印迹细胞学在检查眼表面疾病中的应用

Application of impression cytology in diagnosis of ocular surface diseases

目的 :探讨印迹细胞学在眼表疾病的诊断和疗效评价中的应用价值。方法 :选取正常组 2 0眼 ,干眼综合征组 4 1眼 (包括非 Sj Ogren综合征 2 3眼 ,Sj Ogren综合征 18眼 ) ,眼热化学烧伤疤痕期组 15眼。采用印迹细胞学技术观察结膜上皮鳞状化生程度、杯状细胞密度和角膜上皮的细胞病理学改变。结果 :Sj Ogren综合征与正常组、非Sj Ogren综合征比较 ,球结膜鳞状化生程度明显增加 ,杯状细胞密度明显下降 (P<0 .0 5 ) ,睑结膜差异无显著性 (P>0 .0 5 )。眼热化学烧伤疤痕期组的鼻侧和颞侧及下方球结膜的杯状细胞密度 ,较正常组增多 (P<0 .0 1)。 8只严重眼热化学烧伤眼的印迹细胞学检查发现 ,角膜区由含有丰富杯状细胞的结膜上皮覆盖 ;眼表面重建术后 ,其中 7眼的角膜区恢复了角膜上皮的特性。结论 :印迹细胞学在 Sj Ogren综合征 ,眼热化学烧伤的检查中有特征性的表现 ,是一种无创、快速、简单易行 ,且经济的眼表面疾病细胞学检查方法。

Objective: To evaluate the usefulness of impression cytology in diagnosing of ocular surface diseases. Methods: Impression cytology was performed on 18 eyes with SjOgren's syndrome, 23 eyes with non-SjOgren's syndrome, 15 eyes after thermal or chemical burn at the scarred stage and 20 normal eyes. Conjunctival goblet cell density, conjunctival epithelial squamous metaplasia and corneal cytological features were evaluated respectively. Results: In impression cytology, eyes of SjOgren's syndrome demonstrated a significantly higher grade of squamous metaplasia and lower goblet cell density ( P <0.05) as compared with normal eyes and with eyes of non-SjO-gren's syndrome in the bulbar conjunctiva, whereas no statistically significant difference of squamous metaplasia grade or goblet cell density was found in the palpebral conjunctiva ( P >0.05) in these two groups. In thermal or chemical burned eyes at the scarred stage, the inferior, nasal and temporal bulbar conjunctiva showed higher conjunctival goblet cell density than in the normal eyes ( P <0.01). Before surgery of ocular surface reconstruction, conjunctival goblet cells were detected on the corneal area in the 8 thermal or chemical burned eyes. However, the goblet cells in the corneal area of 7 burned eyes were completely resolved after successful ocular surface reconstruction. Conclusion:The demonstrations of impression cytology in SjOgren's syndrome, thermal or chemical burn are distinctive.Impression cytology is a noninvasive,quick,easy and inexpensive technique,being a useful tool for diag-nosis of ocular surface diseases.