翼状胬肉上皮鳞状化生与泪膜稳定性的研究

Abnormal epithelial differentiation and tear film alteration in pterygium

目的探讨翼状胬肉患者眼表上皮的异常改变及泪膜稳定性。方法回顾性研究。选择2009年11月至2010年2月对15例（15只眼）翼状胬肉患者，观察翼状胬肉切除术前术后泪膜破裂时间（BUT）、基础泪液分泌试验。应用免疫荧光组织化学染色法检测15例翼状胬肉上皮细胞K10、K14、K19、MUC5AC、K16、Ki67和P63蛋白的表达情况，并与正常结膜对照。数据比较采用独立样本t检验。结果正常结膜上皮无表达的K10在翼状胬肉组织中的吸光度（A）值为2017．51±2114．3。翼状胬肉上皮中K19的A值下降至3727．86±2544．73，MUC5AC下降至2080．48±2340．17，K14增强至6027．5±1058．32，与正常结膜组织相比，差异均有统计学意义（t=9．261，3．538，-6．151；P〈0．05）。增殖指标Ki67、P63和K16的A值分别为881．67±517．96、4247．96±2009．38和4455．62±2699．44。翼状胬肉患者术前及术后6个月基础泪液分泌试验结果在常值范围内，泪液BUT平均值为（11．8±4．5）S，较术前的（5．6±2．9）s显著延长（t=-4．222，P〈0．05）。结论翼状胬肉上皮异常分化，以眼表上皮鳞状化生伴随增殖为主，破坏泪膜稳定，从而影响患者眼表功能。

Objective To investigate the differentiation and proliferation of the conjunctival epithelium and tear film function in pterygia. Methods It was a retrospective study. Fifteen patients （15 eyes） who underwent excision for pterygium were enrolled in this study. Immunostaining for K10,K14, K19,MUCSAC, K16, Ki67 and P63 was performed on the pterygial epithelium and normal conjunctival epithelium. Schirmer I test was performed, and the tear film break-up time （BUT） was evaluated just prior to and 6 months after surgery. Multi-factor regression analysis was assessed to observe if there is a correlation between pterygial growth and tear film function. Results The average absorbency of K19 and MUCSAC immuno-staining all significantly changed （ 3727.86 ±2544. 73 vs. 25 528.00 ± 12 901.06, 2080. 48 ± 2340. 17 vs. 7182.51 ±3069. 20, t =9. 261,3. 538, P 〈0. 05） , and increased in K10 and K14 in patients with pterygia compared with normal conjunctivae keratin （2017.51 ± 2114. 3 vs. O, 6027.5 ± 1058.32 vs. 2123.28 ± 1249.09, t = - 6. 151, P 〈 0. 05 ） . Furthermore, pterygial epithelium showed activated proliferation, evidenced by significantly up-regulated expression of K16, P63 and Ki67 compared to normal control. The Schirmer I test did not indicate any significant differences pre- and post-operatively. However, the BUT was signficantly prolonged 1 month post surgery compared to pre-surgery （ t = - 4. 222, P 〈 0. 05 ）. Conclusion This study indicates that abnormal epithelial differentiation and proliferation are present in pterygium , which is characterized by squamous metaplasia, accompanied with instability of tear film and normal basic tear secretion.