本文關(guān)鍵詞： 角膜敏感性 角膜神經(jīng) 朗格漢斯細胞 NSSDE 角膜觸覺 角膜神經(jīng) 朗格漢斯細胞 角膜神經(jīng)痛 干眼癥 角膜知覺 角膜神經(jīng) 朗格漢斯細胞　出處：《復旦大學》2012年博士論文　論文類型：學位論文

【摘要】：第一部分 活體共焦顯微鏡下人角膜神經(jīng)形態(tài)及其與角膜敏感性的相關(guān)性研究 目的：觀察正常亞洲人角膜神經(jīng)密度、中央?yún)^(qū)朗格漢斯細胞(Langerhans cell, LC)密度及角膜敏感性的范圍,分析三者的年齡、性別特點及相關(guān)性。 方法：選取24位健康志愿者的24眼(10男14女,44.25±11.80歲),接受裂隙燈檢查、非接觸式眼壓測量、淚液分泌功能(Schirmer I test, SIt)、淚膜破裂時間(Tear Breakup Time, TBUT)、角膜熒光染色(Fluorescein, FL)、接觸式角膜知覺測量(Cochet-Bonnet角膜知覺計)和激光活體共聚焦顯微鏡(Laser In Vivo Confocal Microscopy, LSCM)檢查。量表詢問包括眼表疾病指數(shù)(Ocular Surface Disease Index, OSDI)和綜合醫(yī)院焦慮抑郁量表(Hospital Anxiety and Depression, HADS)評估。所有入組對象均詳細記錄相關(guān)病史和既往史。 結(jié)果：角膜觸覺在中央、上方、下方、鼻側(cè)、顳側(cè)等方位的均值依次為：58.70±3.76mm,41.67±16.53mm,42.08±15.32mm,47.71±15.88mm,50.21±14.10mm;周邊四個方位平均47.77±9.51mm；各方位平均49.96±8.16mm；兩兩比較顯示中央與上方(p=0.000)、下方(p=0.000)及周邊(p=0.012)均值的差異顯著；各年齡層間或性別間無顯著差異(p0.05)。LSCM下平均角膜神經(jīng)密度(u m/幅)為2442.09±653.05,男、女分別為2598.62±642.14,2222.95±634.65,性別間無統(tǒng)計學差異(p=0.170)。平均LC密度(個/mm2)為10.24±19.38,其中未成熟型7.90±14.85,成熟型2.34±5.11；男、女平均LC密度分別為13.84±23.44,5.21±10.86,性別間差異不顯著(p=0.292)。角膜觸覺、角膜神經(jīng)密度與角膜中央?yún)^(qū)LC密度三者間未見無明顯相關(guān)。 結(jié)論：角膜機械覺閾值及神經(jīng)密度水平與現(xiàn)有其他人種的報道結(jié)果相近,而中央?yún)^(qū)LC密度及其存在比例高于既往研究結(jié)果。三者均未發(fā)現(xiàn)年齡性別差異或相關(guān)性。 第二部分 非干燥綜合征干眼癥角膜神經(jīng)變化及其與癥狀的相關(guān)性研究 目的：觀察輕中度非干燥綜合征型干眼癥(non-Sjogren's syndrome dry eye, NSSDE)患者的癥狀、體征、角膜機械覺、角膜神經(jīng)形態(tài)學改變,并分析其相關(guān)性。 方法：選取2010年10月至2011年11月于復旦大學附屬眼耳鼻喉科醫(yī)院眼表病�？圃\斷為NSSDE的24眼(7男17女,平均48.13±13.87歲),設(shè)年齡及性別匹配的健康對照組24眼(10男14女,44.25±11.80歲),均接受裂隙燈檢查、非接觸式眼壓測量、淚液分泌功能(Schirmer Ⅰ test, SIt)、淚膜破裂時間(Tear Breakup Time, TBUT)、角膜熒光染色(Fluorescein, FL)、接觸式角膜知覺測量(Cochet-Bonnet角膜知覺計)和激光活體共聚焦顯微鏡(Laser In Vivo Confocal Microscopy, LSCM)檢查�；颊叩陌Y狀、疼痛程度及精神狀態(tài)分別通過眼表疾病指數(shù)(Ocular Surface Disease Index, OSDI)、視覺模擬評分法(Visual Analogue Scale, VAS)和綜合醫(yī)院焦慮抑郁量表(Hospital Anxiety and Depression Scale, HADS)予以評估。所有入組對象均詳細記錄相關(guān)病史和既往史。 結(jié)果：NSSDE組SIt、TBUT均值分別為9.75±5.99mm,3.92±2.31Sec,顯著低于正常組的14.26±8.18mm (p=0.036),11.89±6.43sec (p=0.000)。 NSSDE患者眼干及不適主訴明顯,OSDI及VAS分別為15.83±3.23、1.79±0.38,均顯著高于正常組的8.14±1.66和0.00(p值均0.001)。NSSDE患者HADS中焦慮(a)和抑郁(d)評價分別為4.84±3.00、4.21±3.55,與正常組(3.38±1.88；4.5±2.72)比均無統(tǒng)計學差異(p(a)=0.189, p(d)=0.988). NSSDE患者的各方位平均角膜機械覺閾值(48.91±7.42mm)與正常人(49.96±8.16mm)相當,組間比較p=0.622。