Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China.
Transl Vis Sci Technol. 2023 Oct 3;12(10):19. doi: 10.1167/tvst.12.10.19.
The aim of this study was to investigate conjunctival goblet cell density (GCD) and tear mucin-5AC (MUC5AC) protein levels in patients with Graves' ophthalmopathy (GO) and their association with dry eye indicators.
A total of 99 patients with GO (54 active, 45 inactive) and 40 healthy controls were recruited. Comprehensive ophthalmic examinations, including the external eye, ocular surface, GCD, and tear MUC5AC ELISA, were performed. The GCD examination was performed in temporal bulbar conjunctiva, including IVCM GCD by in vivo confocal microscopy (IVCM) and filled GCD of cytokeratin-7 and MUC5AC-positive co-immunomarkers by impression cytology. Tear MUC5AC protein was detected using samples extracted from Schirmer strips.
The GO group showed a significant decrease in IVCM GCD, filled GCD, and normalized tear MUC5AC protein compared to controls, with the active GO group showing the greatest decrease (all P < 0.05). Tear MUC5AC protein levels in GO correlated with those of IVCM GCD (r = 0.40, P < 0.001) and filled GCD (r = 0.54, P < 0.001, respectively). Higher ocular surface disease index (r = -0.22, P < 0.05; r = -0.20, P < 0.05; r = -0.21, P < 0.05) and lisamine green staining (r = -0.23, P < 0.05; r = -0.38, P < 0.001; r = -0.42, P < 0.001) were associated with lower tear MUC5AC protein levels, IVCM GCD, and filled GCD, respectively, which decreased with increasing clinical activity score (r = -0.24, P < 0.05; r = -0.28, P < 0.01; r = -0.27, P < 0.01) and conjunctival congestion score (r = -0.27, P < 0.01; r = -0.33, P < 0.001; r = -0.42, P < 0.001).
The goblet cell count and tear MUC5AC protein in GO eyes were decreased, possibly due to ocular surface inflammation.
This study observed the change of tear film mucin in GO patients.
本研究旨在探讨格雷夫斯眼病（GO）患者的结膜杯状细胞密度（GCD）和泪液粘蛋白-5AC（MUC5AC）蛋白水平及其与干眼症指标的关系。
共纳入 99 例 GO 患者（54 例活动期，45 例静止期）和 40 例健康对照者。进行全面的眼科检查，包括外眼、眼表、GCD 和泪液 MUC5AC ELISA。GCD 检查在颞侧球结膜进行，包括使用活体共聚焦显微镜（IVCM）进行 IVCM GCD 检查和使用免疫印迹法检测细胞角蛋白-7 和 MUC5AC 阳性共免疫标志物的填充 GCD。使用 Schirmer 条提取的样本检测泪液 MUC5AC 蛋白。
GO 组 IVCM GCD、填充 GCD 和正常化的泪液 MUC5AC 蛋白均明显低于对照组，活动期 GO 组下降最明显（均 P<0.05）。GO 患者的泪液 MUC5AC 蛋白水平与 IVCM GCD（r = 0.40，P<0.001）和填充 GCD（r = 0.54，P<0.001）呈正相关。眼表面疾病指数（r = -0.22，P<0.05；r = -0.20，P<0.05；r = -0.21，P<0.05）和丽胺绿染色（r = -0.23，P<0.05；r = -0.38，P<0.001；r = -0.42，P<0.001）与较低的泪液 MUC5AC 蛋白水平、IVCM GCD 和填充 GCD 相关，且随着临床活动评分（r = -0.24，P<0.05；r = -0.28，P<0.01；r = -0.27，P<0.01）和结膜充血评分（r = -0.27，P<0.01；r = -0.33，P<0.001；r = -0.42，P<0.001）的增加而降低。
GO 眼的杯状细胞计数和泪液 MUC5AC 蛋白减少，可能是由于眼表面炎症所致。
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