泪液中（1，3）-β-D-葡聚糖水平检测对真菌性角膜炎的诊断和监测价值  

The diagnosis and monitor for fungal keratitis by detection of （1,3-）β-D-glucan in tears

作　　者：刘珂凤[1] 梁涛[1] 何宏[2] 王婷[1] 喻文倩[1] 王沛涛[3] 李强[3] 

机构地区：[1]青岛大学医学院附属医院眼科,266003 [2]青岛大学医学院附属医院检验科,266003 [3]青岛大学医学院附属医院深低温冷冻室,266003

出　　处：《中华实验眼科杂志》2013年第11期1065-1068,共4页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景真菌性角膜炎的早期诊断对有效治疗极为重要，但目前尚缺乏能够准确、定量诊断和判断疗效的客观指标。研究证实血浆中（1，3）一6一D一葡聚糖对全身真菌感染性疾病诊断有较高的敏感性和特异性，但泪液中（1，3）-β-D一葡聚糖含量的检测能否用于角膜真菌感染患者的早期诊断和病情监测尚不清楚。目的观察真菌性角膜炎患者接受抗真菌药物治疗过程中泪液中（1，3）-β—D一葡聚糖质量浓度的变化，客观评价其在真菌性角膜炎诊断和病情监测中的临床价值。方法选取2010年7月至2012年5月在青岛大学医学院附属医院眼科诊治的角膜溃疡直径≤5mm的真菌性角膜炎患者60例60眼为患病组，同期健康无眼疾的成年志愿者30人30眼为正常对照组。患病组接受抗真菌药物治疗，平均治疗时间为29d。分别在治疗前及治疗后7、14、28d和停药后7d、14d收集患眼泪液50斗l，进行（1，3）一p—D一葡聚糖质量浓度检测，同时结合激光扫描共焦显微镜检查及患者临床表现，对（1，3）一p—D一葡聚糖的诊断价值进行评估。对泪液中（1，3）一p．D一葡聚糖质量浓度低于20ng／L、激光扫描共焦显微镜检查未发现菌丝的患者，巩固治疗1周后停药，随访2个月。结果治疗前，患病组患者泪液中（1，3）-β—D-葡聚糖质量浓度为（Log）（6．37-＋0．48）ng／L，明显高于正常对照组（Log）的（2．00~0．31）ng／L，差异有统计学意义（t=2．89，P〈0．01）。真菌性角膜炎患者病情在治疗7d后开始好转，表现为溃疡边界逐渐清晰，病灶面积缩小，激光扫描共焦显微镜下显示菌丝密度比治疗前降低等。患病组患者泪液中（1，3）-β-D-葡聚糖质量浓度随着治疗时间的延长逐渐下降，其变化呈时间依赖性。治疗后7、14、28d患者泪液中（1，3）-β-D-葡聚糖质量浓度（Log）分别为（5．19±0Background The diagnosis and treatment of fungal keratitis are knotty. There is no quantitative method to identify the disease and judge the therapeutic effect of the antifungal agent. Studies have determined that serum （1,3-） β-D-glucan level can sensitively and specifically reflect the state of systemic mycotic-causing diseases. However, whether （ 1,3-）β-D-glucan level in tear can monitor and diagnose mycotic keratitis is unclear. Objective Purpose of this study was to investigate the change of tear （1,3-） β-D-glucan level following the administration of antifungal drug in fungal keratitis patients, and evaluate the diagnosis and monitor value of （ 1,3-） β-D-glucan in tears for fungal keratitis. Methods Sixty patients who were diagnosed as fungal keratitis by fungal culture were analyzed in Affiliated Hospital of Qingdao University Medical College from July 2010 to May 2012. The patients received the topical administration of antifungal drug for 28 days. Thirty healthy volunteers without eye disease served as normal controls. The tear of 50μ1 was collected from each subject for the detection of （1,3）-β-D-gluean before the therapy, 7,14,28 days after therapy and 7 days, 14 days after the drugs were stopped, respectively. The dynamic changes of （ 1,3-）-β-D-glucan levels in tears were evaluated and compared with the manifestation of the lesions under the laser scanning confocal microscope. The patients without hyphal by the laser scanning confocal microscopy and tear （1,3-）β-D-glucan level less than 20 ng/L were subsequently treated for another 7 days, and the following-up duration was 2 months. The informed consent was obtained before any medical examination was performed from each subject. Results （1,3-） -βD-glucan level in tears （Log value） was （ 6. 37 ± 0. 48 ） ng/L in the patient group, and was significantly higher than （2.00±0.31）ng/L in the normal control group （t= 2.89 ,P〈0. 01 ）. The lesion was smaller with the gradually clear border, and the nu

关 键 词：葡聚糖 (1 3)-β—D-葡聚糖 显微镜检查 激光扫描共焦显微镜 眼感染 真菌性角膜炎 

分 类 号：R978.5[医药卫生—药品]