Correlation of CT scanning and pathologic features of ophthalmic Graves' disease.
Correlation of CT scanning and pathologic features of ophthalmic Graves' disease.
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CT扫描与眼科Graves病病理特征的相关性。
DOI：
10.1016/s0161-6420(81)34993-8
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发表时间：
1981
期刊：
影响因子：
13.7
通讯作者：
Jakobiec,FA
中科院分区：
文献类型：
--
作者：
Trokel,SL;Jakobiec,FA
将眼眶Graves病患者的CT扫描特征与组织病理学观察相关联，可以更具体地关注这种疾病的显著特征，并对未来的研究产生影响。CT扫描和病理检查均明确显示眼外肌是本病的主要病灶。眼外肌的肿胀通常发生在其bellys与保留的肌腱。这与肌肉特发性炎症或肌炎形成鲜明对比，后者往往也涉及肌腱。眼眶Graves病的所有相关表现可能源于眼外肌体积增大：眼球突出、内侧纸样板弯曲以适应内直肌肿胀的腹部、因眼眶静脉引流直接受压引起的静脉淤滞而充血、结膜和眼睑肿胀以及泪腺增大。眼眶脂肪的影像学和病理学改变都是继发性的，相对而言不明显。虽然似乎没有视神经脑膜或神经周围结缔组织的选择性炎症，但眼外肌bellys在拥挤的眶尖处会聚的扩大导致视神经受压，损害其功能，并导致视力下降。淋巴细胞和浆细胞浸润沿着眼外肌肌内膜水肿，导致成纤维细胞活化，产生酸性粘多糖和进行性纤维化。目前尚不清楚是什么吸引淋巴细胞到眼外肌，为什么某些眼外肌优先受影响，为什么这种疾病可能是不对称的单侧，以及T细胞或B细胞功能（或两者）的缺陷是否是免疫缺陷。
Correlating the CT scan features of patients with orbital Graves' disease with histopathologic observations allows one to focus more specifically on the distinguishing features of this disease with future research implications. Both CT scanning and pathologic studies have shown clearly that the extraocular muscles are the primary focus of the disease. Swelling of the extraocular muscles generally occurs within their bellys with sparing of the tendons. This contrasts with idiopathic inflammation of the muscles or myositis, which tends to involve the tendon as well. All of the associated findings in orbital Graves' disease probably flow from the enlarged volume of the extraocular muscles: proptosis, bowing of the medial lamina papyracea to accommodate the swollen belly of the medial rectus muscle, venous engorgement from stasis induced by direct compression of the orbital venous drainage, conjunctival and lid swelling, and lacrimal gland enlargement. Both radiographic and pathologic changes in the orbital fat are secondary and comparatively insignificant. While there appears to be no selective inflammation of the optic nerve meninges or the perineural connective tissues, enlargement of the extraocular muscle bellys where they converge at the crowded orbital apex brings about compression of the optic nerve, impairs its function, and causes visual decrease. Lymphocytic and plasmacytic infiltration along with edema within the endomysium of the extraocular muscles leads to the activation of fibroblasts with the production of acid mucopolysaccharides and progressive fibrosis. It is not known what attracts the lymphocytes to the extraocular muscles, why certain extraocular muscles are affected preferentially, why the disease may be asymmetrically unilateral, and whether a defect in T cell or B cell functions (or both) is immunologically at fault.