허혈성 인자가 군날개 발병에 미치는 영향

목적 : 비측 구결막의 상대적인 허혈 상태가 군날개 발병과 비측 호발성에 영향을 미치는지 알아보고자 하였다.<BR> 대상과 방법 : 비측의 상대적 저혈관밀도를 보기 위해 전안부형광혈관조영술과 전안부 온도측정을 시행하였다. 초기군날개 환자와 정상에서 눈물 내 SDF-1 (stromal cell-derived factor-1)의 차이를 보고, 군날개 조직에서 HIF-1(hypoxia-inducible factor-1), SDF-1, CXCR4에 대한 항체를 이용하여 발현 여부 및 양상을 비교하였다.<BR> 결과 : 조영술 결과 비측 구결막 혈관밀도가 가장 낮았고 비측 형광충만시간은 환자군에서 정상에 비해 지연되었다. 비측 구결막 온도는 이측 보다 낮았다. 눈물 속 SDF-1은 환자군에서 정상에 비해 증가되었다. 군날개 조직은 HIF-1, SDF-1, CXCR4를 모두 발현하였고, 상피의 바닥세포와 간질의 혈관내피세포에서 주로 염색되었다.<BR> 결론 : 저혈관밀도 및 저온상태는 비측 구결막의 상대적인 허혈 상태를 초래하는 바 군날개 발생 및 비측 호발성의 한 근거이며, 이러한 저산소증에 의한 조직 발생 과정에 HIF-1, SDF-1의 발현을 통한 골수로부터 줄기세포의 이동이 관여할 것이다.〈한안지 47(2):205-213, 2006〉

Purpose: Ultraviolet rays, dust, and the human papilloma virus are well known as extrinsic risk factors in pterygium pathogenesis, but the intrinsic factors and nasal predominance related to the development of pterygium have not been fully ulucidated. Herein, we sought to determine whether the relative ischemic state of nasal bulbar conjunctiva affects the development of nasal predominance in pterygium pathogenesis.<BR> Methods: Anterior segment fluorescein angiography was performed and the anterior bulbar conjunctival temperature was obtained to identify the presence of nasal ischemia. Tear samples were collected from both a normal and a patient group. The difference in SDF-1 (stromal cell-derived factor-1) was determined through ELISA and Western blot anyalyses. The excised pterygium tissues were immunohistochemically stained by antibodies for HIF-1 (hypoxia-inducible factor-1), SDF-1, and CXCR4.<BR> Results: Results of the anterior segment fluorescein angiography showed that, the vascularity of the nasal limbus was lowest among each groups and the nasal filling time was significantly delayed in the patient group. The temperature of the nasal bulbar conjunctiva was lower than that of the temporal bulbar conjunctiva. The concentration of SDF-1 in tears was significantly higher in the patient group. In the immunohistochemical stain, HIF-1, SDF-1, and CXCR4 were revealed at epithelial basal cells or vascular endothelia in the stroma and the stained areas corresponded to each other.<BR> Conclusions: From the above results, we assumed that low nasal vascularity and temperature resulted in relative ischemic state and this hypoxic injury may be a major risk factor in pterygium development through the mobilization of endothelial progenitor cells by HIF-1 induced SDF-1 overexpression. J Korean Ophthalmol Soc 47(2):205-213, 2006