单纯疱疹病毒性角膜炎治疗中应用定量PCR技术的研究  

Research of Treating the Herpes Simplex Keratitis under the Guidance of Quantitative PCR

作　　者：吴年浪[1] 赵江浩[1] 张惠成[1] 

机构地区：[1]杭州市第一人民医院眼科,310006

出　　处：《医学研究杂志》2013年第6期133-136,共4页Journal of Medical Research

基　　金：杭州市医药卫生科技计划项目(2010A006)

摘　　要：目的在单纯疱疹病毒性角膜炎(HSK)的治疗过程中,研究应用定量PCR检测单纯疱疹病毒(HSV)Ⅰ型DNA数量,结合临床症状体征,指导HSK的治疗。方法将HSK分成浅层的上皮型角膜炎组和深层的角膜基质炎和角膜内皮炎组,两组再按不同治疗方法各分A、B两组,A组为单纯局部用药,B组为A组基础上联合口服阿昔洛韦。以症状体征评分的变化来比较单纯局部用药与联合口服阿昔洛韦的不同治疗效果。所有患者在治疗前与治疗后作定量PCR检测HSV-ⅠDNA数量,以定量PCR数值的lg数作为定量PCR得分来比较AB组的PCR数值变化,与症状体征评分对照来指导HSK的治疗。结果所有HSK病人治疗后8周A组症状体征评分均显著大于B组,差异有统计学意义。上皮型角膜炎病人的定量PCR得分显示治疗后A>B,差异有统计学意义。深层型角膜炎病人治疗前后定量PCR无显著差异。上皮型角膜炎中定量PCR值>105的病人,治疗后6、8周,A组症状体征评分显著>B组,差异有统计学意义;<105的病人,A、B两组症状体征评分无显著差异。结论对于上皮型角膜炎,定量PCR有以下的作用:①可定性,用于明确单纯疱疹病毒Ⅰ型感染;②可定量,明确HSV-Ⅰ型DNA拷贝数,如拷贝数>105,建议加用口服抗病毒药;如拷贝数<105,可以单纯局部抗病毒。对于角膜基质炎和角膜内皮炎,定量PCR意义不大。Objective To detect the HSV - I in the treatment of HSK,by the quantitative PCR, and combined with the clinical signs,to research the feasibility of treating the HSK under the guidance of quantitative PCR. Methods First,we devided HSK into superficial layer and deep layer. Superficial layer included epithelial keratitis, and deep layer included stromal keralitis and corneal endotheliitis. Then devided both superficial layer and deep layer into A and B two groups by different treatment. Patients in A group were treated by topical remedy,and Patients in B group were treated by topical remedy and oral acyclovir. We used the mark of symptom and sign to reveal the different treatment effect of A and B groups. The HSV - I DNA was measured by quantitative PCR of all the patient before and after the treatment. We regarded the lg digit of HSV - I DNA copies as the scores to compare the difference between two groups,and directed the treatment contrast with symptom and sign. Results The scores of symptom and sign in group A were more higher than those in group B after 8 weeks treatment in all HSK patients, and the difference was significant in statistics. The scores of quantitative PCR were similar in two groups of epithelial keratitis before the treatment,and it was significantly higher in group A than B after the treatment. There was no significant difference in stromal keralitis and corneal endotheliitis before or after the treatment. When the amount of HSV - 1 DNA copies greater than l0s , the scores of symptom and sign in group A were more higher than in group B after 6 and 8 weeks treatment in epithelial keratitis,and the difference was significant in statistics. When the amount of HSV - I DNA copies less than 105, the scores of symptom and sign in group A and B were similar, and there was no significant difference within them. Conclusion With regard to epithelial keratitis, quantitative PCR first can be a qualitative test. It can definite the diagnose of HSK. Second, it can definite the copies of HSV - I DNA. If the

关 键 词：单纯疱疹病毒 角膜炎 PCR 阿昔洛韦 

分 类 号：R772.21[医药卫生—眼科]