【摘要】：目的：研究伴有下斜肌功能亢進的外斜v征患者下斜肌和內(nèi)直肌的病理學改變及myogenin活性衛(wèi)星細胞數(shù)量的變化，探討myogenin在眼外肌病理學改變中的作用。 方法：收集我院2011年1-9月期間收治伴有下斜肌功能亢進的外斜v征患者6例，其手術(shù)方式為下斜肌部分切除+內(nèi)直肌縮短術(shù)及聯(lián)合外直肌后徙術(shù)者。將斜視術(shù)中截除的下斜肌及內(nèi)直肌作為斜視組；對照組為角膜移植供體的下斜肌及內(nèi)直�。�6例6眼），且供體無斜視和神經(jīng)肌肉疾病病史。分別對斜視組和對照組眼外肌行HE染色，光鏡下觀察病理學改變，測量肌細胞的橫截面積；myogenin免疫組織化學染色，統(tǒng)計myogenin陽性染色的衛(wèi)星細胞核數(shù)。 結(jié)果：斜視組功能亢進的下斜肌和弱側(cè)內(nèi)直肌均發(fā)生了明顯的病理改變。對照組肌纖維形態(tài)結(jié)構(gòu)正常。斜視組下斜肌部分肌纖維輕度肥大增粗，粗細不等，排列紊亂，走形不規(guī)則，橫紋結(jié)構(gòu)欠清晰；可見部分肌纖維出現(xiàn)核內(nèi)移現(xiàn)象，玻璃樣變性及少量膠原纖維增生。肌纖維平均橫截面積為854.1±64.8μm2，與對照組（719.7±80.4μm2）無顯著性差異（P0.05）。斜視組內(nèi)直肌同樣發(fā)生了病理改變。除了肌纖維走形不規(guī)則，橫紋結(jié)構(gòu)欠清晰，部分肌纖維出現(xiàn)核內(nèi)移現(xiàn)象，，玻璃樣變性外，主要還表現(xiàn)為肌纖維減少，排列疏松、紊亂，間隙變大，膠原增生較明顯。其肌纖維平均橫截面積為324.9±63.3μm2，較對照組（690.8±67.3μm2）明顯減�。≒0.05）。斜視組和對照組下斜肌中myogenin免疫染色陽性肌衛(wèi)星細胞數(shù)占總細胞數(shù)比例分別為22.7%±7.03%和4.2%±0.75%，具有顯著性差異（P0.05）。斜視組和對照組內(nèi)直肌中myogenin免疫染色陽性的肌衛(wèi)星細胞數(shù)分別為2.2%±0.75%和4.5%±1.05%，具有顯著性差異（P0.05）。 結(jié)論：外斜v征伴有功能亢進的下斜肌形態(tài)結(jié)構(gòu)發(fā)生了多樣性改變，大量的myogenin免疫染色陽性肌衛(wèi)星細胞提示可能參與了肌纖維的再生及重塑過程，使肌肉力量增加，從而引起下斜肌功能改變。弱側(cè)內(nèi)直肌發(fā)生了肌纖維數(shù)量減少、橫截面積減小的萎縮變性，myogenin免疫染色陽性肌衛(wèi)星細胞數(shù)量減少，說明可能使眼外肌的自我修復功能受到抑制，進行性加重了病理改變，導致內(nèi)直肌功能減弱。
[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 鹵64.8 渭 m ~ 2, which was not significantly different from that of the control group (719.7 鹵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 鹵63.3 渭 m ~ 2, which was significantly lower than that of the control group (690.8 鹵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% 鹵7.03% and 4.2% 鹵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% 鹵0.75% and 4.5% 鹵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.
【學位授予單位】：第四軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R779.6

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