交感性眼炎的免疫病理学及其免疫治疗

Sympathetic ophthalmia:immuno-pathologic mechanism and its immunotherapy

交感性眼炎是一眼穿透性外伤后发生的双侧肉芽肿性葡萄膜炎。其主要病理特征为葡萄膜的弥散性非坏死性肉芽肿性炎症反应。免疫病理学研究证实 :T淋巴细胞在发病机制中起着重要的作用。疾病早期的T淋巴细胞主要为CD4 + 细胞 ,而晚期则以CD8+ 细胞为主。B细胞占脉络膜浸润细胞的 2 0 %以下 ,可能与疾病的慢性过程相关。另外 ,局部还存在黏附分子、MHC和FasL等免疫相关分子的表达增加。交感性眼炎患者具有一定的遗传倾向 ,与宿主的HLA状态存在某种关联性。其治疗原则是使用免疫抑制剂尽快控制眼内炎症 ,但应密切观察其相应的毒副作用。另外 ,还讨论了有关眼球摘除的问题。

Sympathetic ophthalmia is a bilateral inflammatory disease that occurs following penetrating trauma to one eye.The primary feature of sympathetic ophthalmia is a diffuse non-necrotizing granulomatous inflammation of the uvea,with prominent lymphocytic infiltration of the choroids.Immunopathologic studies demonstrate the important role of the T lymphocyte in the sympathetic ophthalmia pathogenesis.Whereas CD4+ T lymphocyte dominate early in disease,the CD8+ T lymphocyte is more common later.B lymphocytes make up less than 20% of the cellular infiltrate and may correlate with prolonged disease.Adhesive molecule,MHC molecule,Fas and Fas ligand expression were found to be increased in sympathetic ophthalmia eyes.Sympathetic ophthalmia patients have a genetic predisposition.There is an association between sympathetic ophthalmia and the HLA status of the host.Treatment principle of sympathetic ophthalmia is to control the intraocular inflammation with immunosuppressive agents as soon as possible,but should closely observe the adverse effects and toxicity.In addition,the advisability regarding enucleating the exciting eye is discussed.