人体角膜移植内皮排斥反应的共焦显微镜研究  

Endothelial rejection of human corneal allograft under confocal microscope

作　　者：林跃生[1] 黎明 陈龙山[1] 陈家祺[1] 宋书华[1] 肖启国[1] 黄挺[1] 周世有[1] 

机构地区：[1]中山大学中山眼科中心,510060

出　　处：《中国实用眼科杂志》2003年第11期814-819,共6页Chinese Journal of Practical Ophthalmology

基　　金：卫生部课题基金 (基金编号 961 1 2 2 );广东省自然科学基金 (基金编号 960 1 4 5);广东省重点科技攻关项目 (编号962 2 0 50 0 4 )资助

摘　　要：目的 :应用共焦显微镜探讨活体角膜内皮排斥反应的早期形态学特征和变化。方法 :19例 ( 19只眼 )角膜移植术后发生内皮排斥反应的人群根据角膜内皮排斥反应轻重的不同分为轻、中、重三组。应用共焦显微镜 (Confoscan2 0 )对角膜植片进行检查 ,并分析其相关因素。结果 :活体角膜内皮排斥反应特有的共焦显微镜改变主要包括 :①早期发现在KP及其附近的内皮细胞面有少量的免疫细胞附着 ,紧靠KP处的角膜基质细胞出现轻度水肿 ,细胞排列较混乱 ,胞浆中出现少量空泡状暗区。②中期发现在内皮细胞表面可见较多的免疫细胞聚集并被完全激活 ,基质细胞明显水肿 ,细胞核不清楚 ,基质中有免疫细胞进入 ;可见由高反光的免疫细胞和不明成份的组织碎片混合组成内皮排斥线。③在晚期排斥的患者中可见大量“激活”的免疫细胞在角膜内皮细胞面聚集 ,内皮细胞几乎完全破坏 ;基质细胞明显水肿 ,部分被“激活”且伴有大量免疫细胞聚集。结论 :①内皮排斥反应的早期能够发现角膜内皮面有免疫细胞沉积 ;②角膜内皮面的免疫细胞沉积与角膜内皮排斥反应的轻重成正相关 ;③角膜内皮排斥反应实际上是一个混合排斥反应的过程 ;④共焦显微镜对角膜内皮排斥反应具有实时、无创、敏感、准确以及可重复、可比较、可活体观察等临床价值。Objective:To observe and analyze the early morphologic characteristics and varieties of the enothelium of human corneal allograft in the endothelial rejection by in vivo confocal microscope. Methods:19 patients (19 eyes) with endothelial rejection of allograft after penetrating keratoplasty were devided into three groups according to the degree of rejection and examined by confocal microscopy (Confoscan 2.0)and slit-lamp biomicroscopy.The related factors of the results were analyzed. Results:The characteristics of the changes in endothelium during rejection by confocal microscope were as following.Near the KP in slight endothelial rejection, there were few of immune cells on the endothelium,slight stromal edema,the edema keratocytes represented the blur bubble area and arranged disorder.In moderate endothelial rejection,on the endothelium there were many immune cells accumulated that were activated completely.The edema of stromal cell was frank,the nuclei were not distinct,and some immune cells went into the stroma.The Khodadoust′s line were composed of the high reflective immune cells and cell fragments.In severe endothelial rejection,there were a lot of the activated immune cells accumulated on the endothelium.The endotheial cells were destroyed.The stroma was edema obviously and some keratocytes were activated.Some immune cells went into the stroma. Conclusions:There were few of immune cells on the endothelium in the slight endothelial rejection.There were affinitive correlation between endothelial rejection and immune cells.The endothelial rejection was exactly a mixed rejection by the confocal microscope.

关 键 词：人体角膜移植 共焦显微镜 免疫细胞 形态学特征 角膜内皮排斥反应 

分 类 号：R779.65[医药卫生—眼科] R392[医药卫生—临床医学]