息肉状脉络膜血管病变的临床病理研究现状  

Research status of clinicopathologic studies of polypoidal choroidal vasculopathy

作　　者：李妙玲(综述) 文峰(审校)[1] LI Miaoling;WEN Feng(State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060,China)

机构地区：[1]中山大学中山眼科中心,眼病防治全国重点实验室,广东省眼科视觉科学重点实验室,广州510060

出　　处：《眼科学报》2025年第2期196-201,共6页Eye Science

摘　　要：息肉状脉络膜血管病变(polypoidal choroidal vasculopathy, PCV)是中国人新生血管性年龄相关性黄斑变性的(age-related macular degeneration, AMD)主要亚型。PCV与典型的新生血管性AMD在流行病学、临床表现、影像学特征和自然病程方面存在一定差异。近年来的研究表明,除了传统的玻璃膜疣驱动机制外,PCV可能与肥厚脉络膜机制相关,后者在亚洲人群中更为常见。深入的病理学探索将有助于揭示PCV的发病机制,并探索PCV与其他脉络膜疾病之间的内在联系。由于PCV患者眼球标本的稀缺,现有的病理学研究较少,且结果之间存在一定差异。文章通过介绍笔者最新的临床病理研究结果,并结合历年来国内外的研究,总结了关于PCV病灶所在的层次、起源及血管内皮生长因子(vascular endothelial growthfactor,VEGF)表达水平的争议问题,阐明了PCV的临床病理研究现状。第一,PCV病灶的层次。临床上,OCT成像显示PCV病灶位于视网膜色素上皮(retinal pigment epithelium, RPE)与Bruch膜的高反射线之间,属于I型脉络膜新生血管的特殊亚型。部分病理学研究认为PCV病灶位于Bruch膜内,但实际上PCV病灶更准确地位于RPE基底膜下。第二,异常分支血管网(branching vascular networks, BVN)的起源。尸体眼标本的病理分析表明,BVN起源于脉络膜动脉,且动脉穿过Bruch膜后,转变为薄壁毛细血管形成I型脉络膜新生血管。少数研究指出PCV可能由静脉扩张形成,并存在脉络膜静脉的淤滞。第三,VEGF在PCV病灶中的表达。VEGF是新生血管性AMD的关键致病因子,一些研究表明PCV病灶中VEGF表达升高,提示PCV可能与新生血管性AMD具有相似的发病机制,但也有研究发现PCV病灶中的VEGF表达为阴性,提示PCV的机制可能不完全依赖于VEGF。综上,PCV的病理特征具有复杂性,既有与新生血管性AMD相似的表现,也有肥厚脉络膜的特征。随着眼球捐献意识的提高,未来有望�Polypoidal choroidal vasculopathy(PCV)is the main subtype of neovascular age-related macular degeneration(AMD)in China.PCV differs from typical neovascular AMD in terms of epidemiology,clinical presentation,imaging features,and natural disease course.Recent studies suggest that,in addition to the traditional drusen-driven mechanism,PCV may also be associated with pachychoroid mechanism,which is particularly more common in Asian populations.In-depth pathological research will help uncover the pathogenesis of PCV and explore the intrinsic connections between PCV and other choroidal diseases.Due to the rarity of eye specimens from PCV patients,there is limited pathological research,and results can vary.Herein,this article summarize the controversial issues regarding the location level,origin,and the vascular endothelial growth factor(VEGF)expression of PCV lesions by introducing our latest clinicopathologic study on PCV and combining with previous studies in China and worldwide.First,the layer of PCV lesions.Clinically,OCT imaging shows that PCV lesions are located between the retinal pigment epithelium(RPE)and the hyperreflective line of Bruch membrane,making them a special subtype of type I choroidal neovascularization.Some pathological studies suggest that PCV lesions are located within Bruch membrane,but in fact,PCV lesions are more accurately located beneath the RPE basement membrane.Second,the origin of the branching vascular networks(BVN).Pathological analysis of postmortem eye specimens indicates that BVN originates from choroidal arteries,and after passing through Bruch membrane,they transform into thin-walled capillaries,forming type I choroidal neovascularization.A few studies suggest that PCV may result from dilation of choroidal vein,accompanied with vein stasis.Third,VEGF expression in PCV lesions.VEGF is a key pathogenic factor in neovascular AMD.Some studies show increased VEGF expression in PCV lesions,suggesting that PCV may share a similar pathogenic mechanism with neovascular AMD.However,other st

关 键 词：息肉状脉络膜血管病变 临床病理 玻璃膜疣 肥厚脉络膜 

分 类 号：R774.5[医药卫生—眼科]