Graves眼病患者球后组织免疫组化研究

An immunohistochemical study of retrobulbar tissues of patients with Graves Ophthalmopathy

目的：为了探索Graves眼病的确切发病机制。方法；应用布克隆抗体人类白细胞DR抗原（HLA－DR）、巨噬细胞（CD68）、第八因子相关性抗原（F8／86）、T细胞（CD3）、辅助性／诱导性T细胞（CD4）、抑制性／细胞毒T细胞（CD8）、B细胞（CD20）对11例Graves眼病患者球后组织主要为眼外肌标本冰冻或石蜡切片用碱性磷酸酶－抗碱性磷酸酶（APAAP）法进行免疫组织化学研究，5例正常人眼外肌作为对照。结果：（1）Graves眼病患者眼外肌肌纤维细胞内无DR表达，但在其间质中有大量的DR阳性细胞、这些DR阳性细胞包括巨噬细胞（CD68阳性）、淋巴细胞、部分血管内皮细胞（F8／86阳性）及成纤维细胞样细胞；（2）CD68染色显示Craves眼外肌中有大量的巨噬细胞浸润；（3）FS／86染色显示Graves眼外肌中血管丰富、扩张；（4）Graves眼外肌中淋巴细胞是弥漫性和／或局灶性浸润，以T细胞为主（CD3阳性），B细胞相对较少（CD20阳性），CD4阳性细胞较CD8阳性细胞略占优势。淋巴细胞多呈DR阳性染色。5例未见淋巴细胞浸润。（5）球后脂肪与上述抗体无阳性反应。结论：研究提示眼外肌是Graves眼病自身免疫反应进行的主要部位，其间质细胞中HLA－DR抗原的异常表达在该病的发生发展中起重要作用。细胞免疫在局部炎症中有重要意义。

Our study is to inyestigate the pathogenesis of Graves Ophthalmopathy. 17 retrobulbar tissue specimens frum 14 cases with Graves OphthalmOPatby (GO) were studied by immunohistochemical staining of APAAP essay with mono-antibodies of HLA-DR,CD68, F8/86,CD3, CD4,CD20.5 normal extraocular muscle specimens seryed as the control. We found:(1)The muscle cell of GO was not stained with HLADR while the interstitial cells were strong positive.All of the DR+ cells were macrophages (CD68+), infiltrated lymphocytes, capillary cells (F8/86+) and fibroblast-like cells. (2) The CD68 staining showed that there were enormous macrophages in the extraocular muscles of GO. (3) F8/86+ staining showed that the extraocular muscles vascularized and the vessels dilated. (4) The extraocular muscles of GO had diffuse and/or local lymphocytes infiltrations,the majority of which were T lymphocytes (CD3+)and a few B cells(CD20+). There was a slight predominance of CD4+ T cells over CD8+ cells. Most lymphocytes were HLA-DR positive. 5 cases showed that no lymphocytes infiltrated in extraocular muscles.(5) The retrobulbar fat tissue did not react with antibodies above. Our study suggests that extraocular muscles are the main site of the autoimmune process in GO. The aberrant expression of HLA-DR antigen by the interstitial cells of extraocular muscles of GO maybe play an important role in inducing and strengthening auto-immunological reaction. Cell-immune may be important to local inflammation.