角膜上皮树突状细胞和神经纤维密度与干眼程度的相关性研究

目的 应用角膜共聚焦显微镜观察不同程度干眼患者角膜上皮树突状细胞的密度和基底层下神经纤维的密度,以进一步探讨干眼和炎症及神经密度之间的关系,为干眼的诊断治疗提供依据。方法 收集2016年12月至2017年9月在我院门诊就诊的确诊为干眼的患者,轻度、中度和重度各20例(40只眼)进行共聚焦显微镜检查,观察测量角膜中央区域树突状细胞的密度及基底层下神经纤维的密度,比较不同程度干眼患者之间的变化。结果 轻度、中度、重度干眼患者角膜上皮树突状细胞密度与干眼程度呈正相关(r=0.293,P=0.001);角膜基底层下神经纤维密度与干眼程度为负相关(r=-0.331,P＜0.001)。随着干眼程度的增加,角膜上皮树突状细胞的密度增加,基底层下神经纤维密度下降。不同程度干眼患者角膜树突状细胞密度总体差异有统计学意义(H=11.502,P=0.003);神经纤维密度总体差异有统计学意义(H=13.157,P=0.001)。结论 角膜上皮树突状细胞的密度反映了干眼炎症的程度,基底层下神经纤维的密度反映了神经支配和营养,两者均与干眼程度相关,对其定量分析可以为干眼的诊断治疗提供依据。

Observation of corneal epithelial dendritic cells and nerve fibers in dry eye

Objective To observe the density of corneal epithelial dendritic cells and the density of subbasal nerve fibers in patients with different degrees of dry eye by confocal microscopy,so as to further explore the relationship between dry eye,inflammation and nerve density,and to provide evidence for the diagnosis and treatment of dry eye.Methods From December 2016 to September 2017,20 patients (40 eyes) with mild,moderate and severe dry eye were examined by confocal microscopy.Dendritic cell density in the central cornea and nerve fibers density in the basal layer were observed and measured,and the changes of the two were compared between patients with different degrees of dry eye.Results Dendritic cell density of corneal epithelium was positively correlated with the degree of dry eye (r=0.293,P=0.001) and negatively correlated with the degree of dry eye (r=-0.331,P＜0.001).With the increase of dry eye degree,the density of corneal epithelial dendritic cells increased and the density of basal nerve fibers decreased.There were significant differences in corneal dendritic cell density (H=11.502,P=0.003)and nerve fiber density (H=13.157,P=0.001) in different degrees of dry eye.Conclusion The density of corneal epithelial dendritic cells reflects the degree of dry eye inflammation,and the density of subbasal nerve fibers reflects nerve innervation and nutrition.Both of them are related to the degree of dry eye.Quantitative analysis of them can provide a basis for diagnosis and treatment of dry eye.