甲状腺相关性眼病眶内组织的病理改变

目的 观察甲状腺相关性眼病（TAO）患者结膜、眼外肌、pulley等组织的组织病理学改变特点。设计 实验研究。研究对象 16例临床确诊为TAO且行斜视矫正术患者，其中男性8例，女性8例，年龄32~65岁，平均（50.3±6.7）岁；12例手术治疗的非TAO共同性斜视患者，其中男性6例，女性6例，年龄6~52岁，平均（28.8±7.4）岁。方法 收集上述患者手术中的结膜、眼外肌、pulley等组织标本。TAO组留取结膜标本16例，眼外肌标本12例， pulley标本9例；对照组留取结膜标本12例，眼外肌标本8例，pulley标本8例。以术中所见及采集标本的HE染色、Masson、Van Gieson及免疫组化染色，对比两组之间病理学改变的差异。主要指标 结膜、眼外肌、pulley的病理改变。结果 与对照组相比，TAO组14例结膜上皮层肥厚，2例可见上皮层萎缩，16例结膜标本均显示固有层纤维化，组织结构紊乱，血管壁周围可见少量炎性细胞浸润；10例眼外肌标本病理改变表现为眼外肌肌纤维增粗，2例为肌纤维变性萎缩，12例标本均显示眼外肌肌纤维不同程度断裂、纤维化，胶原纤维明显增多，空泡形成；9例pulley标本均显示pulley肌纤维断裂，结构紊乱，弹力纤维断裂，胶原纤维明显增多，空泡形成。结论 TAO患者不仅是眼外肌，结膜组织及眶内结缔组织可能均经历了由炎性反应到纤维化的退行性变过程，由此引起眼部各种临床表现。（眼科，2014, 23： 130-134）

Pathological changes of intraorbital tissues of thyroid associated ophthalmopathy

 Objective To study pathological changes of conjunctiva, extraocular muscle and pulley of thyroid associated ophthalmopathy (TAO). Design Experiment study. Participants The TAO group consisted of 16 TAO patients who need surgical correction of strabismus. There were 8 males and 8 females with an age range of 32 to 65 years (mean 50.3±6.7 years); the control group consisted of 12 non-TAO patients with concomitant strabismus. There were 6 males and 6 females with an age range of 6 to 52 years (mean 28.8±7.4 years). Methods The samples of conjunctivas, extraocular muscles and pulleys were collected from those TAO patients who need surgical correction, including 16 conjunctivas, 12 extraocular muscles, and 9 pulleys. And 12 conjunctivas, 8 extraocular muscles, and 8 pulleys were obtained from the control group. Operation findings，HE staining, special staining and immunohistochemical staining were used to observe the pathologic changes of the samples from the two groups. Main Outcome Measures Pathological changes of conjunctiva, extraocular muscle and pulley. Results Comparing with the control group, 14 conjunctival epitheliums were thickened, 2 conjunctival epitheliums were atrophy, 16 conjunctival samples showed substantia proprias fibrosis, tissues disturbanced, inflammatory cellular infiltration around the vascular walls in the TAO group；10 extraocular muscle fibers were thickened, 2 extraocular muscle fibers were atrophied，and all 12 extraocular muscles fibers showed various degrees of ruptured fibrosis, significant collagen fibers proliferation, vacuolization in the TAO group; 9 pulley muscle fibers were ruptured, tissues disturbanced, elastic fibers ruptured, collagen fibers proliferation significantly, vacuolization in the TAO group. Conclusion In TAO group, not only the extraocular muscles, but the connective tissue, as well as conjunctivas, probably experienced similar process from the degenerative inflammatory response to fibrosis, which result into various clinical manifestations of the eye. (Ophthalmol CHN, 2014, 23: 130-134)