论文部分内容阅读
背景:翼状胬肉与阳光、风尘等各种外界因素的慢性刺激和局部慢性炎症反应有关。目前关于翼状胬肉发病机制有多种理论和学说,但均未得到公认。目的:观察翼状胬肉组织病理学特征,探讨多能干细胞在翼状胬肉发生过程中的作用。设计:开放性实验。单位:中山大学中山眼科中心。材料:实验于2006-09/2007-01在中山大学眼科学国家重点实验室完成。218例经临床及病理诊断为翼状胬肉的石蜡标本均来自中山大学中山眼科中心病理室。方法:对手术切除的翼状胬肉标本进行形态学、免疫组织化学和免疫荧光共聚焦显微镜观察。主要观察指标:翼状胬肉形态学变化及CD34、波形纤维蛋白、平滑肌肌动蛋白、S-100在翼状胬肉中的表达。结果:①形态学变化:纤维组织增生及新生血管形成为翼状胬肉的主要病理改变。增生的纤维组织不同区域变化不一,主要呈现两类变化:一为排列致密,类似巩膜纤维组织;另外就是疏松区:仅见一些梭形、多角形、星状具有一些突起的纤维母细胞样的细胞,疏松排列,之间无明显的胶原纤维存在。②CD34免疫组织化学染色显示一些增生活跃的纤维母细胞明显表达CD34,成熟的纤维组织内的纤维细胞CD34则为阴性。波形纤维蛋白免疫组织化学染色在大部分纤维细胞、血管内皮细胞、血管壁及周细胞呈阳性反应。平滑肌肌动蛋白染色显示嗜碱性的小团状、梭形或不规则形的细胞束呈阳性反应,证明为平滑肌,218例中56例显示了平滑肌的存在。S-100染色神经纤维丝及脂肪细胞均呈阳性反应,218例中44例有脂肪组织。免疫荧光染色共聚焦显微镜进一步证明增生活跃的细胞为阳性反应,呈现为苹果绿色。结论:翼状胬肉组织中的纤维组织源自于间充质干细胞,并可向平滑肌及脂肪组织分化。
Background: Pterygium and the sun, dust and other external factors of chronic stimulation and local chronic inflammation related. At present there are many theories and theories about the pathogenesis of pterygium, but none have been recognized. Objective: To observe the histopathological features of pterygium and explore the role of pluripotent stem cells in the pathogenesis of pterygium. Design: Open experiment. Unit: Sun Yat-sen Zhongshan Eye Center. Materials: The experiment was performed at the State Key Laboratory of Ophthalmology, Sun Yat-sen University from September 2006 to January 2007. The paraffin specimens of 218 cases with pterygium diagnosed clinically and pathologically were from the Department of Pathology, Zhongshan Ophthalmic Center, Sun Yat-sen University. Methods: Surgical resection of pterygium specimens were observed by morphology, immunohistochemistry and immunofluorescence confocal microscopy. MAIN OUTCOME MEASURES: Morphological changes of pterygium and expression of CD34, vimentin, smooth muscle actin, S-100 in pterygium. Results: ① Morphological changes: fibrosis and neovascularization were the main pathological changes of pterygium. Hyperplasia of fibrous tissue varies in different regions, there are two main changes: one for the dense arrangement, similar to the scleral fiber tissue; the other is the loose area: only some fusiform, polygonal, stellate-like with some protruding fibroblast-like Cells, loosely arranged, there is no obvious collagen fibers exist. ②CD34 immunohistochemical staining showed that some actively proliferating fibroblasts obviously expressed CD34, and mature fibroblasts showed negative CD34. Waveform fibrin immunohistochemical staining in most of the fibroblasts, vascular endothelial cells, vascular wall and pericytes positive reaction. Smooth muscle actin staining showed a basophilic cluster of small, fusiform or irregular shaped cell bundles positive, proved smooth muscle, 56 of 218 cases showed the presence of smooth muscle. S-100 staining of nerve fibers and fat cells were positive, 44 cases of 218 cases of adipose tissue. Confocal microscopy with immunofluorescence staining further demonstrated that the proliferating cells were positive and appeared as apple green. Conclusion: The fibrous tissue in pterygium originated from mesenchymal stem cells and can differentiate into smooth muscle and adipose tissue.