CAJ | 학술논문

目的采用角膜激光共聚焦显微镜观察角膜浅层斑翳形成过程中的眼表郎罕细胞(langerhans' cells,LC),分析LC在角膜浅层斑翳形成中的作用.方法临床病例实验研究.对2006年1月至2013年12月在深圳市眼科医院就诊的342例(342只眼)浅层角膜溃疡和角膜炎、轻度的角膜外伤和化学伤患者,进行连续的共聚焦显微镜检查观察,对恢复期的LC共聚焦显微镜图像进行研究总结,分析LC在角膜浅层斑翳形成中所起的作用.结果 (1) 342例(342只眼)中,有317例(317只眼)患者在角膜激光共聚焦显微镜检查中发现郎罕细胞从角膜缘的毛细血管和(或)新生血管中游离移行出来,占92.69％ (317/342). (2)有287例(287只眼)发现郎罕细胞移行参与角膜上皮细胞层及前弹力层的修复过程,占83.92％ (287/342).(3)有231例(231只眼)发现郎罕细胞在角膜上皮修复后继续移行至病灶周边部,同时郎罕细胞变形、伸出更多突触,开始参与角膜浅层斑翳的修复过程,占67.54％(231/342).(4)有322例(322只眼)发现郎罕细胞移行聚集至病灶处,参与与角膜浅层斑翳的修复过程,占94.15％ (322/342).结论郎罕细胞在角膜浅层斑翳的形成中有重要作用,根据研究将其分为三个阶段:第1阶段渗漏移行期:毛细血管或者新生血管扩展,郎罕细胞从血管中移行出来.第2阶段角膜上皮及前弹力层的修复移行期:郎罕细胞向病灶聚集移行,参与角膜上皮的修复过程和前弹力层的修复过程.第3阶段角膜浅层斑翳形成期:郎罕细胞在溃疡灶处聚集,参与浅层斑翳的形成.
목적 채용각막격광공취초현미경관찰각막천층반예형성과정중적안표랑한세포(langerhans' cells,LC),분석LC재각막천층반예형성중적작용.방법 림상병례실험연구.대2006년1월지2013년12월재심수시안과의원취진적342례(342지안)천층각막궤양화각막염、경도적각막외상화화학상환자,진행련속적공취초현미경검사관찰,대회복기적LC공취초현미경도상진행연구총결,분석LC재각막천층반예형성중소기적작용.결과 (1) 342례(342지안)중,유317례(317지안)환자재각막격광공취초현미경검사중발현랑한세포종각막연적모세혈관화(혹)신생혈관중유리이행출래,점92.69％ (317/342). (2)유287례(287지안)발현랑한세포이행삼여각막상피세포층급전탄력층적수복과정,점83.92％ (287/342).(3)유231례(231지안)발현랑한세포재각막상피수복후계속이행지병조주변부,동시랑한세포변형、신출경다돌촉,개시삼여각막천층반예적수복과정,점67.54％(231/342).(4)유322례(322지안)발현랑한세포이행취집지병조처,삼여여각막천층반예적수복과정,점94.15％ (322/342).결론 랑한세포재각막천층반예적형성중유중요작용,근거연구장기분위삼개계단:제1계단삼루이행기:모세혈관혹자신생혈관확전,랑한세포종혈관중이행출래.제2계단각막상피급전탄력층적수복이행기:랑한세포향병조취집이행,삼여각막상피적수복과정화전탄력층적수복과정.제3계단각막천층반예형성기:랑한세포재궤양조처취집,삼여천층반예적형성.
Objective To observe the Langerhans' cells in the formation of superficial corneal macula by confocal microscopy.Analyze the role of LC in the superficial corneal macula formation.Methods To consecutively observe the 342 patients(342 eyes)with superficial corneal ulcers or keratitis,mild corneal trauma or chemical burn by confocal microscopy.The confocal microscope images of LC in the forming of the superficial corneal macula were summarized and analyzed.The role of the LC in the recovery time was studied.Results (1)In 342 cases(342 eyes),there were 317 cases(317 eyes)found Langerhans' cells migration from the limbal capillaries or neovascularization by confocal microscopy,accounted for 92.69％.(2)There were 287 cases(287 eyes)found Langerhans' cells migration in the corneal epithelium and Bowman's layer in the repair process,accounted for 83.92％.3.There were 231 cases(231 eyes)found Langerhans' cells continue to shift to the lesions in the peripheral corneal epithelial repair,and Langerhans' cells deformation,extending more synapses,began to participate in the repair process of superficial corneal macula,accounted for 67.54％.4.There were 322 cases(322 eyes)found Langerhans' cells migration accumulation to participate the repair process of superficial corneal macula,accounted for 94.15％.Conclusion Langerhans' cells have an important role in the superficial corneal macula formation.According to our study,the processes will be divided into three stages by confocal microscopy.The first stage leakage transitional period:Capillary or new blood vessels to dilate,Langerhans' cells migration from blood vessels.The second stage of repair corneal epithelium and Bowman's layer of the transitional period:Aggregation transitional Langerhans' cellss to the lesion,participate in the corneal epithelium and Bowman's layer repair repair process.The third stage of formation of shallow layer corneal macula:Langerhans' cells aggregation in the ulcer lesions,involved in the formation of shallow macula.