摘要
目的通过检测SJS／TEN患者急性期结膜上皮细胞人类白细胞抗原DR（human leukocyte antigen—DR，HLA—DR）的表达，探讨局部HLA—DR表达与SJS／TEN患者眼部损伤以及疾病严重程度的相关性，以进一步探讨HLA—DR抗原在SJS／TEN发病中的作用。方法收集临床确诊的sJs和TEN急性期患者，同一时间采用SCORTEN评分系统进行疾病严重程度评分（severity of illness score，SIS），根据结膜充血、结膜渗出、结膜假膜、角膜糜烂、眼睑累及和睑缘累及6个方面进行眼部损伤程度评分（severity of eye score，SES），通过结膜印迹细胞学方法获取球结膜上皮细胞，应用流式细胞术检测球结膜上皮细胞中HLA—DR的表达，并分析各指标间的相关性。结果SJS和TEN急性期患者共8例，SIS平均为n=8，（1．25±1．83）分，SES平均为17=16，（7．38±3．48）分，结膜上皮细胞HLA—DR的表达量为n=16，（35．25±12．30）％。相关分析发现，SES和双眼结膜上皮细胞HLA—DR的表达量的平均值成正相关（n=16，r=0．739，P=0．001）；双眼SES和SIS无相关（n=8，r=0．626，P=0．097）；SIS和双眼结膜上皮细胞HLA—DR的表达量的平均值无相关（n=8，r=0．600，P=0．116）。结论在SJS／TEN急性期眼部损伤的发生过程中，存在HLA—DR介导的结膜上皮细胞作为非特异性抗原递呈细胞的激活状态，眼部损伤和疾病的严重程度具有不同步性，在急性期应同时进行眼部损伤评分，根据评分采取相应的眼部治疗，减少并发症的发生。
ObJective To examine the expression of human leucocyte antigen-DR （HLA-DR）, a marker of inflammation, in conjunctiva epithelial cells of the acute stage SJS/TEN patients. Meth- ods Eight patients with SJS/TEN were included in the study, the severity of illness score （SIS） was identified using SCORTEN. The severity of eye score （SES） was evaluated according to conjunctival hyperemia, conjunctival exudate, conjunctival pseudomembrane, corneal erosion, eyelid involving and lid margin involving. The expression of HLA-DR in conjunctiva epithelial cells was detected by impression cytology and flow cytometry （FCM）. The SIS, SES and conjunctival HLA-DR expression were investigated zimultancously, Informed consent was obtained from all patients. The correlation between SIS, SES and HLA-DR expression were performed by pearson correlation analysis. Results The mean SIS of 8 patients with SJS/TEN was 1.25±1.83 （n =8）, the mean SES was 7.38±3.48 （n = 16）, the mean conjunctival HLA-DR expression was 35.25±12.30% （n =16）. The SES was positively associated with conjunctival HLA-DR expression （n =16, r =0.739, P =0.001）. There was no significant correlation between SES and SIS, SIS and conjunctival HLA-DR expression （n =8, r =0.626, P =0.097; n =8, r =0.600, P =0.116, respectively）. Conclusions Conjunctival HLA-DR expression may play a pivotal role in the pathogenesis of the eye damage in SJS/TEN patients. Since ocular in- volvement in the acute stage may not relate to SJS/TEN, early ophthalmic assessment is helpful to put patients on proper treatment to reduce ocular complications.
出处
《中国实用眼科杂志》
CSCD
北大核心
2013年第3期299-303,共5页
Chinese Journal of Practical Ophthalmology
基金
国家自然科学基金项目（81070755）
