角膜缘干细胞移植在眼科的临床应用及发展

Clinical application and development of limbal stem cell transplantation in ophthalmology

目的:探讨角膜缘干细胞移植的应用现状及发展前景。资料来源:应用计算机检索PUBMED 2000/2007与角膜缘干细胞移植相关的文章,检索词“limbal stem cells,transplantation”,限定文献语种为“English”;同时检索万方数据库2000/2007相关文章,检索词“角膜缘干细胞,移植”,限定文献语种为中文。资料选择:共检索到相关文献180余条,选择与角膜缘干细胞的组织生物学特征、角膜缘干细胞的体外培养以及角膜缘干细胞的临床应用相关的文章。资料提炼:将初步筛选的文章进一步查找全文,排除综述和重复文献,内容相似的选择发表在权威杂志或近3年发表的文献,无论有无对照组,观察对象为人或动物均纳入。最后共纳入37篇进行综述,其中7篇研究角膜缘干细胞的组织生物学特性,8篇介绍角膜缘干细胞的体外培养,剩余22篇文章为角膜缘干细胞移植的基础和临床研究。资料综合:角膜缘干细胞移植,可以恢复正常的角膜缘屏障功能,重建眼表的完整性;而最终改善角膜的透明性和视功能。目前开展的角膜缘干细胞移植,包括自体或异体角膜缘组织移植和体外培养的角膜缘干细胞移植。自体角膜缘干细胞的移植已成为临床上较为可靠和日益成熟的治疗方法,但来源有限,且不适合双眼角膜缘病变的患者,异体角膜缘组织移植存在排斥反应,因此自体角膜缘干细胞体外培养移植术被认为是目前较理想的角膜缘干细胞移植方法,但其远期疗效需进一步临床观察。结论:目前角膜缘干细胞移植治疗严重角膜病变的研究尚处于初步阶段,自体角膜缘干细胞移植成功率是较高,自体角膜缘干细胞培养后移植治疗眼表疾病已初步获得成功,但还存在一些问题,如角膜缘干细胞生存的微环境、培养的干细胞生理、生化的免疫特性,以及黏附、增殖、分化能力等问题尚需进一步研究。

OBJECTIVE： To explore the present development and perspective of limbal stem cells. DATA SOURCES： The Pubmed database was undertaken to identify the articles of limbal stem cell transplantation published from 2000 to 2007 with the key words of ＂limbal stem cells, transplantation＂ in English. Simultaneously, Wanfang database was searched for relevant articles published between 2000 and 2007 with the key words of ＂limbal stem cells, transplantation＂ in Chinese. STUDY SELECTION： Totally over 180 relevant articles ware retneved. Articles on histological biological characteristics, in vitro culture and clinical application of limbal stem cells were selected. DATA EXTRACTION： Full-texts Of the articles ware checked, and articles on review and with repetitive content ware excluded. Articles with similar content, which were issued in authorized journals or published in recently 3 years, ware selected, no matter with or without control group, no matter human or animals as subjects. At last, totally 37 articles ware included for review, of which 7 articles were on histological biological characteristics of limbal stem cells, 8 articles were on in vitro culture of limbal stem cells, and 22 articles ware on basis and clinical application of limbal stem cells. DATA SYNTHESIS： Limbal stem cell transplantation could recover normal limbal barrier function and reestablish integrity of eye, and finally could ameliorate corneal transparency and visual function. At present, limbal stem cell transplantation included autologous or allogenic limbal transplantation and in vitro limbal stem cell transplantation. Autologous limbal stem cell transplantation had become a reliable and increasingly mature therapeutic method in clinic, but the source was limited and it was not fit for cornea lesion of both eyes. Allogenic limbal transplantation had rejection reaction. Therefore, autologous limbal stem cell transplantation in vitro was known as a deal limbal stem cell transplantation method at present, but long-term curative effect needed further clinical observation. CONCLUSION： Currently, limbal stem cell transplantation for severe limbal lesior, is in initial phase. The successful rate of autologous limbal stem cell transplantation is high, and autologous limbal stem cell transplantation for eye disease has obtained successful effect pdmanly. However, there are still some problems to be solved, such as survival microenvironment of limbal stem cells, physiological biochemical immune characteristics of stem cells, adherence, proliferation, differentiation and so on.