【摘要】：目的：研究激光共聚焦顯微鏡HRT3-RCM在棘阿米巴角膜炎診斷中的應(yīng)用,比較分析與傳統(tǒng)診療辦法相比,該方法的優(yōu)缺點(diǎn),探討在治療過程中作為隨診觀察治療效果手段的意義。 方法：收集以往臨床確診棘阿米巴性角膜炎患者5例(5眼)的病歷資料,對(duì)比病人共聚焦顯微鏡檢查,及角膜刮片細(xì)菌、真菌鏡檢與培養(yǎng)及阿米巴原蟲鏡檢的結(jié)果。并按照患者入院確診時(shí)的裂隙燈表現(xiàn)區(qū)分為早期患者和晚期患者,探討使用共聚焦顯微鏡檢查對(duì)于早期發(fā)現(xiàn)及治療過程隨訪的重要意義。 結(jié)果：5患者中,4例患者裂隙燈檢查見角膜混濁、浸潤,基質(zhì)霧狀水腫,后彈力層皺褶,角膜潰瘍形成；1患者表現(xiàn)為典型角膜基質(zhì)環(huán)形浸潤。角膜刮片鏡檢及培養(yǎng)均無陽性病例。HRT3-RCM顯示棘阿米巴包囊位于角膜上皮下或淺層基質(zhì)150μm以內(nèi),1例患者角膜內(nèi)查見多個(gè)包囊,余均見1個(gè)包囊,包囊形態(tài)為圓形至橢圓形高回聲結(jié)構(gòu),雙層囊壁,大小為25-150μm,多為60μm左右,內(nèi)核形態(tài)類圓形。藥物治療過程中,2例患者包囊形態(tài)發(fā)生改變,為包囊變小,雙層囊壁結(jié)構(gòu)不清。1例患者治療12周后HRT3-RCM檢查包囊消失、基質(zhì)炎癥減退�；颊吲R床癥狀的加重與緩解與患者的就診時(shí)間及感染原蟲數(shù)目有關(guān)。 結(jié)論：共焦顯微鏡,是一種快速無創(chuàng)的檢查方法,實(shí)時(shí)活體檢查,具有高清晰度及分辨率、確切的深度定位、時(shí)間動(dòng)態(tài)觀察、縱向斷層掃描等優(yōu)勢(shì),可作為棘阿米巴性角膜炎病原學(xué)診斷及療程中隨訪觀察的重要輔助檢查手段。早期明確的診斷對(duì)于棘阿米巴角膜炎患者是否痊愈以及病程的長短具有重要意義,而共聚焦顯微鏡是當(dāng)前重要的早期快速確診角膜炎類型的輔助檢查之一。
[Abstract]:Objective: to study the application of laser confocal microscope (HRT3-RCM) in the diagnosis of Acanthamoeba keratitis. Methods: 5 cases (5 eyes) of Acanthoamoeba keratitis were collected and compared with the results of confocal microscope, corneal scraping bacteria, fungal microscopy and amoeba protozoa. According to the slit-lamp findings of admission, the patients were divided into early and late stage patients. The significance of confocal microscopy in early detection and follow-up was discussed. Results: in 5 cases, 4 cases showed corneal opacity, infiltration, matrix fog edema, posterior elastic layer fold, corneal ulcer formation, 1 typical corneal stroma ring infiltration. HRT3-RCM showed that Acanthamoeba cyst was located within 150 渭 m of the corneal subcutaneous or superficial stroma. In one case, multiple cysts were found in the cornea, and 1 cyst was found in the rest. The shape of the cyst is round to elliptical hyperechoic structure, double layer wall, 25-150 渭 m in size, mostly about 60 渭 m, and the core is round in shape. In the course of drug therapy, the cystic morphology was changed in 2 cases, the cyst became smaller and the structure of double layer cyst wall was unclear. After 12 weeks of treatment, HRT3-RCM examination disappeared and matrix inflammation decreased in 1 patient. The exacerbation of clinical symptoms was related to the time of visit and the number of infected protozoa. Conclusion: confocal microscope is a rapid and noninvasive examination method with high definition and resolution, precise depth location, time dynamic observation, longitudinal tomography and so on. It can be used as an important auxiliary examination for etiological diagnosis and follow-up observation of Acanthamoeba keratitis. Early and definite diagnosis is of great significance for the recovery and duration of the disease in patients with Acanthamoeba keratitis. Confocal microscopy is one of the most important assistant examinations for the early and rapid diagnosis of keratitis.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R772.21

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