Ahmed房水引流物植入术后瘢痕形成的免疫组化研究

Immunohistochemical study on scarring after Ahmed aqueous drainage implantation

目的 探讨Ahmed房水引流物植入术后瘢痕形成而导致手术失败的原因。设计 病例对照研究。研究对象 分为植管组和对照组,植管组为难治性青光眼行Ahmed引流物植入术后,Ⅱ期手术切除的植入物周围瘢痕组织石蜡标本10例,对照组为同年龄段青光眼患者滤过术前剪取的球筋膜组织标本10例。方法 植管组和对照组的组织标本采用免疫组织化学技术(SP法)检测转化生长因子β1(transforminggrowthfactorbeta1,TGF β1)和Ⅲ型胶原的表达,采用独立样本t检验比较植管组和对照组TGF β1和Ⅲ型胶原表达是否存在差异。主要指标 TGF β1和Ⅲ型胶原的表达。结果 植管组TGF β1(平均灰度值为12 9 6 9±3 2 2 )和Ⅲ型胶原(平均灰度值为10 7 75±4 5 4 )免疫组织化学染色均呈强阳性表达,与对照组相比均有显著性差异(t=2 12 7,P =0 0 38和t =3 6 74 ,P =0 0 0 2 )。结论 TGF β1促进Ⅲ型胶原的合成是房水引流物植入术后瘢痕形成的原因之一。

Objective To explore the possible mechanism of subconjunctiva scarring leading to failure after Ahmed aqueous drainage implantation and provide theoretical basis for clinical application.Design Observational case-control study.Participants The paraffin samples of conjunctiva were divided into drainage implantation group (10 cases) and normal control group (10 cases).The former samples taken from patients who had Ahmed aqueous drainage implantation surgery for refractory glaucoma but failed because of scarring,the latter came from the same range of age of glaucoma patients just at the beginning of filtration surgery.Methods Immunohistochemical staining technique (Supervision method) was used to detect the expression of TGF-β 1 and collagen Ⅲ in the drainage implantation group and control group.Independent-samples T test was used to compare the expression of TGF-β 1 and collagen Ⅲ between the two groups.Main Outcome Measures The expression level of TGF-β 1 and collagen Ⅲ.Results The expression of TGF-β 1 (mean value of grayscale was 129.69±3.22) and collagen Ⅲ (mean value of grayscale was 107.75±4.54) in the drainage implantation group were higher than that in the control group.There were significant difference of expression of TGF-β 1 and collagen Ⅲ between the two groups(t=2.127,P=0.038,and t=3.674,P=0.002).Conclusion TGF-β 1 as one of cell growth factor inducing the synthesizing of extracellular matrix (ECM) such as collagen Ⅲ,may play a critical role on scarring after the Ahmed aqueous drainage implantation.