伴有下斜肌功能亢进外斜v征眼外肌病理学和myogenin研究

发布时间：2019-06-04 18:29

【摘要】：目的：研究伴有下斜肌功能亢进的外斜v征患者下斜肌和内直肌的病理学改变及myogenin活性卫星细胞数量的变化，探讨myogenin在眼外肌病理学改变中的作用。 方法：收集我院2011年1-9月期间收治伴有下斜肌功能亢进的外斜v征患者6例，其手术方式为下斜肌部分切除+内直肌缩短术及联合外直肌后徙术者。将斜视术中截除的下斜肌及内直肌作为斜视组；对照组为角膜移植供体的下斜肌及内直肌（6例6眼），且供体无斜视和神经肌肉疾病病史。分别对斜视组和对照组眼外肌行HE染色，光镜下观察病理学改变，测量肌细胞的横截面积；myogenin免疫组织化学染色，统计myogenin阳性染色的卫星细胞核数。 结果：斜视组功能亢进的下斜肌和弱侧内直肌均发生了明显的病理改变。对照组肌纤维形态结构正常。斜视组下斜肌部分肌纤维轻度肥大增粗，粗细不等，排列紊乱，走形不规则，横纹结构欠清晰；可见部分肌纤维出现核内移现象，玻璃样变性及少量胶原纤维增生。肌纤维平均横截面积为854.1±64.8μm2，与对照组（719.7±80.4μm2）无显著性差异（P0.05）。斜视组内直肌同样发生了病理改变。除了肌纤维走形不规则，横纹结构欠清晰，部分肌纤维出现核内移现象，，玻璃样变性外，主要还表现为肌纤维减少，排列疏松、紊乱，间隙变大，胶原增生较明显。其肌纤维平均横截面积为324.9±63.3μm2，较对照组（690.8±67.3μm2）明显减小（P0.05）。斜视组和对照组下斜肌中myogenin免疫染色阳性肌卫星细胞数占总细胞数比例分别为22.7%±7.03%和4.2%±0.75%，具有显著性差异（P0.05）。斜视组和对照组内直肌中myogenin免疫染色阳性的肌卫星细胞数分别为2.2%±0.75%和4.5%±1.05%，具有显著性差异（P0.05）。 结论：外斜v征伴有功能亢进的下斜肌形态结构发生了多样性改变，大量的myogenin免疫染色阳性肌卫星细胞提示可能参与了肌纤维的再生及重塑过程，使肌肉力量增加，从而引起下斜肌功能改变。弱侧内直肌发生了肌纤维数量减少、横截面积减小的萎缩变性，myogenin免疫染色阳性肌卫星细胞数量减少，说明可能使眼外肌的自我修复功能受到抑制，进行性加重了病理改变，导致内直肌功能减弱。
[Abstract]:Aim: to study the pathological changes of inferior oblique muscle and internal rectus muscle and the number of myogenin active satellite cells in patients with oblique v sign with hyperfunction of inferior oblique muscle, and to explore the role of myogenin in pathological changes of extraocular muscle. Methods: from January to September 2011, 6 patients with exotropia v sign with hyperfunction of inferior oblique muscle were treated in our hospital. The surgical methods were partial resection of inferior oblique muscle, shortening of internal rectus muscle and combined with recession of external rectus muscle. The inferior oblique muscle and internal rectus muscle cut off during strabismus were used as strabismus group, while the control group was the inferior oblique muscle and internal rectus muscle of corneal transplantation donor (6 eyes), and the donor had no history of strabismus and neuromuscular diseases. The extraocular muscles of strabismus group and control group were stained with HE, the pathological changes were observed under light microscope, the cross section area of muscle cells was measured, and the number of satellite nucleus of myogenin positive staining was counted by myogenin histochemical staining. Results: in strabismus group, there were obvious pathological changes in hyperfunctional inferior oblique muscle and weak medial rectus muscle. The morphology and structure of muscle fibers in the control group were normal. In strabismus group, some muscle fibers of oblique muscle slightly enlarged and thickened, the thickness was different, the arrangement was disordered, the shape was irregular, the transverse structure was not clear, and some muscle fibers showed nuclear movement, vitreous degeneration and a small amount of collagen fiber proliferation. The average cross section area of muscle fiber was 854.1 卤64.8 渭 m ~ 2, which was not significantly different from that of the control group (719.7 卤80.4 渭 m ~ 2) (P 0.05). Pathological changes also occurred in rectus muscle in strabismus group. In addition to irregular shape of muscle fibers, unclear transverse structure, nuclear movement of some muscle fibers and vitreous degeneration, muscle fibers were mainly reduced, arranged loose, disordered, the gap became larger, and collagen proliferation was obvious. The average cross section area of muscle fiber was 324.9 卤63.3 渭 m ~ 2, which was significantly lower than that of the control group (690.8 卤67.3 渭 m ~ 2) (P 0.05). The proportion of myogenin immunostaining positive muscle satellite cells in strabismus group and control group was 22.7% 卤7.03% and 4.2% 卤0.75%, respectively, with significant difference (P 0.05). The number of muscle satellite cells positive for myogenin immunostaining in rectus muscle in strabismus group and control group was 2.2% 卤0.75% and 4.5% 卤1.05%, respectively, with significant difference (P 0.05). Conclusion: the morphological and structural changes of inferior oblique muscle with exotropia v sign with hyperfunction have taken place. A large number of myogenin immunostaining positive muscle satellite cells may be involved in the regeneration and remodeling of muscle fibers and increase muscle strength. Thus, the function of inferior oblique muscle is changed. The number of muscle fibers decreased, the cross section area decreased, and the number of myogenin immunostaining positive muscle satellite cells decreased in the weak medial rectus muscle, indicating that the self-repair function of extraocular muscles may be suppressed and the pathological changes may be aggravated gradually. Resulting in the weakening of the function of the internal rectus muscle.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

【参考文献】

中国期刊全文数据库 前2条

1 沈燕国,徐建光,顾玉东,胡韶楠,黄汉伟,李继峰;成肌调节因子MyoD和Myf-5在人体失神经骨骼肌中的表达及其临床意义[J];复旦学报(医学版);2002年04期

2 赵磊;姜东林;孙钧铭;严志强;吕广明;;高选择性神经损伤模型骨骼肌MyoD和myogenin mRNA的表达[J];神经解剖学杂志;2008年06期

本文编号：2492912