CAJ | 학술논문

背景真菌性角膜炎的早期诊断对有效治疗极为重要,但目前尚缺乏能够准确、定量诊断和判断疗效的客观指标.研究证实血浆中(1,3)-β-D-葡聚糖对全身真菌感染性疾病诊断有较高的敏感性和特异性,但泪液中(1,3)-β-D-葡聚糖含量的检测能否用于角膜真菌感染患者的早期诊断和病情监测尚不清楚.目的观察真菌性角膜炎患者接受抗真菌药物治疗过程中泪液中(1,3)-β-D-葡聚糖质量浓度的变化,客观评价其在真菌性角膜炎诊断和病情监测中的临床价值.方法选取2010年7月至2012年5月在青岛大学医学院附属医院眼科诊治的角膜溃疡直径≤5 mm的真菌性角膜炎患者60例60眼为患病组,同期健康无眼疾的成年志愿者30人30眼为正常对照组.患病组接受抗真菌药物治疗,平均治疗时间为29 d.分别在治疗前及治疗后7、14、28 d和停药后7d、14 d收集患眼泪液50μl,进行(1,3)-β-D-葡聚糖质量浓度检测,同时结合激光扫描共焦显微镜检查及患者临床表现,对(1,3)-β-D-葡聚糖的诊断价值进行评估.对泪液中(1,3)-β-D-葡聚糖质量浓度低于20 ng/L、激光扫描共焦显微镜检查未发现菌丝的患者,巩固治疗1周后停药,随访2个月. 结果治疗前,患病组患者泪液中(1,3)-β-D-葡聚糖质量浓度为(Log) (6.37 ±0.48) ng/L,明显高于正常对照组(Log)的(2.00±0.31)ng/L,差异有统计学意义(t=2.89,P＜0.01).真菌性角膜炎患者病情在治疗7 d后开始好转,表现为溃疡边界逐渐清晰,病灶面积缩小,激光扫描共焦显微镜下显示菌丝密度比治疗前降低等.患病组患者泪液中(1,3)-β-D-葡聚糖质量浓度随着治疗时间的延长逐渐下降,其变化呈时间依赖性.治疗后7、14、28 d患者泪液中(1,3)-β-D-葡聚糖质量浓度(Log)分别为(5.19±0.42)、(4.16±0.33)、(2.99±0.42) ng/L,停药后7d、14 d分别为(2.91±0.39) ng/L、(2.80 ±0.40) ng/L,均明显低于治疗前的(6.37±0.48) ng/L,差异均有统计学意义(P＜0.01).治疗后28 d至随访结束,患者泪液中(1,3)-β-D-葡聚糖保持稳定的低质量浓度,随访期间所有患者均无复发.结论作为一种定量检测方法,泪液中(1,3)-β-D-葡聚糖水平的检测可用于真菌性角膜炎的早期诊断及病情变化监测. 揹景真菌性角膜炎的早期診斷對有效治療極為重要,但目前尚缺乏能夠準確、定量診斷和判斷療效的客觀指標.研究證實血漿中(1,3)-β-D-葡聚糖對全身真菌感染性疾病診斷有較高的敏感性和特異性,但淚液中(1,3)-β-D-葡聚糖含量的檢測能否用于角膜真菌感染患者的早期診斷和病情鑑測尚不清楚.目的觀察真菌性角膜炎患者接受抗真菌藥物治療過程中淚液中(1,3)-β-D-葡聚糖質量濃度的變化,客觀評價其在真菌性角膜炎診斷和病情鑑測中的臨床價值.方法選取2010年7月至2012年5月在青島大學醫學院附屬醫院眼科診治的角膜潰瘍直徑≤5 mm的真菌性角膜炎患者60例60眼為患病組,同期健康無眼疾的成年誌願者30人30眼為正常對照組.患病組接受抗真菌藥物治療,平均治療時間為29 d.分彆在治療前及治療後7、14、28 d和停藥後7d、14 d收集患眼淚液50μl,進行(1,3)-β-D-葡聚糖質量濃度檢測,同時結閤激光掃描共焦顯微鏡檢查及患者臨床錶現,對(1,3)-β-D-葡聚糖的診斷價值進行評估.對淚液中(1,3)-β-D-葡聚糖質量濃度低于20 ng/L、激光掃描共焦顯微鏡檢查未髮現菌絲的患者,鞏固治療1週後停藥,隨訪2箇月. 結果治療前,患病組患者淚液中(1,3)-β-D-葡聚糖質量濃度為(Log) (6.37 ±0.48) ng/L,明顯高于正常對照組(Log)的(2.00±0.31)ng/L,差異有統計學意義(t=2.89,P＜0.01).真菌性角膜炎患者病情在治療7 d後開始好轉,錶現為潰瘍邊界逐漸清晰,病竈麵積縮小,激光掃描共焦顯微鏡下顯示菌絲密度比治療前降低等.患病組患者淚液中(1,3)-β-D-葡聚糖質量濃度隨著治療時間的延長逐漸下降,其變化呈時間依賴性.治療後7、14、28 d患者淚液中(1,3)-β-D-葡聚糖質量濃度(Log)分彆為(5.19±0.42)、(4.16±0.33)、(2.99±0.42) ng/L,停藥後7d、14 d分彆為(2.91±0.39) ng/L、(2.80 ±0.40) ng/L,均明顯低于治療前的(6.37±0.48) ng/L,差異均有統計學意義(P＜0.01).治療後28 d至隨訪結束,患者淚液中(1,3)-β-D-葡聚糖保持穩定的低質量濃度,隨訪期間所有患者均無複髮.結論作為一種定量檢測方法,淚液中(1,3)-β-D-葡聚糖水平的檢測可用于真菌性角膜炎的早期診斷及病情變化鑑測.
