特发性黄斑前膜的组织病理学特征

目的：观察各期特发性黄斑前膜（IMEM）的病理结构特征，分析黄斑前膜病理组织学特点及其发展 规律。方法：前瞻性临床研究。选取2016年2月至2018年9月在台州医院路桥院区进行玻璃体切割 联合内界膜-黄斑前膜剥除术治疗的IMEM患者60例（62眼），根据OCT图像4期分期方案分为1期 IMEM组、2期IMEM组、3期IMEM组及4期IMEM组。将术中剥除的带内界膜的IMEM标本HE染 色后进行膜平铺及切片观察，并进一步行SMA、GFAP、S-100、CD34、CD68等免疫组织化学染色 及弹力纤维染色、Masson染色等特殊染色检查。记录各组膜组织类型、病理组织学结构特征、主要 细胞和纤维成分及免疫组织化学的阳性率。采用χ2 检验进行各组膜组织类型分布及免疫组织化学阳 性率比较，Kruskal-Wallis H检验进行组间细胞密度比较。结果：将膜组织类型分为致密型及稀疏型， 4组膜组织类型分布差异有统计学意义(χ2=11.44，P=0.006)。切片观察组织病理学特点发现：从1期 到4期组织的细胞聚集度降低，细胞的胞质减少，组织内胶原纤维由致密变得疏松。4组间细胞密度 总体比差异有统计学意义（H=13.73，P=0.003），多重比较分析发现2期与4期的细胞密度差异有统计 学意义（H=3.69，P=0.001）。免疫组织化学染色显示CD34均阴性表达，GFAP均阳性表达，部分膜组 织表达SMA、S-100、CD68，但各组间SMA、S-100、CD68阳性率比较差异均无统计学意义。弹力 纤维染色及Masson染色提示各组的IMEM纤维成分均为胶原纤维，从1期到4期纤维逐渐扩张增厚。 结论：IMEM属于非血管性纤维增生组织，其主要细胞成分为胶质细胞及成纤维细胞，各期细胞成 分相似，纤维成分为胶原纤维。在疾病发展后期细胞密度下降，整个过程纤维呈逐渐扩张状态。

Histopathologic Characteristics of the Idiopathyic Macular Epiretinal Membrane

Objective: To observe the histopathological structure characteristics and cellular fiber components of the idiopathic epimacular membrane (IMEM) in each stage, thus to study the pathologic development of IMEM. Methods: This is a prospective clinical study. A total of sixty patients (62 eyes) with IMEM who underwent vitrectomy combined with internal limiting membrane and IMEM peeling treatment in Luqiao Branch of Taizhou Hospital from February 2016 to September 2018 were selected. The patients were then divided into 4 groups based on OCT images (stage 1 group to stage 4 group). The IMEM tissues were collected and stained with HE. Further immunohistochemical staining was performed for SMA,GFAP, S-100, CD34 and CD68. And Elastic and Masson staining were conducted as well. The types of IMEM, pathological structural characteristics, cell density, fiber components, and immunohistochemical positive rates were recorded. The Chi-square test was applied to analyze the proportion of IMEM types and immunohistochemical positive rates, while the Kruskal-Wallis H test was utilized to compare cell density. Results: The IMEM could be divided into two types: dense membrane and sparse membrane. The proportion of the two types was statistically different among the groups (χ2=11.44, P=0.006). Under the microscope, it was found that the cell numbers and cell cytoplasm decreased from stage 1 to stage 4, and the collagen fibers in the tissue changed from dense to sparse. The cell density of IMEM in the four groups was also statistically different (H=13.73, P=0.003). Post-hoc analyses found there was a statistical difference in cell density between stage 2 and stage 4 (H=3.69, P=0.001). Immunohistochemical staining showed that CD3 was negative, GFAP was positive, and some membrane tissues expressed SMA, S-100, and C68, however, there was no significant difference in the positive rates among groups. Elastic fiber staining and Masson staining showed that the IMEM fibers were collagen fibers, and the fibers gradually expanded and thickened from stage 1 to stage 4. Conclusion: IMEM was a kind of non-vascular fibroproliferative tissue. Its major cell components were glial cells and fibroblasts. The cell components in each stage were similar, and the fibers were composed of collagen. The cell density decreased and the fibers gradually expanded as the disease developed.