中国实用眼科杂志
中國實用眼科雜誌
중국실용안과잡지
CHINESE JOURNAL OF PRACTICAL OPHTHALMOLOGY
2013年
10期
1349-1356
,共8页
殷丽%姚勇%杨国仪%管怀进%杨玲
慇麗%姚勇%楊國儀%管懷進%楊玲
은려%요용%양국의%관부진%양령
非结核分枝杆菌%角膜炎%临床病理学%动物模型
非結覈分枝桿菌%角膜炎%臨床病理學%動物模型
비결핵분지간균%각막염%림상병이학%동물모형
Non-tuberculous mycobacteria%Keratitis%Clinical pathology%Animal model
目的 非结核分枝杆菌性角膜炎(non-tuberculous mycobacteria keratitis,NTMK)有快速增加趋势.目前,国内外有关NTMK的病理学研究较少.文中为探讨兔NTMK的临床病理变化.方法 将50只兔(50只眼)随机分为两组:A组(单纯接种细菌组)及B组(接种细菌联合局部使用糖皮质激素组).观察角膜基质炎症浸润情况,并于接种后5、7、14、21、28、42及63天进行角膜病灶细菌定量培养、组织病理学检查、免疫组织化学检查及7、14、21及28天进行透射电镜检查.结果 兔NT-MK在接种后5天角膜浅基质层出现灰白色点状或不规则小浸润灶；7～14天浸润逐渐扩大加深,融合成基质内脓肿或形成溃疡,并出现多个卫星灶、感染性结晶样角膜病变；14～21天大部分兔角膜浸润逐渐减轻,溃疡逐渐为瘢痕组织取代,新生血管形成.但部分动物此期感染加重,出现新生血管破裂出血、角膜中央大溃疡及角膜穿孔.21天后角膜出现瘢痕性混浊.病变严重兔角膜穿孔后形成葡萄肿.角膜基质浸润面积,B组大于A组,差异有统计学意义(F =5.470,P＜0.05).14～21天两组模型角膜溃疡的发生率比较有统计学意义(P＜0.05).7、14天角膜细菌定量培养,A组高于B组,差异有统计学意义(P＜0.05).病理学观察,5～7天浅基质层大量中性白细胞浸润；14天,A组角膜大量淋巴细胞浸润,而B组仍以中性白细胞为主；28天,A组兔角膜上皮明显增生,基质层结构紊乱,新生血管形成,而B组浅基质层大量淋巴细胞浸润,成纤维细胞增生明显；42～63天大部分呈修复完成状态.接种后7、14天角膜组织中CD4+细胞计数差异均有统计学意义(P＜0.05),CD8+细胞计数在接种后7、14、21天差异均有统计学意义(P＜0.05).透射电镜下观察,7天大量中性白细胞浸润,并见大量分枝杆菌；14～21天大量中性白细胞、淋巴细胞及单核细胞浸润；28天基质层纤维组织增生、排列紊乱,分枝杆菌较少见.结论 角膜基质多灶性点、片状灰白浸润为兔NTMK的临床特征.感染早期呈急性化脓性炎症改变,中晚期呈一般慢性炎症改变.糖皮质激素的使用可使病情加重,病程延长.
目的 非結覈分枝桿菌性角膜炎(non-tuberculous mycobacteria keratitis,NTMK)有快速增加趨勢.目前,國內外有關NTMK的病理學研究較少.文中為探討兔NTMK的臨床病理變化.方法 將50隻兔(50隻眼)隨機分為兩組:A組(單純接種細菌組)及B組(接種細菌聯閤跼部使用糖皮質激素組).觀察角膜基質炎癥浸潤情況,併于接種後5、7、14、21、28、42及63天進行角膜病竈細菌定量培養、組織病理學檢查、免疫組織化學檢查及7、14、21及28天進行透射電鏡檢查.結果 兔NT-MK在接種後5天角膜淺基質層齣現灰白色點狀或不規則小浸潤竈；7～14天浸潤逐漸擴大加深,融閤成基質內膿腫或形成潰瘍,併齣現多箇衛星竈、感染性結晶樣角膜病變；14～21天大部分兔角膜浸潤逐漸減輕,潰瘍逐漸為瘢痕組織取代,新生血管形成.但部分動物此期感染加重,齣現新生血管破裂齣血、角膜中央大潰瘍及角膜穿孔.21天後角膜齣現瘢痕性混濁.病變嚴重兔角膜穿孔後形成葡萄腫.角膜基質浸潤麵積,B組大于A組,差異有統計學意義(F =5.470,P＜0.05).14～21天兩組模型角膜潰瘍的髮生率比較有統計學意義(P＜0.05).7、14天角膜細菌定量培養,A組高于B組,差異有統計學意義(P＜0.05).病理學觀察,5～7天淺基質層大量中性白細胞浸潤；14天,A組角膜大量淋巴細胞浸潤,而B組仍以中性白細胞為主；28天,A組兔角膜上皮明顯增生,基質層結構紊亂,新生血管形成,而B組淺基質層大量淋巴細胞浸潤,成纖維細胞增生明顯；42～63天大部分呈脩複完成狀態.接種後7、14天角膜組織中CD4+細胞計數差異均有統計學意義(P＜0.05),CD8+細胞計數在接種後7、14、21天差異均有統計學意義(P＜0.05).透射電鏡下觀察,7天大量中性白細胞浸潤,併見大量分枝桿菌；14～21天大量中性白細胞、淋巴細胞及單覈細胞浸潤；28天基質層纖維組織增生、排列紊亂,分枝桿菌較少見.結論 角膜基質多竈性點、片狀灰白浸潤為兔NTMK的臨床特徵.感染早期呈急性化膿性炎癥改變,中晚期呈一般慢性炎癥改變.糖皮質激素的使用可使病情加重,病程延長.