배경 진균성각막염적조기진단대유효치료겁위중요,단목전상결핍능구준학、정량진단화판단료효적객관지표.연구증실혈장중(1,3)-β-D-포취당대전신진균감염성질병진단유교고적민감성화특이성,단루액중(1,3)-β-D-포취당함량적검측능부용우각막진균감염환자적조기진단화병정감측상불청초.목적 관찰진균성각막염환자접수항진균약물치료과정중루액중(1,3)-β-D-포취당질량농도적변화,객관평개기재진균성각막염진단화병정감측중적림상개치.방법 선취2010년7월지2012년5월재청도대학의학원부속의원안과진치적각막궤양직경≤5 mm적진균성각막염환자60례60안위환병조,동기건강무안질적성년지원자30인30안위정상대조조.환병조접수항진균약물치료,평균치료시간위29 d.분별재치료전급치료후7、14、28 d화정약후7d、14 d수집환안루액50μl,진행(1,3)-β-D-포취당질량농도검측,동시결합격광소묘공초현미경검사급환자림상표현,대(1,3)-β-D-포취당적진단개치진행평고.대루액중(1,3)-β-D-포취당질량농도저우20 ng/L、격광소묘공초현미경검사미발현균사적환자,공고치료1주후정약,수방2개월. 결과 치료전,환병조환자루액중(1,3)-β-D-포취당질량농도위(Log) (6.37 ±0.48) ng/L,명현고우정상대조조(Log)적(2.00±0.31)ng/L,차이유통계학의의(t=2.89,P＜0.01).진균성각막염환자병정재치료7 d후개시호전,표현위궤양변계축점청석,병조면적축소,격광소묘공초현미경하현시균사밀도비치료전강저등.환병조환자루액중(1,3)-β-D-포취당질량농도수착치료시간적연장축점하강,기변화정시간의뢰성.치료후7、14、28 d환자루액중(1,3)-β-D-포취당질량농도(Log)분별위(5.19±0.42)、(4.16±0.33)、(2.99±0.42) ng/L,정약후7d、14 d분별위(2.91±0.39) ng/L、(2.80 ±0.40) ng/L,균명현저우치료전적(6.37±0.48) ng/L,차이균유통계학의의(P＜0.01).치료후28 d지수방결속,환자루액중(1,3)-β-D-포취당보지은정적저질량농도,수방기간소유환자균무복발.결론 작위일충정량검측방법,루액중(1,3)-β-D-포취당수평적검측가용우진균성각막염적조기진단급병정변화감측.
Background The diagnosis and treatment of fungal keratitis are knotty.There is no quantitative method to identify the disease and judge the therapeutic effect of the antifungal agent.Studies have determined that serum (1,3-) β-D-glucan level can sensitively and specifically reflect the state of systemic mycotic-causing diseases.However,whether (1,3-) β-D-glucan level in tear can monitor and diagnose mycotic keratitis is unclear.Objective Purpose of this study was to investigate the change of tear (1,3-) β-D-glucan level following the administration of antifungal drug in fungal keratitis patients,and evaluate the diagnosis and monitor value of (1,3-) β-D-glucan in tears for fungal keratitis.Methods Sixty patients who were diagnosed as fungal keratitis by fungal culture were analyzed in Affiliated Hospital of Qingdao University Medical College from July 2010 to May 2012.The patients received the topical administration of antifungal drug for 28 days.Thirty healthy volunteers without eye disease served as normal controls.The tear of 50 μl was collected from each subject for the detection of (1,3)-β-D-glucan before the therapy,7,14,28 days after therapy and 7 days,14 days after the drugs were stopped,respectively.The dynamic changes of (1,3-) β-D-glucan levels in tears were evaluated and compared with the manifestation of the lesions under the laser scanning confocal microscope.The patients without hyphal by the laser scanning confocal microscopy and tear (1,3-)β-D-glucan level less than 20 ng/L were subsequently treated for another 7 days,and the following-up duration was 2 months.The informed consent was obtained before any medical examination was performed from each subject.Results (1,3-)β-D-glucan level in tears (Log value) was (6.37 ±0.48)ng/L in the patient group,and was significantly higher than (2.00±0.31) ng/L in the normal control group (t =2.89,P＜0.01).The lesion was smaller with the gradually clear border,and the number of mycelia was decreased under the laser scanning confocal microscope 7 days after treatment.(1,3-) β-D-glucan level in tears was gradually declined in a time-dependent manner after treatment.The (1,3)-β-D-glucan level in tears (Log) was (5.19 ± 0.42),(4.16 ± 0.33),(2.99 ±0.42),(2.91 ±0.39),(2.80±0.40) ng/L 7,14,28 days after treatment,and 7 days,14 days after the drugs were stopped,respectively,with a statistically significant difference in comparison with (6.37±0.48)ng/L before treatment (P＜0.01).(1,3)-β-D-gluean level in tears remained a lower level till the end of follow-up,and no recurrence of lesion was found in the patient group.Conclusions Detecting (1,3)-β-D-glucan level in tears is of good diagnosis and monitor value in the evaluation of fungal keratitis.