CAJ | 학술논문

目的探讨氯己定(洗必泰)对棘阿米巴角膜炎患者角膜内分离培养虫株的作用,为临床治疗棘阿米巴角膜炎提供实验室依据.方法实验研究.利用扫描电镜观察分离培养虫株的形态特征以及0.02%氯己定作用后的结构变化;利用透射电镜观察角膜病变组织内棘阿米巴的超微结构特征.结果体外培养的棘阿米巴滋养体大小约15～45μm呈圆形、椭圆形、不规则形状,虫体体表粗糙,有棘状胞质突起,以二分裂方式繁殖.包囊大小约10～25 μm,球形,表面见皱襞、壁孔及圆形孔盖.棘阿米巴自壁孔处逸出转变成滋养体,脱囊后遗留空囊.经0.02%氯己定作用24 h后的滋养体和包囊结构被破坏,虫体崩解成残膜碎片或凝块、颗粒状.经过抗棘阿米巴治疗后的角膜病变组织内未见滋养体,仅见包囊.包囊内外壁结构基本保留,但细胞质蛋白凝固,哑细胞结构退变缺失,包囊处于变性失活状态.结论 0.02%氯己定在体外可杀灭棘阿米巴滋养体和包囊,在组织内可杀灭棘阿米巴滋养体,致包囊变性失活.变性失活的棘阿米巴包囊仍可较长时间存留在角膜组织中,并可引发免疫病理性炎性反应,临床治疗中应引起注意.
목적 탐토록기정(세필태)대극아미파각막염환자각막내분리배양충주적작용,위림상치료극아미파각막염제공실험실의거.방법 실험연구.이용소묘전경관찰분리배양충주적형태특정이급0.02%록기정작용후적결구변화;이용투사전경관찰각막병변조직내극아미파적초미결구특정.결과 체외배양적극아미파자양체대소약15～45μm정원형、타원형、불규칙형상,충체체표조조,유극상포질돌기,이이분렬방식번식.포낭대소약10～25 μm,구형,표면견추벽、벽공급원형공개.극아미파자벽공처일출전변성자양체,탈낭후유류공낭.경0.02%록기정작용24 h후적자양체화포낭결구피파배,충체붕해성잔막쇄편혹응괴、과립상.경과항극아미파치료후적각막병변조직내미견자양체,부견포낭.포낭내외벽결구기본보류,단세포질단백응고,아세포결구퇴변결실,포낭처우변성실활상태.결론 0.02%록기정재체외가살멸극아미파자양체화포낭,재조직내가살멸극아미파자양체,치포낭변성실활.변성실활적극아미파포낭잉가교장시간존류재각막조직중,병가인발면역병이성염성반응,림상치료중응인기주의.
Objective To observe the ultrastructure of the strains of acanthamoeba isolated from acanthamoeba keratitis (AK), the morphologic changes of acanthamoeba after culture with 0.02% chlorhexidine, and ultrastructure characteristics of acanthamoeba in corneal tissue of AK. Methods It was a experimental study. The uhrastructure of acanthamoeba strains cultured with 0.02% chlorbexidine was observed with scanning electron microscope (SEM). The excited cornea tissues from AK were observed with transmission electron microscope (TEM). Results Cultured acanthamoeba trophozoites were approximately 15-45 μm in diameter, appeared irregularly round or oval in shape, with rough surface and intrusion of cytoplasm. The trophozoite propagated by ways of binary division. The acanthamoeba cysts were approximately 10-25 μm in diameter, round in shape and with a plica-like surface. The acanthomoeba could change from trophozoite to cyst. The amoeba emerging through ostioles could turn into trophozoite and left an empty cyst After cultured with 0.02% chlorhexidine for 24 hours, the trophozoite and cyst collapsed and distorted. However, after clinical treatment with 0.02% ehiorhexidine, only the cysts could be seen in corneal tissue of AK. Eetro-and endo-cystic walls were preserved, but the cytoplasma was aggregated and the sub-cytoarehitectures were degenerated or disappeared. Discussion Chlorhexidine at a concentration of 0.02% kills acanthamoeba trophozoites and cysts in vitro. Chlorhexidine (0.02%) also kills trophozoites and inhibits the activity of cysts in corneal tissues. However, it should be noticed that the inactive cysts can stay in the cornea for a long time and may cause an immuno-pathologic inflammation of the cornea.