中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2011年
5期
416-422
,共7页
乐琦骅%洪佳旭%朱文卿%孙兴怀%徐建江
樂琦驊%洪佳旭%硃文卿%孫興懷%徐建江
악기화%홍가욱%주문경%손흥부%서건강
显微镜检查,共焦%结膜炎,变应性%角膜
顯微鏡檢查,共焦%結膜炎,變應性%角膜
현미경검사,공초%결막염,변응성%각막
Microscopy,confocal%Conjunctivitis,allergic%Cornea
目的 探讨应用活体激光共聚焦显微镜观察春季角结膜炎(VKC)患者的角膜形态变化.方法 观察型系列病例研究.选择2008年10月至2009年8月在复旦大学附属眼耳鼻喉科医院眼科就诊的26例双眼VKC患者,其中眼睑型13例、角膜缘型5例、混合型8例;另选择26名年龄、性别匹配的正常志愿者作为对照.使用活体激光共聚焦显微镜对患者右眼角膜进行检查,分别取中央角膜和上方周边部角膜为检查点,对所得图像进行记录和分析.利用内置细胞计数软件计算角膜各层组织的细胞密度,ImageJ软件分析神经密度、直径、分支数量及弯曲度.使用独立t检验比较VKC患者与正常人群角膜各层细胞密度的差异以及VKC患者周边与中央角膜细胞密度的差异;Fisher精确卡方检验比较VKC患者和对照组角膜上皮内郎格罕细胞浸润情况差异;方差分析比较VKC 3种亚型之间和不同病程之间各层细胞密度的差异;独立t检验和卡方检验分析VKC患者与正常人群之间的神经差异.结果 VKC患者的角膜形态学变化包括角膜上皮最表层的高亮多角形细胞缺失、上皮内和上皮下大量郎格罕细胞浸润及浅基质层内大量基质细胞活化.共焦显微镜下,角膜出现新生血管翳的患者表现为角膜上皮结膜化,基质内可见新生血管;合并圆锥角膜的患者,深基质内可见大量粗大的斜形或纵形暗纹.正常对照组的中央和周边部角膜上皮细胞密度分别为(6033.1±998.7)个/mm2和(6098.4±298.3)个/mm2,VKC患者分别为(5972.2±1148.2)个/mm2和(6178.5±318.9)个/mm2,差异无统计学意义(t=1.191,1.011;P=0.238,0.318);但VKC患者周边部上皮细胞密度显著高于中央部(t=2.249,P=0.03).正常对照组的中央和周边浅基质细胞密度分别(1001.4±125.3)个/mm2和(924.6±201.4)个/mm2,VKC患者分别为(1184.5±115.3)个/mm2和(1101.4±151.1)个/mm2,均显著高于正常对照(t=6.617,3.439;均P=0.001).正常对照与VKC患者中央角膜深基质层细胞密度分别为(537.7±42.6)个/mm2和(548.7±79.8)个/mm2,内皮细胞层细胞密度分别为(2985.7±401.2)个/mm2和(3021.5±383.3)个/mm2,两者比较均无明显差异(t=0.174,1.112;P=0.864,0.282).61.5%(16例)VKC患者的角膜上皮内发现郎格罕细胞浸润,显著高于正常人群(2例,7.7%)(x2=12.49,P=0.001).3种不同亚型VKC患者中,角膜缘型和混合型患者上皮内郎格罕细胞浸润情况较为严重.与正常对照组相比,VKC患者的上皮下神经密度和直径下降、弯曲度增加.结论 VKC主要累及角膜上皮层、上皮下神经及浅基质层.共焦显微镜对于VKC的分型诊断有一定辅助价值.
