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Title: | 以上部球結膜局部切除手術治療上輪部角結膜炎研究及肥胖細胞與基質金屬蛋白酵素在上輪部角結膜炎中所扮演角色之探討 Conjunctival Resection for the Treatment of Superior Limbic Keratoconjunctivitis (SLK) and the Involvement of Mast Cells and Matrix Metalloproteinases in SLK |
Authors: | Yi-Chen Sun 孫逸珍 |
Advisor: | 胡芳蓉(Fung-Rong Hu) |
Keyword: | 上輪部角結膜炎,肥胖細胞,基質金屬蛋白酵素, Superior limbic keratoconjuncitivitis,Mast cell,Matrix metalloproteinase, |
Publication Year : | 2006 |
Degree: | 碩士 |
Abstract: | 本研究計畫的宗旨是想要更深入去了解「上輪部角結膜炎(Superior limbic keraconjunctivitis, SLK)」,這個眼科門診中並不罕見的疾病,希望以稍大規模的臨床病例個案,來研究以「上部球結膜(superior bulbar conjunctiva)局部切除手術」治療那些對於藥物反應不良的病患,並利用其病理切片組織來研究肥胖細胞(Mast cell)及基質金屬蛋白酵素(Matrix metalloproteinases, MMPs)在上輪部角結膜炎中所扮演之角色。
自1992至2005年在臺大醫院眼科部門診當中,一共有三十位病人之四十個眼睛被包括在本研究當中,這些病人都是在確定診斷為上輪部角結膜炎後,使用局部藥物(包括局部類固醇眼藥水及人工淚液等眼藥)效果不佳之情形下,才接受上部球結膜局部切除手術,所有的病人在術前及術後皆有詳細的病歷紀錄其臨床症狀及徵兆。在醫療倫理委員會通過之情形下,這四十個眼睛之結膜病理切片皆進行後續的肥胖細胞、T與B淋巴球細胞及基質金屬蛋白酵素之免疫組織化學染色,而其中自2005年7月1日起接受前述結膜切除手術之病人,則一併收集其結膜組織進行反轉錄聚合酶連鎖反應,且在該同一時刻起,也收集因眼睛其他疾病於台大醫院接受眼科手術,但無上輪部角結膜炎患者,在病人知情同意且傷口關闔無虞之情形下,共取得二十位病人之結膜標本作為對照組。 所有四十個眼睛在手術後皆獲得臨床症狀及徵兆之緩解,唯獨其中有三個眼睛在結膜切除範圍之邊緣有病灶復發之情形,他們在接受第二次結膜切除手術後臨床症狀也都獲得完全的緩解。免疫組織化學染色方面則是顯示在上輪部角結膜炎組之肥胖細胞數目有顯著增加的趨勢(P = 0.004)。而反轉錄聚合酶連鎖反應則是顯示MMP-1與MMP-3在上輪部角結膜炎組與對照組有明顯的差異,MMP-2與MMP-9則是兩組沒有差別。再進一步以免疫組織化學染色來驗證MMP-1、MMP-2與MMP-3在病理切片中之情況,也證實MMP-1特別會聚集在肥胖細胞中(P < 0.0001),此外還有結膜表皮下之基質部分也會有基質金屬蛋白酵素的分布。 上輪部角結膜炎患者在臨床上對於局部眼藥反應不佳者,以上部球結膜局部切除手術來治療之效果非常明顯且無特別之併發症。而肥胖細胞數目增加以及MMP-1與MMP-3之表現增加的現象在此系列實驗中之上輪部角結膜炎患者也特別的明顯。因此,我們相信肥胖細胞以及基質金屬蛋白酵素包括MMP-1與MMP-3的增加,在上輪部角結膜炎之病理機轉應佔有一重要之角色。 Although medication therapy for this not unusual disease, superior limbic keraconjunctivitis (SLK) had been done for years, failed results after this conservative treatment are commonly seen. Mostly, these patients with poor response to medication will be arranged conjunctival resection as therapy. Unfortunately, large scale of study for the effectiveness evaluation is absent. Therefore, we intend to explore the effectiveness of conjunctival resection in treating superior limbic keratoconjunctivitis (SLK) and the role of mast cell and matrix metalloproteinase (MMP) in SLK. In this study, 40 eyes from 30 SLK patients since 1992 to 2005, who were unresponsive to medical treatment received superior bulbar conjunctival resection were selected. Another 20 patients from cataract and retinal surgery were served as control group. The conjunctiva specimens were examined by H-E stain and immunohistochemistry (IHC) using antibodies against mast cell tryptase, MMP-1, -2 and -3. All the fresh conjunctiva tissue including SLK group and control group were also processed to extract the total mRNA. Using MMP-1, -2, -3 and -9 as the primer, reverse transcription and polymerase chain reaction (RT-PCR) were also done in this study, In all operated eyes, the clinical symptoms and signs, including irritation/redness and superior bulbar conjunctival hyperemia / superior tarsal conjunctival papillary hypertrophy, subsided significantly one month after the operation. Only 3 eyes had recurrence from the margin of conjunctival resection, which were relieved after re-operation. Keratinized conjunctival epithelium, loss of goblet cells, increased mast cell numbers (P=0.004) and overexpression of MMP-1 and MMP-3 (P<0.0001) were found in SLK group. The results of RT-PCR were also compatible to that of IHC with the up-regulation of MMP-1 and MMP-3. Conclusively, our results demonstrate that superior bulbar conjunctival resection is an effective and safe treatment modality for SLK. The findings of immunohistochemistry and reverse transcription and polymerase chain reaction suggested that mast cells and up-regulation of MMPs play some roles in the pathogenesis of SLK. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/34055 |
Fulltext Rights: | 有償授權 |
Appears in Collections: | 臨床醫學研究所 |
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