不同类型单疱病毒性角膜炎角膜内细胞变化共聚焦显微镜观察  

The changes of cells in cornea in different types of herpes simplex keratitis observed with in vivo confocal microscopy

作　　者：余晓菲[1] 

机构地区：[1]河南省眼科研究所河南省立眼科医院,郑州450003

出　　处：《中国实用眼科杂志》2015年第3期245-249,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的利用活体共聚焦显微镜（IVCM）观察不同类型单纯疱疹病毒性角膜炎（HSK）发病过程中角膜固有细胞及角膜内炎症细胞的变化差异。方法临床病例对照研究。对2012年1月至2014年1月，在河南省眼科研究所应用活体激光扫描角膜共聚焦显微镜对86例（88只眼）HSK患者进行观察，依据HSK累及病变部位而分为：上皮型（EPT）组、基质型（STT）组及内皮型（EDT）组，正常人健眼作为对照组。在不同区域的全景角膜扫描过程中，记录角膜各层细胞图像，并对其进行分析。结果EPT组中表层及翼状上皮细胞数量较对照组明显减少，差异显著有统计学意义（Fac=28．83，Pac=0．000；Ede=93．87，Pde=0．000）；sTT组中表层上皮细胞、前基质细胞及内皮细胞数量与对照组相比减少，差异有统计学意义（Fbe=5．501，R=0．041；Ffg=16．30，R=0．002；Faj=12．473，R=0．005），EDT组中内皮细胞数量较对照组减少，差异有统计学意义（Ej=19．230，Pij=0．001）；余各组中角膜固有细胞数量变化与对照组相比无统计学意义（P〉0．05）。IVCM下可见EPT组中参与炎症反应的主要有树突状细胞、直径10～15μm和〉15μm的圆形细胞；和EPT组相比，STT组中直径〉15μm的圆形炎症细胞明显减少，差异显著有统计学意义（x2ij=23．135，Pij=0．000）；EDT组中参与炎症反应的主要是直径10-15μm圆形细胞。结论使用IVCM可以清晰观察不同类型HSK角膜固有细胞和参与炎症反应细胞的变化差异，为临床治疗提供理论依据和指导。Objective To observe the different changes of corneal inherent cells and inflammato ry cells in different types of herpes simplex keratitis （HSK） using in vivo confocal microscopy （IVCM）. Methods Eightysix patients （88 eyes） with HSK were observed with laser scanning IVCM, and grouped into epithelial keratitis （EPT）, stromal keratitis （STT）, endotheliitis （EDT） based on the location of involving lesions. The normal eye was grouped as control. The images of cornea were recorded during the whole corneal scanning in different areas, and were analyzed using statistical methods. Results The density of superficial epithelial cells and wing cells in EPT group was less than the control group and the difference was statistically significant （Pac=0.000, Pde=0.000）. The density of superficial epithelial cells, anterior stromal cells and endothelial cells in STT group was less than the control group and the difference was statistically significant （Pbc=0.041, Pfg=0.002, Phi= 0.005）. The density of endothelial cells in EDT group was less than the control group and the differ ence was statistically significant （Pij=0.001）. Compared with control group, the changes of other cor neal inherent cell amounts in affected groups had no significant differences. Under IVCM, dendritic cells and round cells whose diameter over 10μm were main inflammatory cells as part of the inflammatory response in EPT group, and in STT group, round inflammatory cells whose diameter over 15 μm were obviously less than ones in EPT group and the difference was statistically significant （Rj= 0.000）, but in EDT group, the main inflammatory cells were round cells whose diameter was during 10μm to 15μm. Conclusions Using IVCM can clearly observe the different changes of corneal in herent cells and inflammatory cells in different types of HSK, which provide theoretical base and guidance for the treatment of HSK.

关 键 词：活体共聚焦显微镜 单纯疱疹病毒性角膜炎 角膜固有细胞 炎症细胞 差异 

分 类 号：R772.21[医药卫生—眼科]