目的 探討應用活體激光共聚焦顯微鏡觀察春季角結膜炎(VKC)患者的角膜形態變化.方法 觀察型繫列病例研究.選擇2008年10月至2009年8月在複旦大學附屬眼耳鼻喉科醫院眼科就診的26例雙眼VKC患者,其中眼瞼型13例、角膜緣型5例、混閤型8例;另選擇26名年齡、性彆匹配的正常誌願者作為對照.使用活體激光共聚焦顯微鏡對患者右眼角膜進行檢查,分彆取中央角膜和上方週邊部角膜為檢查點,對所得圖像進行記錄和分析.利用內置細胞計數軟件計算角膜各層組織的細胞密度,ImageJ軟件分析神經密度、直徑、分支數量及彎麯度.使用獨立t檢驗比較VKC患者與正常人群角膜各層細胞密度的差異以及VKC患者週邊與中央角膜細胞密度的差異;Fisher精確卡方檢驗比較VKC患者和對照組角膜上皮內郎格罕細胞浸潤情況差異;方差分析比較VKC 3種亞型之間和不同病程之間各層細胞密度的差異;獨立t檢驗和卡方檢驗分析VKC患者與正常人群之間的神經差異.結果 VKC患者的角膜形態學變化包括角膜上皮最錶層的高亮多角形細胞缺失、上皮內和上皮下大量郎格罕細胞浸潤及淺基質層內大量基質細胞活化.共焦顯微鏡下,角膜齣現新生血管翳的患者錶現為角膜上皮結膜化,基質內可見新生血管;閤併圓錐角膜的患者,深基質內可見大量粗大的斜形或縱形暗紋.正常對照組的中央和週邊部角膜上皮細胞密度分彆為(6033.1±998.7)箇/mm2和(6098.4±298.3)箇/mm2,VKC患者分彆為(5972.2±1148.2)箇/mm2和(6178.5±318.9)箇/mm2,差異無統計學意義(t=1.191,1.011;P=0.238,0.318);但VKC患者週邊部上皮細胞密度顯著高于中央部(t=2.249,P=0.03).正常對照組的中央和週邊淺基質細胞密度分彆(1001.4±125.3)箇/mm2和(924.6±201.4)箇/mm2,VKC患者分彆為(1184.5±115.3)箇/mm2和(1101.4±151.1)箇/mm2,均顯著高于正常對照(t=6.617,3.439;均P=0.001).正常對照與VKC患者中央角膜深基質層細胞密度分彆為(537.7±42.6)箇/mm2和(548.7±79.8)箇/mm2,內皮細胞層細胞密度分彆為(2985.7±401.2)箇/mm2和(3021.5±383.3)箇/mm2,兩者比較均無明顯差異(t=0.174,1.112;P=0.864,0.282).61.5%(16例)VKC患者的角膜上皮內髮現郎格罕細胞浸潤,顯著高于正常人群(2例,7.7%)(x2=12.49,P=0.001).3種不同亞型VKC患者中,角膜緣型和混閤型患者上皮內郎格罕細胞浸潤情況較為嚴重.與正常對照組相比,VKC患者的上皮下神經密度和直徑下降、彎麯度增加.結論 VKC主要纍及角膜上皮層、上皮下神經及淺基質層.共焦顯微鏡對于VKC的分型診斷有一定輔助價值.
목적 탐토응용활체격광공취초현미경관찰춘계각결막염(VKC)환자적각막형태변화.방법 관찰형계렬병례연구.선택2008년10월지2009년8월재복단대학부속안이비후과의원안과취진적26례쌍안VKC환자,기중안검형13례、각막연형5례、혼합형8례;령선택26명년령、성별필배적정상지원자작위대조.사용활체격광공취초현미경대환자우안각막진행검사,분별취중앙각막화상방주변부각막위검사점,대소득도상진행기록화분석.이용내치세포계수연건계산각막각층조직적세포밀도,ImageJ연건분석신경밀도、직경、분지수량급만곡도.사용독립t검험비교VKC환자여정상인군각막각층세포밀도적차이이급VKC환자주변여중앙각막세포밀도적차이;Fisher정학잡방검험비교VKC환자화대조조각막상피내랑격한세포침윤정황차이;방차분석비교VKC 3충아형지간화불동병정지간각층세포밀도적차이;독립t검험화잡방검험분석VKC환자여정상인군지간적신경차이.결과 VKC환자적각막형태학변화포괄각막상피최표층적고량다각형세포결실、상피내화상피하대량랑격한세포침윤급천기질층내대량기질세포활화.공초현미경하,각막출현신생혈관예적환자표현위각막상피결막화,기질내가견신생혈관;합병원추각막적환자,심기질내가견대량조대적사형혹종형암문.정상대조조적중앙화주변부각막상피세포밀도분별위(6033.1±998.7)개/mm2화(6098.4±298.3)개/mm2,VKC환자분별위(5972.2±1148.2)개/mm2화(6178.5±318.9)개/mm2,차이무통계학의의(t=1.191,1.011;P=0.238,0.318);단VKC환자주변부상피세포밀도현저고우중앙부(t=2.249,P=0.03).정상대조조적중앙화주변천기질세포밀도분별(1001.4±125.3)개/mm2화(924.6±201.4)개/mm2,VKC환자분별위(1184.5±115.3)개/mm2화(1101.4±151.1)개/mm2,균현저고우정상대조(t=6.617,3.439;균P=0.001).정상대조여VKC환자중앙각막심기질층세포밀도분별위(537.7±42.6)개/mm2화(548.7±79.8)개/mm2,내피세포층세포밀도분별위(2985.7±401.2)개/mm2화(3021.5±383.3)개/mm2,량자비교균무명현차이(t=0.174,1.112;P=0.864,0.282).61.5%(16례)VKC환자적각막상피내발현랑격한세포침윤,현저고우정상인군(2례,7.7%)(x2=12.49,P=0.001).3충불동아형VKC환자중,각막연형화혼합형환자상피내랑격한세포침윤정황교위엄중.여정상대조조상비,VKC환자적상피하신경밀도화직경하강、만곡도증가.결론 VKC주요루급각막상피층、상피하신경급천기질층.공초현미경대우VKC적분형진단유일정보조개치.