NSSDE患者與正常組角膜神經(jīng)密度分別為2826.28±291.24u m/幅、2442.09±653.05μm/幅(p=0.030),兩組角膜中央?yún)^(qū)LC密度分別為33.43±39.80個/mm2、10.24±19.38個/mm2(p=0.014)。NSSDE患者中央?yún)^(qū)出現(xiàn)LC的比例為72.73%,高于正常組的41.67%。VAS與OSDI、角膜神經(jīng)密度,角膜LC密度呈正相關(guān),rho依次為0.722(p0.001)、0.322(p=0.032)、0.337(p=0.025)。TBUT與VAS、OSDI均呈負相關(guān),rho分別為-0.613(p0.001)、-0.600(p0.001)。Sit與TBUT呈正相關(guān),rho=0.342(p=0.019)。HADd與Sit呈負相關(guān),rho=-0.330(p=0.033); HADd與角膜神經(jīng)密度呈正相關(guān),rho=0.348(p=0.026)。 結(jié)論：輕中度NSSDE患者角膜機械覺無明顯變化,但其角膜神經(jīng)密度及炎癥細胞浸潤多明顯增加,且后兩者與干眼癥狀嚴重程度一致。 第三部分 角膜神經(jīng)痛的癥狀、體征及角膜神經(jīng)的形態(tài)學觀察 目的：觀察角膜神經(jīng)痛的臨床特點,探討該病有效的診斷方法。 方法：選取2010年10月至2011年11月于復旦大學附屬眼耳鼻喉科醫(yī)院眼表病�？圃\斷為角膜神經(jīng)痛的25眼(9男16女,平均47.08±14.57歲),設(shè)年齡及性別匹配的干眼癥對照組24眼(7男17女,平均48.13±13.87歲),健康對照組24眼(10男14女,44.25±11.80歲),三組均接受裂隙燈檢查、非接觸式眼壓測量、淚液分泌功能(Schirmer I test, SIt)、淚膜破裂時間(Tear Breakup Time, TBUT)、角膜熒光染色(Fluorescein, FL)、接觸式角膜知覺測量(Cochet-Bonnet角膜知覺計)和激光活體共聚焦顯微鏡(Laser In Vivo Confocal Microscopy, LSCM)檢查�；颊叩陌Y狀、疼痛程度及精神狀態(tài)分別通過眼表疾病指數(shù)(Ocular Surface Disease Index, OSDI)、視覺模擬評分法(Visual Analogue Scale, VAS)和綜合醫(yī)院焦慮抑郁量表(Hospital Anxiety and Depression Scale, HADS)予以評估。所有入組對象均詳細記錄相關(guān)病史和既往史。 結(jié)果：角膜神經(jīng)痛組的平均SIt (12.79±7.29mm), TBUT (11.90±3.67sec)及FL(0.02±0.14分)與正常對照組(14.26±8.18mm;11.89±6.43sec;0.02±0.15分)比無顯著差異(p0.1),而干眼癥組SIt(9.75±5.99mm)、TBUT(3.92±2.31sec)、FL(0.42±0.97分)皆異常(p0.001)。三組眼壓均正常,且HADS平均得分無統(tǒng)計學差別(p0.05)。神經(jīng)痛患者的OSDI (38.67±19.51)及VAS(5.29±1.74)均與干眼組(29.80±15.83；4.77±1.79)相近(p0.05),明顯高于正常組(7.84±8.26；0.00；p0.001),且OSDI與VAS正相關(guān)(rho=0.458,p0.01)。神經(jīng)痛患者的角膜機械覺更敏感(56.43±4.51mm),高于干眼(48.91±7.42mm)和健康組(49.96±8.16mm)(p0.001)。三組平均角膜神經(jīng)密度分別為(μm/幅)：神經(jīng)痛組3094.35±887.09：干眼癥組2668.36±534.59；正常組2476.08±600.23：差別顯著(p=0.011)；研究組的朗格漢斯細胞(LC)密度(個/mm2)59.51±83.12,高于干眼對照組33.43±39.80(p0.10),顯著高于正常組的10.24±19.38(p0.01)。LC密度與OSDI值間正相關(guān)(0.423,p=0.04)。 結(jié)論：角膜神經(jīng)痛是一種有干眼類似癥狀卻無“眼干”體征的疾病,常伴有角膜機械覺過度敏感、角膜神經(jīng)密度及中央?yún)^(qū)LC密度明顯增高,且與癥狀嚴重程度正相關(guān)；IVCM是該病確診的關(guān)鍵。
[Abstract]:Part one
The correlation of corneal nerve morphology and corneal sensitivity in human confocal microscopy
Objective: To observe the normal corneal nerve density of Central Asians, Lange Hans (Langerhans cell, LC) cell density range and corneal sensitivity, analysis of the three age, gender characteristics and correlation.
