共聚焦显微镜在感染性角膜炎诊断及疗效判定中应用价值.PDFVIP

《现代仪器与医疗》 2016年  第22卷   第4期 临床研究 共聚焦显微镜在感染性角膜炎诊断及疗效判定中 应用价值 1 2 杨华 　唐德荣 （1.第四军医大学西京医院健康管理中心，陕西西安　710032；2.安康市中心医院眼科，陕西安康　725000 ） [摘　要]　目的：分析共聚焦显微镜（In vivo confocal microscopy ，IVCM ）在感染性角膜炎诊断及病情评估 中应用价值。方法 ：选取2011 年3 月—2015 年3 月收治的98 例感染性角膜炎住院患者，于治疗前行IVCM、 角膜刮片镜检及溃疡标本细菌、真菌培养，而后行保守治疗，治疗失败者行角膜移植或眼内容物剜除。分别 于治疗2 周、治疗1 个月后再次行IVCM 检查，评价治疗效果。结果 ：IVCM 共检出真菌感染70 例，检出率 89.7%，检出细菌感染28 例，检出率90.3% ，总检出率为89.9% ；角膜刮片镜检共检出感染性角膜炎64 例，总 检出率58.7% ，其总检出率显著低于IVCM 检查，差异有统计学意义（ ＜0.05 ）。98 例患者中，行保守治疗的 P 患者，病原菌平均浸润深度为（64.37 ±8.85 ）μm ，行手术治疗的患者，病原菌平均浸润深度为（69.52 ±9.71 ） μm 。患者治疗2 周后治愈率为0 ，治疗1 个月后治愈率为67.3%。结论 ：作为一种无创诊断方式，IVCM 在感 染性角膜炎的早期诊断中具有较高价值，同时可准确评估患者病情改变，指导治疗方案的实施与预后评价，在 感染性角膜炎临床诊治中均发挥了重要作用。 [关键词]　共聚焦显微镜；感染性角膜炎；诊断 中图分类号：R772.2　文献标识码：B　文章编号：2095-5200(2016)04-023-04 DOI：10.11876/mimt201604009 Discussion on the application value ofIn vivo confocal microscopy (IVCM) in diagnosing and treatinginfectious keratitis　YANG Hua1 ，TANG Derong2 . (1.Health Management Center,Xijing Hospital,Xian 710032,China;2. Department of Ophthalmology,Ankang city central Hospital,Ankang 725000,China) [Abstract]　Objective: Analyze the application value of IVCM in diagnosing and assessing infectious keratitis. Methods: 98 patients with infectious keratitis hospitalized from March, 2011 to March 2015 were selected and checked with IVCM, microscopic examination of cornea smear, germ and fungi cultivation in ulcer, then they were treated with conservative methods. For patients who failed to recover, cornea was transplanted and eye imputieswas removed. Results: Through IVCM, 70 cases of fungi were detected (89.7%) and 28 cases of germs were discovered (90.3%). The overall detection rate was 89.9%. Through microscopic examination of cornea smear, 64 cases of infectious keratitis were detected, the overall detection rate standing as 58.7%, whi