목적 비결핵분지간균성각막염(non-tuberculous mycobacteria keratitis,NTMK)유쾌속증가추세.목전,국내외유관NTMK적병이학연구교소.문중위탐토토NTMK적림상병리변화.방법 장50지토(50지안)수궤분위량조:A조(단순접충세균조)급B조(접충세균연합국부사용당피질격소조).관찰각막기질염증침윤정황,병우접충후5、7、14、21、28、42급63천진행각막병조세균정량배양、조직병이학검사、면역조직화학검사급7、14、21급28천진행투사전경검사.결과 토NT-MK재접충후5천각막천기질층출현회백색점상혹불규칙소침윤조；7～14천침윤축점확대가심,융합성기질내농종혹형성궤양,병출현다개위성조、감염성결정양각막병변；14～21천대부분토각막침윤축점감경,궤양축점위반흔조직취대,신생혈관형성.단부분동물차기감염가중,출현신생혈관파렬출혈、각막중앙대궤양급각막천공.21천후각막출현반흔성혼탁.병변엄중토각막천공후형성포도종.각막기질침윤면적,B조대우A조,차이유통계학의의(F =5.470,P＜0.05).14～21천량조모형각막궤양적발생솔비교유통계학의의(P＜0.05).7、14천각막세균정량배양,A조고우B조,차이유통계학의의(P＜0.05).병이학관찰,5～7천천기질층대량중성백세포침윤；14천,A조각막대량림파세포침윤,이B조잉이중성백세포위주；28천,A조토각막상피명현증생,기질층결구문란,신생혈관형성,이B조천기질층대량림파세포침윤,성섬유세포증생명현；42～63천대부분정수복완성상태.접충후7、14천각막조직중CD4+세포계수차이균유통계학의의(P＜0.05),CD8+세포계수재접충후7、14、21천차이균유통계학의의(P＜0.05).투사전경하관찰,7천대량중성백세포침윤,병견대량분지간균；14～21천대량중성백세포、림파세포급단핵세포침윤；28천기질층섬유조직증생、배렬문란,분지간균교소견.결론 각막기질다조성점、편상회백침윤위토NTMK적림상특정.감염조기정급성화농성염증개변,중만기정일반만성염증개변.당피질격소적사용가사병정가중,병정연장.
Objective To study clinical pathological changes of NTMK in rabbits.Methods Fifty rabbits with NTMK were divided into 2 groups:group A (simple inoculation of bacteria group)and group B (inoculation of bacteria and topical glucocorticoid-treated group).The corneal infilitration of all rabbits were observed.Bacterial quantitative culture,histopathological and immunohistochemical examination were performed on the 5th,7th,14th,21st,28th,42nd and 63rd day,transmission electron microscope (TEM) on the 7th,14th,21st and 28th day.Results In the earliest stage (5 days),the cornea was cloudy and edematous and a punctate infiltration was noted.Among 7 to 14 days,the infiltration enlarged and deepened into abscess and ulcer,a lot of satellite lessions and infectious crystalline keratopathy were noted.Among 14 to 21 days,the infiltration relieved and the ulcer were insteaded by scar.The infections worsened,cornea punching occurred and big ulcers were noted in some animials.After 21 days,corneal fibrosis developed and scar formed.The mean stromal infiltration areas in group B was greater than than those of group A (F =5.470,P =0.047＜0.05).The number of NTM in group B was higher than than those of group A (P =0.035 or 0.04on the 7th or 14th day).The histopathological examination,there were plenty of neutrophile granulocyte and acid-fast bacilli in the corneal stroma.Then a lot of lymphocytes were noted.In the latter stage,the fibroblast cells proliferation and corneal ulcer were cured.Granulation tissue and fibroblasts proliferation and infilitration with a plenty of neutrophile granulocyte were found in the cornea punching ones.On the 7th and 14th day,the number of CD4+ T lymphocyte increased significantly in group A compared with group B (P ＜0.05).On the 7th,14th and 21st day,the number of CD8+ T lymphocyte increased significantly (P ＜0.05).Lots of neutrophile granulocyte and acid-fast bacilli were noted by TEM in the early stage.Latter,fibrous tissue proliferated.Conclusions Multifocal superficial canous stromal infilitrates is the clinical characteristic of NTMK in rabbits.In the early stage,NTMK presents acute purulent inflammatory changes,the advanced stage shows chronic and non-specificity inflammation changes.The disease is aggravated and prolonged after use of glucocorticoid.
