浸润性突眼眼外肌超微结构的研究

Ultrastructure study on extraocular muscle of infiltrative exophthalmos

目的 研究浸润性突眼眼外肌组织病理学及超微结构的改变 ,为阐明其发病机制奠定基础。方法 将 10例严重浸润性突眼术后肥大的眼外肌组织标本 ,每例标本 1/ 2行HE染色 ,光镜观察 ;1/ 2标本制作超薄切片 ,行透射电镜观察。结果 光镜检查显示 ,早期浸润性突眼眼外肌细胞无异常。中晚期眼外肌细胞肌浆凝缩 ,颗粒变性 ,部分溶解形成空泡 ,部分肌纤维变性坏死。电镜检查显示 ,早期可见肌原纤维部分Z线紊乱、消失。中晚期时可见不同程度的肌细胞肌浆网扩张 ,肌原纤维部分溶解破坏 ,形成空泡 ,可见次级溶酶体和残质体。重者可见肌细胞完全破坏 ,吞噬细胞吞噬 ,纤维化 ,并可见肌纤维母细胞。结论 浸润性突眼眼外肌细胞有不同程度的破坏 。

Objective To investigate histopathologic and ultrastructural changes of extraocular muscles (EOMs) in infiltrative exophthalmos in order to collect some evidences of pathogenesis Methods Ten EOM samples in infiltrative exophthalmos were obtained after operation Each of them was cut into two pieces. One of them was stained with HE and observed by light microscope Another one was sectioned with ultrathin method and observed by transmission electron microscope Results Under the light microscope, the extraocular muscular cells had no significant abnormality at the early stage, while at the middle and late stage, sarcoplasm coagulation, granular degeneration, vacuolization and necrosis were found in the cells Under the electron microscope, there were disturbance and disappearance of the Z line in part of muscular fibers in early cases; at the middle and late stage, various degrees of sarcoplasmic reticulum dilatation, myofilament lysis and destruction with formation of vacuoles, secondary lysosome and remnant bodies were seen In severe cases, the muscular cells could be completely destroyed and phagocytosed by macrophages, fibrosis occurred and myofibroblasts were found in some cases Conclusions The EOMs in infiltrative exophthalmos are destroyed in various degrees, and the muscular cells may be the target cells in Graves′ ophthalmopathy