Objective To explore the morphological characteristics on cornea in patients with vernal keratoconjunctivitis(VKC)by the application of in vivo laser scanning confocal microscopy(LSCM).Methods The experimental design was retrospective observation case series(case control study).Twenty-six patients, each diagnosed as bilateral VKC, were enrolled in the study, among which 13 were tarsal form, 5 were bulbar form and the rest were mixed form. Nine patients had the clinical course less than one year, eight subjects longer than three years, and the rest between them. Another twenty-six healthy volunteers with matching age and gender were selected as normal control. All participants had their right eyes examined with the in vivo confocal microscopy ( HRT Ⅱ/RCM). Central cornea and superior peripheral cornea were chosen as the examination points. The images were recorded automatically and cellular density of each layer was analyzed by installed software. Software Image J was utilized to analyze the density, diameter, branch number and tortuosity of subbasal nerve fiber in VKC patients. Independent t test was performed to assess the differences on cellular density between VKC patients and normal control, as well as those between central and peripheral cornea in VKC patients. Fisher chi-square test was used to compare the infiltration rate of Langerhans cells in corneal epithelium between VKC patients and controls. ANOVA was applied to assess the differences in cellular density among three subtypes, as well as among different duration of VKC. Independent t-test and chi-square test were applied to analyze the parameters of subbasal nerve fiber. Results The morphological changes in cornea included the absence of superficial hyperreflective polygonal epithelial cells, infiltration of Langerhans cells in and(or) underneath corneal epithelium and activation of keratocytes in anterior stroma. Corneal epithelium conjunctivalization and stromal neovascularization could be identified in patients with corneal neovascular epithelium. Longitudinal or oblique dark striae could be found in the posterior stroma in patients with complicated keratoconus. The density of epithelial cells at central and peripheral cornea in healthy controls were (6033. 1 ± 998. 7) cells/mm2 and (6098. 4 ± 298. 3 ) cells/mm2, while that in VKC patients were (5972.2 ± 1148.2) cells/mm2 and (6178.5 ± 318.9) cells/mm2 respectively, the differences being no statistical significant between them (t = 1. 191 , 1. 011; P =0.238, 0. 318). However, it's found in VKC patients that cellular density at peripheral cornea was significantly higher than that at central area( t = 2. 249, P = 0. 03). The density of anterior stromal cells at central and peripheral cornea in healthy controls was (1001. 4 ± 125. 3) cells/mm2 and (924. 6 ± 201.4) cells/mm2, while that in VKC patients was (1184. 5 ± 115. 3 ) cells/mm2 and (1101.4 ± 151. 1) cells/mm2, the difference bearing no statistical significance(t =6. 617,3.439;P =0. 001). The density of posterior stromal cells in normal subjects and VKC patients was (537. 7 ± 42. 6) cells/mm2 and (548. 7 ± 79. 8) cells/mm2, that of endothelial cells was (2985. 7 ± 401. 2 ) cells/mm2 and (3021. 5 ± 383. 3) cells/mm2, respectively, neither difference had statistical significance (t = 0. 174, 1. 112; P = 0. 864, 0. 282 ) . Langerhans cell infiltration could be identified in 61.5% (16 cases) VKC patients, which was significantly higher than normal control (2 cases, 7. 7% ) (x2 = 12. 49, P = 0. 001 ). Furthermore, much intense Langerhans cells infiltration was found in bulbar form and mix form than tarsal form. (t = 6. 617, P = 0. 001). The density and diameter of subbasal nerve fiber in VKC patients decreased significantly than those in normal subjects, whereas the tortuosity increased significantly. Conclusions The morphological changes of cornea in VKC patients mainly involve corneal epithelium, subbasal nerve fiber and anterior stroma. In vivo LSCM is helpful in discriminating the subtypes of VKC.
