角膜缘干细胞移植对真菌性角膜溃疡的疗效及其对微生物组的影响  

Efficacy of corneal limbal stem cell transplantation in the treatment of fungal corneal ulcers and its effect on the microbiome

作　　者：王兵 耿若君[2] 付珂 邹培 曾明范 WANG Bing;GENG Ruojun;FU Ke;ZOU Pei;ZENG Mingfan(l.MedicalAestheticEpartment Department,the First Affiliated Hospital of Nanyang Medical College,Nanyang 473000,Henan,China;Ophthalmology Teaching and Research Section of Nanyang Medical College;Department of Ophthalmology,the First Affiliated Hospital of Nanyang Medical College,Nanyang 473000,Henan,China;Department of Neurolgy,Xinye Country Hospital)

机构地区：[1]南阳医专一附院医疗美容科,河南南阳473000 [2]南阳医学高等专科学校眼视光教研室 [3]南阳医专一附院眼科,河南南阳473000 [4]新野县人民医院神经内科

出　　处：《中国病原生物学杂志》2025年第1期57-63,共7页Journal of Pathogen Biology

基　　金：国家自然科学基金面上项目(No.82074076);河南省科技发展计划项目(No.202300410022)。

摘　　要：目的本研究旨在评估角膜缘干细胞移植(LSCT)在真菌性角膜溃疡治疗中的临床疗效,并探讨其对角膜微生物组的影响。方法本研究为对照试验,共纳入100例真菌性角膜溃疡患者,分为LSCT治疗组和标准抗真菌药物治疗组(对照组),每组50例。主要疗效评估指标包括角膜溃疡的愈合情况、视力恢复、角膜炎症反应的改善以及角膜微生物组的变化。患者在治疗前(基线)及治疗后第1周、第2周、第4周和第8周接受详细的眼科检查,并通过16S rRNA基因测序分析微生物群落结构。结果LSCT组在各时间点均表现出显著优于对照组的疗效。治疗第1周,LSCT组的角膜溃疡面积显著减少(4.50±1.16 mm^(2)vs 5.78±1.30 mm^(2),t=-5.268,P<0.01),至第8周几乎完全愈合(0.18±0.29 mm^(2)vs 1.52±0.88 mm^(2),t=-9.414,P<0.01)。视力恢复方面,LSCT组UCVA在第8周改善至0.31±0.17 LogMAR,对照组为0.62±0.28 LogMAR(t=-6.934,P<0.01);BCVA在LSCT组为0.21±0.12 LogMAR,对照组为0.41±0.18 LogMAR(t=-6.233,P<0.01)。角膜炎症反应的改善也显著优于对照组,LSCT组的前房炎症细胞计数在第8周降至0.32±0.29个/高倍视野,对照组为1.00±0.46个/高倍视野(t=-8.186,P<0.01)。微生物组分析显示,LSCT组的Shannon指数在第8周显著增加(5.37±0.51 vs 4.23±0.60,t=10.059,P<0.01),并且表皮葡萄球菌和痤疮丙酸杆菌的相对丰度与角膜溃疡愈合和视力恢复呈显著正相关(Spearman r分别为0.432和0.356,P<0.05)。结论角膜缘干细胞移植在真菌性角膜溃疡的治疗中表现出显著的疗效,能够加速角膜溃疡的愈合、改善视力恢复,并有效减轻角膜炎症反应。此外,LSCT还通过调节角膜微生物组的多样性和关键物种的相对丰度,进一步促进角膜愈合。Purpose To evaluate the clinical efficacy of limbal stem cell transplantation(LSCT)in the treatment of fungal corneal ulcers and explore its impact on the corneal microbiome.Methods This study was a controlled trial.A total of 100 patients with fungal corneal ulcers were included and divided into a LSCT treatment group and a standard antifungal drug treatment group(control group),with 50 cases in each group.The main efficacy evaluation indicators include corneal ulcer healing,visual recovery,improvement of corneal inflammatory response,and changes in the corneal microbiome.Patients underwent detailed eye examinations before treatment(baseline)and at weeks 1,2,4,and 8 after treatment,and the microbial community structure was analyzed by 16S rRNA gene sequencing.Results The LSCT group showed significantly better efficacy than the control group at each time point.In the 1st week of treatment,the corneal ulcer area in the LSCT group was significantly reduced(4.50±1.16 mm^(2)vs 5.78±1.30 mm^(2),t=-5.268,P<0.01),and was almost completely healed by the 8th week(0.18±0.29 mm^(2)vs 1.52±0.88 mm^(2),t=-9.414,P<0.01).In terms of visual acuity recovery,UCVA in the LSCT group improved to 0.31±0.17 LogMAR at the 8th week,compared with 0.62±0.28 LogMAR in the control group(t=-6.934,P<0.01);BCVA in the LSCT group was 0.21±0.12 LogMAR,compared with 0.41 in the control group.0.18 LogMAR(t=-6.233,P<0.01).The improvement of corneal inflammatory response was also significantly better than that of the control group.The anterior chamber inflammatory cell count in the LSCT group dropped to 0.32±0.29 cells/high power field at the 8th week,compared with 1.00±0.46 cells/high power field in the control group(t=-8.186,P<0.01).Microbiome analysis showed that the Shannon index of the LSCT group increased significantly at week 8(5.37±0.51 vs 4.23±0.60,t=10.059,P<0.01),and the relative abundance of Staphylococcusepidermidis and Propionibacteriumacnes was associated with corneal ulcer healing and There was a significant positive correl

关 键 词：角膜缘干细胞移植 真菌性角膜溃疡 微生物组 视力恢复 角膜炎症 

分 类 号：R772.21[医药卫生—眼科]