摘要背景 研究特发性黄斑裂孔(IMH)内界膜的组织病理结构和细胞成分对理解IMH的发病机制,从而预防IMH的发病具有重要意义,但目前的研究报道结果不一致.目的 研究IMH内界膜的组织病理学特征及细胞成分,检测内界膜中胶质纤维酸性蛋白(GFAP)、CD45及CD44的表达分布情况,探讨IMH的发生机制.方法 收集2012年2月至2013年8月在广州医科大学附属第二医院行玻璃体切割联合内界膜剥离的IMH患者7例7眼的内界膜标本,制备石蜡切片,采用苏木精-伊红染色进行组织病理学观察,观察内界膜的组织结构及细胞成分;采用免疫组织化学法检测和定位内界膜中GFAP的表达;采用免疫荧光染色法检测内界膜中CD45及CD44的表达.结果 7例IMH内界膜石蜡切片均可见波浪弯曲状红染膜状结构,其中2例内界膜厚度均匀一致,含较少细胞,其他5例内界膜厚度不均,散在分布有色素上皮细胞、神经胶质细胞、成纤维细胞、巨噬细胞和淋巴细胞.免疫组织化学检测显示,GFAP表达于内界膜外层.免疫荧光染色表明,CD45阳性T淋巴细胞散在分布于内界膜组织中,黏附分子CD44多表达于内界膜的内层细胞.结论 IMH的内界膜上细胞成分较少,但Ⅲ期以上裂孔内界膜中存在神经胶质细胞和CD45阳性T淋巴细胞,表明IMH的发生过程伴有增生和免疫炎症反应.CD44作为黏附分子在内界膜中表达上调,促进IMH的增生和免疫炎症反应过程.

abstractsBackground Researching the pathological characteristics and components of cells in internal limiting membrane of idiopathic macular hole (IMH) has an important clinical significance for the prevention of IMH.However,the study results are still disputable.Objective This study was to investigate the histopathological features of internal limiting membrane of IMH and the types of cells inside it, and explore the pathomechanism of IMH.Methods Seven specimens of internal limiting membrane were obtained during the vitrectomy with IMH patients in the Second Affiliated Hospital of Guangzhou Medical University from February 2012 to August 2013 under the informed consent of patients.The histopathological examination was performed for the structural observation and cellular identification of internal limiting membrane.The expression and location of glial fibrillary acidic protein (GFAP), CD45 and CD44 in internal limiting membrane were examined by using immunochemistry and immunofluorescence technology.Results All the seven specimens showed continuous undulating membrane with red staining.Two specimens appeared to be uniform in thickness and few cells were distributed in the specimens.The internal limiting membranes were uneven in thickness in the other specimens with retinal pigment epithelial cells,neuroglia cells,fibrocytes,macrophages and lymphocytes in them.Immunochemistry showed the positive expression of GFAP in the outer layer of the specimens.CD45 positive cells were detected in the internal limiting membranes, and CD44 was detected in the inner layer of the specimens.Conclusions Few cells exist in the internal limiting memranes of IMH.However,neuroglia cells and CD45 positive cells emerge in the internal limiting memranes of stage 3 or above IMH eyes, indicating the proliferation of cells and immuno-inflammation response exist during the IMH development.The up-regulation of CD44 expression promotes inflammatory response of internal limiting memranes.