单眼感染性角膜炎患者对侧未感染眼活体共聚焦显微镜下改变  

Clinical changes of contralateral unaffected eyes in patients with unilateral infectious keratitis under in vivo confocal microscopy

作　　者：刘馨甜 张红[1] 金鑫[1] 石妍[1] 姜雪[1] Liu Xintian;Zhang Hong;Jin Xin;Shi Yan;Jiang Xue(Department of Ophthalmology,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院眼科医院,150001

出　　处：《中华实验眼科杂志》2019年第6期454-459,共6页Chinese Journal Of Experimental Ophthalmology

基　　金：国家教育部博士点基金项目(20132307110027);黑龙江省自然科学基金项目(LC2012C24、JC2016019);黑龙江省教育厅长江后备基金项目(2014CJHB006).

摘　　要：目的评价患者单眼发生感染性角膜炎时,其对侧未感染眼角膜上皮细胞、角膜内皮细胞、树突状细胞及角膜神经的改变。方法采用前瞻性系列病例观察研究设计,纳入2018年1—8月于哈尔滨医科大学附属第一院眼科医院就诊的单眼感染性角膜炎患者78例,其中病毒性角膜炎患者31例,细菌性角膜炎患者30例,真菌性角膜炎患者17例,同期纳入年龄相关性白内障或翼状胬肉患者50例作为对照组。裂隙灯显微镜下观察患者眼前节结构。使用活体共聚焦显微镜(IVCM)观察患者未感染眼角膜上皮细胞、角膜内皮细胞、树突状细胞形态,并计算3种细胞以及角膜神经总干和分支的数量和密度。结果3个感染组患者对侧未感染眼眼前节均无明显改变。病毒性角膜炎组、细菌性角膜炎组和真菌性角膜炎组患者对侧未感染眼的角膜上皮细胞密度分别为1834(1584,2107)、1905(1651,2332)和1859(1477,1995)个/mm^2,明显低于对照组的3479(3080,3910)个/mm^2,而病毒性角膜炎组和细菌性角膜炎组未感染眼树突状细胞密度分别为175(139,214)个/mm^2和156(118,190)个/mm^2,均大于对照组的69(57,76)个/mm^2,差异均有统计学意义(均P<0.05);病毒性角膜炎组未感染眼的角膜内皮细胞密度为1107(945,1270)个/mm^2,小于细菌性角膜炎组的1905(1651,2332)个/mm^2和真菌性角膜炎组的1859(1477,1995)个/mm^2,差异均有统计学意义(均P<0.05);病毒性角膜炎组未感染眼的角膜神经数量和总神经密度分别为10(7,11)条/mm^2和(1822.85±622.34)μm/mm^2,均小于细菌性角膜炎组的11(9,13)条/mm^2和(2340.91±408.70)μm/mm^2,差异均有统计学意义(P<0.05,P<0.0083)。各角膜感染组角膜上皮细胞和角膜内皮细胞体积均较对照组增大;病毒性和细菌性角膜炎患者对侧眼树突状细胞形态变长,数目增多。结论单眼发生感染性角膜炎时,其对侧未感染眼的角膜上皮细胞、角膜内皮细胞、树突状细胞�Objective To evaluate the clinical changes of corneal epithelial cells, dendritic cells, endothelial cells and corneal nerves in contralateral eyes of patients with unilateral infectious keratitis. Methods A prospective serial case observation study was conducted in patients with unilateral infectious keratitis from January to August 2018 in the First Affiliated Hospital of Harbin Medical University.The corneal epithelial cells density, dendritic cells density, endothelial cells density, total nerve density, total number of nerves and branch nerve density were analyzed with in vivo confocal microscopy (IVCM), slit lamp microscopy was performed on all subjects to observe the conjunctiva, cornea and anterior chamber.Corneal branch nerve density and total nerve density were compared with the control group by homogeneity test of variance.This study was approved by the Ethics Committee of the First Affiliated Hospital of Harbin Medical University (No.IRB-AF/SC-04/01.0). Results Slit lamp microscopy showed no significant changes in anterior segment of the contralateral uninfected eyes in the 3 groups.The corneal epithelial cells density of uninfected eyes in viral keratitis group, bacterial keratitis group and fungal keratitis group was 1 834(1 584, 2 107), 1 905(1 651, 2 332) and 1 859(1 477, 1 995)/mm^2, respectively, which were significantly lower than 3 479(3 080, 3 910)/mm^2 in the control group, the dendritic cells densities in viral keratitis group and bacterial keratitis group were 175(139, 214)/mm^2 and 156(118, 190)/mm^2, which were higher than 69(57, 76)/mm^2 in the control group, the differences were statistically significant (all at P<0.05). The corneal endothelial cells density of uninfected eyes in viral keratitis group was 1 107(945, 1 270)/mm^2, which was less than 1 905(1 651, 2 332)/mm^2 in the bacterial keratitis group and 1 859(1 477, 1 995)/mm^2 in the fungal keratitis group (both at P<0.05). The corneal nerve number and total nerve density of uninfected eyes in viral keratitis group were 10(7, 11

关 键 词：感染性角膜炎 激光扫描共焦显微镜 角膜上皮细胞 树突状细胞 角膜神经密度 角膜内皮细胞 

分 类 号：R772.21[医药卫生—眼科]