CAJ | 학술논문

目的：研究共同性斜视弱侧眼外肌的病理变化及肝细胞生长因子（HGF）的表达。方法实验研究。收集在武汉大学人民医院眼科行共同性斜视手术的58例患者手术中切下的眼外肌作为斜视组，将其分成共同性外斜视（32例）和共同性内斜视（26例）2组，同期10例角膜移植供体眼眼外肌作为对照组（供体均无斜视）。观察眼外肌的组织结构变化，用免疫组织化学法检测眼外肌中HGF的表达，并测定其平均光密度值。比较斜视组与对照组眼外肌HGF的表达差异，并分析其与斜视度、患者年龄之间相关性。所得数据采用t检验及直线相关分析进行统计学处理。结果①共同性外斜视组内直肌肌纤维横截面积（308.9±68.4）μm2，显著低于对照组内直肌[（738.4±56.3）μm2]（t=16.74，P<0．05），共同性内斜视组外直肌肌纤维横截面积（217.9±34.7）μm2，显著低于对照组外直肌[（620.9±46.5）μm2]（t=28.34，P<0．05），差异有统计学意义。②Masson染色显示共同性斜视弱侧眼外肌肌纤维数量减少，排列紊乱，胶原纤维含量增多，纤维组织、脂肪组织和肌纤维间隙增宽。③免疫组化检测HGF在对照眼眼外肌及斜视眼弱侧眼外肌中均有阳性表达，主要表达于胞浆，细胞外基质中有少量的表达。其中共同性外斜视组内直肌（t=6.33，P<0．05）、共同性内斜视组外直肌（t=4.75，P<0．05）HGF的表达均低于对照组。④HGF的表达与患者病程（r=-0.856，P＜0．05）以及斜视度（r=-0.525，P＜0．05）呈负相关。结论共同性斜视弱侧眼外肌出现胶原纤维增生，肌纤维横截面积减小等萎缩性病理改变；HGF的低表达可能是共同性斜视发生的危险因素。
목적：연구공동성사시약측안외기적병리변화급간세포생장인자（HGF）적표체。방법실험연구。수집재무한대학인민의원안과행공동성사시수술적58례환자수술중절하적안외기작위사시조，장기분성공동성외사시（32례）화공동성내사시（26례）2조，동기10례각막이식공체안안외기작위대조조（공체균무사시）。관찰안외기적조직결구변화，용면역조직화학법검측안외기중HGF적표체，병측정기평균광밀도치。비교사시조여대조조안외기HGF적표체차이，병분석기여사시도、환자년령지간상관성。소득수거채용t검험급직선상관분석진행통계학처리。결과①공동성외사시조내직기기섬유횡절면적（308.9±68.4）μm2，현저저우대조조내직기[（738.4±56.3）μm2]（t=16.74，P<0．05），공동성내사시조외직기기섬유횡절면적（217.9±34.7）μm2，현저저우대조조외직기[（620.9±46.5）μm2]（t=28.34，P<0．05），차이유통계학의의。②Masson염색현시공동성사시약측안외기기섬유수량감소，배렬문란，효원섬유함량증다，섬유조직、지방조직화기섬유간극증관。③면역조화검측HGF재대조안안외기급사시안약측안외기중균유양성표체，주요표체우포장，세포외기질중유소량적표체。기중공동성외사시조내직기（t=6.33，P<0．05）、공동성내사시조외직기（t=4.75，P<0．05）HGF적표체균저우대조조。④HGF적표체여환자병정（r=-0.856，P＜0．05）이급사시도（r=-0.525，P＜0．05）정부상관。결론공동성사시약측안외기출현효원섬유증생，기섬유횡절면적감소등위축성병리개변；HGF적저표체가능시공동성사시발생적위험인소。
Objective To study the pathomorphological changes and expression of hepatocyte growth factor (HGF) in the extraocular muscle in concomitant strabismus. Methods In a experimental study, 58 concomitant strabismus patients were recruited for the strabismus group and 10 normal subjects were recruited as the control group. Strabismus patients were divided into a concomitant exotropia group (32 cases) and a concomitant esotropia group (26 cases). All the resected tissues of the rectus muscles were obtained from patients with concomitant strabismus during resection surgery and corneal implants. The mean average optical density of HGF was measured by the SABC method for immunohistochemistry using an image analyzer. The amounts of HGF in the resected muscles of patients were compared with normal subjects , and correlated with factors such as age and degree of deviation in the clinical data of the patients. Results ①The thickness of the cross-sectional area of muscle fiber in the resected rectus muscles of patients with constant exotropia was 308.9 ±68.4 μm2 and for patients with constant esotropia was 217.9 ±34.7 μm2, which were significantly lower than those of normal subjects (t=16.74, 28.34, P<0.05). ②Masson staining showed that the weak side of the extraocular muscles of patients with concomitant strabismus had a decrease in the number of muscle fibers, an increase in collagen fiber content, and a disordered arrangement compared to the normal control group. ③The amount of HGF in the resected rectus muscles of patients with constant exotropia and constant esotropia were significantly lower than those of normal subjects (t=6.33, 4.75, P<0.05). ④The amount of HGF was negatively correlated with age and the degree of deviation (r=-0.856,-0.525, P<0.05). Conclusion A decreased level of HGF expression may contribute to the incidence of concomitant strabismus. The change in the expression of HGF in extraocular muscles may result in a deterioration of concomitant strabismus.