发展类项目(17YF1FA140)。

摘　　要：目的探讨上睑下垂患者提上睑肌组织病理学评价和临床病情的相关性。方法前瞻性病例研究。纳入2014年1月至2020年6月于我院就诊的125例(125只眼)上睑下垂患者为研究对象;根据病程严重程度分为重度组(50例)和中度组(75例)。在手术过程中获得了125例上睑肌腱膜病标本并进行苏木精-伊红染色、Van Gieson染色、Masson染色、免疫组织化学和透射电镜观察,以观察提上睑肌肌腱膜的病理学特征;使用曼恩·惠特尼(Mann-Whitney)的U检验和多元线性回归进行统计分析,探讨上睑下垂患者提上睑肌组织病理学特征与临床病情的相关性。结果透射电子显微镜两组患者均存在胶原纤维增生和细胞变性,包括线粒体肿胀和增生,液泡,脂质滴,脓疱核,染色体凝集,细胞器分解,髓样体和自噬体。两组患者提上睑肌腱膜病理学特征脂肪浸润、横纹肌肌纤维丢失、胶原纤维增生、肌红蛋白分布、提上睑肌厚度组间比较存在差异(P<0.05)。Logistics回归表明脂肪浸润(OR=1.816)、横纹肌肌纤维丢失(OR=2.856)、胶原纤维增生(OR=0.301)是影响上睑下垂患者临床病情的影响因子。结论上睑下垂患者提上睑肌肌腱膜存在肌纤维变性,胶原纤维增生和细胞变性有关,其中脂肪浸润、横纹肌肌纤维丢失、胶原纤维增生与患者临床病情的严重程度呈正相关。Objective To investigate the relationship between histopathological evaluation of the levator palpebral muscle and clinical conditions in patients with ptosis.Methods Prospective case study.125 patients with ptosis who were treated in our hospital from January 2014 to June 2020 were included as the research objects.According to the severity of the disease,patients were divided into severe group(50 cases)and moderate group(75 cases).During the operation,125 specimens of upper eyelid aponeurosis were obtained and were performed in hematoxylin-eosin staining,Van Gieson staining,Masson staining,immunohistochemistry and transmission electron microscope observation to observe the pathology of the levator aponeurosis.The correlation between histopathological characteristics of the levator palpebral muscle and clinical conditions in patients with ptosis were test by Mann-Whitney's U test and multiple linear regression.Results The transmission electron microscopy had collagen fiber hyperplasia and cell degeneration in two groups,including mitochondrial swelling and hyperplasia,vacuoles,lipid droplets,pustular nuclei,chromosome aggregation,organelle decomposition,myeloid bodies and autophagosomes.There were differences in the pathological characteristics of the levator aponeurosis aponeurosis,fat infiltration,striated muscle fiber loss,collagen fiber proliferation,myoglobin distribution,and the thickness of the levator palpebral muscle between the two groups(P<0.05).The results of logistics regression showed that fat infiltration(OR=1.816),striated muscle fiber loss(OR=2.856),and collagen fiber proliferation(OR=0.301)were influencing factors of clinical condition of patients with ptosis.Conclusions The levator aponeurosis of blepharoptosis patients had muscle fiber degeneration,and the collagen fiber proliferation was related to cell degeneration.Fat infiltration,striated muscle fiber loss,and collagen fiber proliferation were positively correlated with the severity of the patient's clinical condition.

关 键 词：肌源性 上睑下垂 提上睑肌 组织病理学 肌腱膜纤维 

分 类 号：R779.6[医药卫生—眼科]