棘阿米巴角膜炎的组织病理学特点与临床预后相关关系分析  

Correlation between histopathologic features and clinical outcomes of acanthamoeba keratitis

作　　者：柳晓辉 李晶 尹瑞杰 袁敏 韩雷 李晓华 Liu Xiaohui;Li Jing;Yin Ruijie;Yuan Min;Han Lei;Li Xiaohua(Department of Ophthalmology,Henan Provincial People′s Hospital,Henan Eye Institute,Henan Eye Hospital,People′s Hospital of Zhengzhou University,Henan University People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院眼科,河南省立眼科医院,河南省眼科研究所,河南省眼科学与视觉科学重点实验室,郑州大学人民医院,河南大学人民医院,450003

出　　处：《中华眼科杂志》2021年第12期939-943,共5页Chinese Journal of Ophthalmology

摘　　要：目的探讨棘阿米巴角膜炎的组织病理学特点, 并分析其与临床表现之间的关系。方法回顾性系列病例研究。收集河南省人民医院眼科2004年至2013年收治的15例组织病理学诊断为棘阿米巴角膜炎患者15例(15只眼), 其中男8例, 女7例, 年龄49.2岁。记录患者的临床诊治资料, 取患者角膜标本分别行苏木素-伊红、过碘酸希夫、六胺银、革兰、吉姆萨染色后于光学显微镜下观察其病理学改变和特点, 分析组织病理学表现与临床特点的关系。结果 15例患者结膜均中度充血, 角膜环形溃疡5例, 中央溃疡8例, 角膜混浊1例, 基质溃疡1例, 其中4例角膜缘见新生血管, 2例浸润灶致密。组织病理学检查可见阿米巴包囊或滋养体结构, 前者呈圆形或椭圆形后者呈长椭圆形, 棘状、矛样突出;其中12例(12/15)角膜基质层部分区域呈化脓性炎性反应的病理改变, 一些中性粒细胞浸润, 炎性坏死组织中可见变性的阿米巴包囊;3例(3/15)角膜基质层纤维坏死变性, 未见明显的中性粒细胞浸润, 坏死组织中可见阿米巴包囊结构;10例(10/15)患者的角膜标本中同时存在无炎症细胞浸润区, 基质层纤维表现为水肿或者轻度变性, 纤维裂隙间可见散在或成群的圆形或椭圆形的包囊及滋养体结构, 虫体周围的基质层纤维无明显的炎症细胞。结论棘阿米巴角膜炎临床表现多样, 组织病理学检查在角膜透明区仍可发现棘阿米巴包囊及滋养体结构, 此为临床治疗成败的重要因素, 应予以重视, 从而改善患者的预后。(中华眼科杂志, 2021, 57:939-943)Objective To study the relationship between the clinical characteristics and the histopathological changes in acanthamoeba keratitis.Methods In this retrospective study,the clinical data and histopathological features of 15 Acanthamoeba keratitis patients(15 eyes)treated in Henan Eye Hospital were collected and analyzed.There were 8 males and 7 females.Mean age was 49.2 years old.The corneal specimens were stained with hematoxylin eosin,periodic acid-schiff,Gomori′s methenamine silver,Gram and Gimsa respectively.The pathological changes and characteristics were observed under microscope,to analyze the relationship between histopathology and clinical features.Results All patients had moderate conjunctival congestion.Five patients showed corneal ring stromal infiltration,8 had central corneal ulcers,1 had corneal opacity,and 1 had a matrix ulcer.We found corneal neovascularization around the ulcer in 4 eyes and a dense ulcer in 2 eyes.Histopathological examinations with hematoxylin-eosin,periodic acid-Schiff,Gomori′s methenamine silver,Gram and Giemsa stainings revealed round or oval amoebic cysts and amebic trophozoites which were of an elongated oval,spine-or spear-like.Twelve patients(80%)showed corneal stromal purulent inflammation infiltrated by neutrophils.Many degenerated amoebic cysts were found.Degeneration and necrosis of corneal stromal fibers were observed in 3 eyes(20%).There were no neutrophils.Amoebic cysts were seen in necrotic tissue.Ten eyes(66.7%)had no inflammatory cell infiltration areas,with edematous or mildly degenerated corneal fibers,scattered or grouped cysts and trophozoites.Conclusions Clinical manifestations of acanthamoeba keratitis are various.Acanthamoeba cysts and trophozoites also exist in the transparent corneal area on the histopathological examination.This is important for the therapeutic outcomes.(Chin J Ophthalmol,2021,57:939-943)

关 键 词：棘阿米巴角膜炎 显微镜检查 预后 

分 类 号：R772.21[医药卫生—眼科]