Methods: 24 eyes of 24 healthy volunteers (10 male and 14 female, 44.25 + 11.80 years), underwent slit lamp examination, non-contact intraocular pressure measurement, tear secretion (Schirmer I test, SIt), break-up time (Tear Breakup, Time, TBUT), corneal fluorescein staining (Fluorescein, FL). Contact corneal measurement (Cochet-Bonnet corneal meter) and laser in vivo confocal microscopy (Laser In Vivo Confocal Microscopy, LSCM). Check the scale about including the ocular surface disease index (Ocular Surface Disease Index, OSDI) and comprehensive hospital anxiety and Depression Scale (Hospital Anxiety and Depression, HADS) in all evaluation. Group of objects were recorded the related history and past history.
Results: the corneal touch in the center, above, below the nose side, the mean temporal range is as follows: 58.70 + 3.76mm, 41.67 + 16.53mm, 42.08 + 15.32mm, 47.71 + 15.88mm, 50.21 + 14.10mm; around four range was 47.77 + 9.51mm; the average range of 49.96 + 8.16mm; 22 shows the central and above and below (p=0.000) (p=0.000) and peripheral (p=0.012) mean significant difference; there is no obvious difference between age or sex between (P0.05).LSCM average corneal nerve density (U m/) 2442.09 + 653.05, male, female were 2598.62 + 642.142222.95 + 634.65, there was no significant difference between the sexes (p=0.170). The average LC density (/mm2) was 10.24 + 19.38, 7.90 + 14.85 in immature and mature 2.34 + 5.11; male, female average LC density was 13.84 + 23.44,5.21 + 10.86, no gender difference (p= 0.292). Corneal touch, corneal nerve density and corneal No significant correlation between the three central LC density were not found.
Conclusion: corneal nerve density and mechanical threshold level and others existing reports similar results, while the central LC density and the proportion is higher than the previous research results. There are gender and age differences or correlation were not found in three.
The second part
The study of corneal nerve change and its correlation with symptoms in dry eye of non dry syndrome
Objective: To observe the symptoms, signs, corneal mechanical changes and morphological changes of corneal nerves in patients with mild to moderate non dry syndrome non-Sjogren's syndrome dry (eye), and analyze their correlation.
Methods: from October 2010 to November 2011 in Otolaryngological Hospital Affiliated to Fudan University of ocular surface disease specialist diagnosed NSSDE in 24 eyes (7 male and 17 female, with an average of 48.13 + 13.87 years), healthy control group 24 eyes with age - and sex matched (10 male and 14 female, 44.25 + 11.80 years), were connected by slit lamp examination, non-contact measurement of intraocular pressure, tear secretion (Schirmer I test, SIt), break-up time (Tear Breakup, Time, TBUT), corneal fluorescein staining (Fluorescein, FL), corneal contact measurement (Cochet-Bonnet corneal meter) and laser in vivo confocal microscopy (Laser In Vivo Confocal Microscopy, LSCM) were checked. The symptoms, pain and mental status were ocular surface disease index (Ocular Surface Disease Index, by OSDI), visual analogue scale (Visual Analogue Scale, VAS) and the hospital anxiety and Depression Scale (Hospital Anxie Ty and Depression Scale, HADS) was evaluated. All the entry objects were recorded in detailed history and previous history.
緇撴灉錛歂SSDE緇凷It,TBUT鍧囧，

本文編號：1494336