Lightman S
Moorfields Eye Hospital, London, UK.
Allergy. 1995;50(21 Suppl):10-3; discussion 34-8. doi: 10.1111/j.1398-9995.1995.tb04251.x.
Immuno-histopathological studies of conjunctival tissue biopsied from patients with non-sight-threatening allergic conjunctivitis or with sight-threatening allergic keratoconjunctivitis should lead to more effective management of these eye conditions, based on the specific cellular involvement. The major difference between these two categories of eye disease was the occurrence of T-lymphocytes, which were absent in the former but prominent in the sight-threatening disorders. Seasonal and perennial allergic conjunctivitis both showed a heavy mast cell increase, due to infiltration of mucosal type mast cells, and allergen challenge studies linked mast cell histamine release to the early phase reaction occurring within 20 minutes. A second histamine peak at six hours after challenge might implicate basophils (or refractory mast cells) and was accompanied by a rise in eosinophil cationic protein. In sight-threatening, chronic allergic keratoconjunctivitis the responses were clearly directed by T-cells, themselves the primary effector cell in atopic keratoconjunctivitis, whereas vernal keratoconjunctivitis displayed a T-cell driven eosinophilia, with increased expression of the adhesion molecules involved in tissue invasion by these cells. Appropriate therapies for each different category of conjunctivitis should be based on the specific immunopathology, and directed at the activated cell types that are primarily responsible for the disease process.
对非威胁视力的过敏性结膜炎患者或威胁视力的过敏性角结膜炎患者的结膜组织活检进行免疫组织病理学研究，应能根据特定的细胞参与情况，更有效地管理这些眼部疾病。这两类眼部疾病的主要区别在于T淋巴细胞的出现情况，前者不存在T淋巴细胞，而在威胁视力的疾病中T淋巴细胞则很突出。季节性和常年性过敏性结膜炎均显示肥大细胞大量增加，这是由于黏膜型肥大细胞浸润所致，过敏原激发试验将肥大细胞组胺释放与20分钟内发生的早期反应联系起来。激发后6小时出现的第二个组胺峰值可能与嗜碱性粒细胞（或难治性肥大细胞）有关，并伴有嗜酸性粒细胞阳离子蛋白升高。在威胁视力的慢性过敏性角结膜炎中，反应显然由T细胞主导，T细胞本身是特应性角结膜炎的主要效应细胞，而春季角结膜炎则表现为T细胞驱动的嗜酸性粒细胞增多，参与这些细胞组织侵袭的黏附分子表达增加。针对每一类不同的结膜炎的适当治疗应基于特定的免疫病理学，并针对主要导致疾病过程的活化细胞类型。
