不同分期圆锥角膜内皮细胞密度和形态变化  

Change in corneal endothelial cell density and morphology in different stages of keratoconus

作　　者：罗燕 赵灿 仲晓维 石佳宁 史伟云 王婷 Luo Yan;Zhao Can;Zhong Xiaowei;Shi Jianing;Shi Weiyun;Wang Ting(Binzhou Medical University,Yantai 264003,China;Eye Institute of Shandong First Medical University,Eye Hospital of Shandong First Medical University(Shandong Eye Hospital),State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,School of Ophthalmology,Shandong First Medical University,Jinan 250021,China)

机构地区：[1]滨州医学院,烟台264003 [2]山东第一医科大学附属眼科研究所、山东第一医科大学附属眼科医院(山东省眼科医院)、山东省眼科学重点实验室-省部共建国家重点实验室培育基地、山东第一医科大学眼科学院,济南250021

出　　处：《中华实验眼科杂志》2023年第3期259-265,共7页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目(82271052);国家自然科学基金区域创新发展联合基金项目(U20A20386);泰山青年学者项目(tsqn201909188)。

摘　　要：目的评估不同分期圆锥角膜患者角膜内皮细胞密度(CD)及形态变化。方法采用横断面研究方法,纳入2018年3月至2021年10月就诊于山东第一医科大学附属眼科医院的圆锥角膜患者119例199眼,按照圆锥角膜Amsler-Krumeich分期标准将患者分为Ⅰ期圆锥角膜组58例111眼、Ⅱ期圆锥角膜组30例41眼和Ⅲ期圆锥角膜组31例47眼。同期纳入年龄和性别匹配的健康受试者25人50眼作为正常对照组。采用Pentacam三维眼前节分析仪获取角膜地形图及角膜曲率(K)、中央角膜厚度(CCT)、最薄处角膜厚度(TCT)、前房深度(ACD)、角膜直径、角膜体积等眼前节参数。通过"中心法"使用非接触式角膜内皮显微镜检查并获取中央区角膜内皮CD、六角形细胞的百分数(6A)、平均细胞面积(AVE)、最大细胞面积(MAX)、最小细胞面积(MIN)、细胞面积标准差(SD)和细胞面积变异系数(CV)。采用Spearman秩相关分析角膜内皮CD和形态参数与角膜地形图相关参数的相关性。结果正常对照组以及Ⅰ期、Ⅱ期和Ⅲ期圆锥角膜组CD分别为2941(2809,3072)、2825(2667,3030)、2747(2475,2903)和2370(2142,2525)个/mm^(2),随着圆锥角膜患者病情进展,CD逐渐降低,各组CD总体比较差异有统计学意义(H=94.862,P<0.001)。各组CV和6A总体比较差异均有统计学意义(H=45.018、20.421,均P<0.001);Ⅲ期圆锥角膜组CV明显高于正常对照组和Ⅰ、Ⅱ期圆锥角膜组,6A明显低于正常对照组和Ⅰ期圆锥角膜组,差异均有统计学意义(均P<0.05)。随着圆锥角膜病情进展,MAX、MIN、AVE和SD逐渐增大,各组MAX、MIN、AVE和SD总体比较差异均有统计学意义(H=37.905、32.437、110.182、72.941,均P<0.001);Ⅲ期圆锥角膜组MAX和MIN显著高于Ⅰ期圆锥角膜组和正常对照组,AVE和SD明显高于正常对照组和Ⅰ、Ⅱ期圆锥角膜组,差异均有统计学意义(均P<0.05)。所有圆锥角膜患者CD与CCT、TCT呈中等程度正相关(r_(s)=0.47,P<0.001;r_(sObjective To assess the changes in corneal endothelial cell density(CD)and morphology in patients with different stages of keratoconus.Methods A cross-sectional study was conducted.One hundred and nineteen patients(199 eyes)with keratoconus who were treated in the Eye Hospital of Shandong First Medical University were included from March 2018 to October 2021.The 199 eyes were classified into stageⅠ(111 eyes of 58 cases),stageⅡ(41 eyes of 30 cases),stageⅢ(47 eyes of 31 cases)keratoconus groups according to the Amsler-Krumeich classification.In the same period,25 age-and sex-matched healthy subjects(50 eyes)were enrolled as a normal control group.Corneal topography and anterior segment parameters such as keratometry(K),central corneal thickness(CCT),thinnest corneal thickness(TCT),anterior chamber depth(ACD),corneal diameter and corneal volume were obtained by Pentacam 3-dimensional anterior segment imaging and analysis system.The corneal endothelial CD,percentage of hexagonal cells(6A),average cell area(AVE),maximum cell area(MAX),minimum cell area(MIN),cell area standard deviation(SD)and cell area coefficient of variation(CV)in the central area were evaluated by non-contact specular microscopy.The correlation between corneal endothelial CD,morphological parameters and corneal topographic parameters was analyzed by Spearman rank correlation.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Shandong Eye Hospital(No.SDSYKYY201803).All patients were informed of the purpose and methods of the study and written informed consent was obtained before any medical examination.Results The CD of the normal control group and stageⅠ,Ⅱ,Ⅲkeratoconus groups was 2941(2809,3072),2825(2667,3030),2747(2475,2903)and 2370(2142,2525)cells/mm^(2),respectively.With the progression of keratoconus,CD decreased gradually,and there was a significant difference in CD among the four groups(H=94.862,P<0.001).There were significant differences in CV and 6A among the four groups(H=45.018,20.42

关 键 词：圆锥角膜 角膜内皮 非接触式角膜内皮显微镜 角膜地形图 

分 类 号：R772.2[医药卫生—眼科]