干眼抗炎治疗前后角膜上皮下神经分布的定量分析  

A quantitative analysis of corneal subbasal nerves before and after the anti-inflammatory therapy in patients with dry eye

作　　者：程燕[1] 吴洁[1] 朱海峰[1] 程钰[1] 朱秀萍[1] CHENG Yan, WU Jie ,ZHU Hai-feng, CHENG Yu,ZHU Xiu-ping(Shaanxi Provincial Institute of Ophthalmology;Shaanxi Key Laboratory of Ophthalmology; First Hospital of Xi＇an, Xi＇ an 710002, Chin)

机构地区：[1]陕西省眼科研究所陕西省眼科学重点实验室西安市第一医院,陕西西安710002

出　　处：《延安大学学报（医学科学版）》2018年第1期35-40,共6页Journal of Yan'an University:Medical Science Edition

基　　金：陕西省社会发展科技攻关项目(2015SF206);西安市卫生局课题项目(J2011004)

摘　　要：目的应用共焦显微镜观察轻度干眼抗炎治疗前后角膜上皮下神经的改变,以期评价干眼抗炎治疗的疗效。方法收集临床诊断为干眼患者60例(120只眼),均为1级干眼患者,随机将其分为两组,每组30例(60只眼)。所有患者均给予人工泪液,非甾体类抗炎药物治疗2周,症状无明显改善。其中一组非甾体类抗炎药换用依碳酸氯替泼诺0.5%眼用混悬液每日3次抗炎治疗,2周后减量为每日2次,1月时停药。治疗前及治疗后3个月,记录角膜上皮下神经纤维密度、分支数量、弯曲度评分,对两组患者的上述指标进行统计学分析。结果人工泪液联合依碳酸氯替泼诺0.5%眼用混悬液组治疗后3个月角膜上皮下神经密度与治疗前无显著差异(P>0.05),但其分支数量明显减少(P<0.05),弯曲度变小,形态趋于正常;人工泪液联合非甾体抗炎药物组上述指标治疗前后均无显著差异(P>0.05)。结论糖皮质激素类药物对于常规治疗无效的轻度干眼患者临床有效,通过共焦显微镜观察角膜上皮下神经可以作为干眼患者激素抗炎治疗疗效评估的有效方法。Objective Confocal microscope was used to observe the change of corneal subbasal nerve before and after mild dry eye anti-inflammatory treatment in order to evaluate the effect of anti-inflammatory dry eye treatment.Methods Sixty patients（ 120 eyes） with dry eye were randomly divided into two groups（ 60 eyes）. All patients were given artificial tears,non-steroidal anti-inflammatory drugs for 2 weeks,no significant improvement in symptoms. One group of non-steroidal anti-inflammatory drugs for use of loteprednol etabonate 0. 5% ophthalmic suspension 3 times a day anti-inflammatory treatment,2 weeks after the reduction to 2 times a day,January withdrawal. Before treatment and 3 months after treatment,the density of corneal subbasal nerve fibers,the number of branches and the curvature score were recorded,and the above indexes of two groups of patients were statistically analyzed. Results There was no significant difference in the density of corneal subbasal nerve between the artificial tears combined with loteprednol etabonate 0. 5% ophthalmic suspension 3 months after treatment（ P〉0. 05）,but the number of branches was significantly decreased（ P〈0. 05）,Less curvature,the shape tends to be normal; Artificial tears combined with non-steroidal anti-inflammatory drug group indicators before and after treatment were no significant difference（ P〉0. 05）. Conclusion Glucocorticoids are clinically effective in patients with mild dry eye that are ineffective with conventional therapy. Observation of the corneal subbasal nerve by confocal microscopy can be used as an effective method for evaluating the curative effect of steroid-anti-inflammatory treatment in patients with dry eye.

关 键 词：干眼 角膜上皮下神经 共焦显微镜 

分 类 号：R77[医药卫生—眼科]