真菌性角膜炎病源及病理学检查结果分析

目的 分析真菌性角膜炎病理学及病源检查的相关性以及病理学特点.方法 复习2005年至2007年经病理检查证实的77例真菌性角膜溃疡的真菌涂片和真菌培养结果,并分析真菌涂片、真菌培养与病理学诊断的相关性和病理形态学特点.真菌涂片使用10%KOH方法,真菌培养采用沙氏琼脂培养基.病理学检查的标本均为角膜移植术切除标本,采用石蜡切片,分别使用HE和PAS染色.结果 在77例真菌性角膜炎的角膜刮片标本中,真菌涂片阳性58例(75.3%);真菌培养阳性64例(83.1%),其中8例为酵母菌,56例为丝状真菌.真菌涂片和真菌培养假阴性标本的病理切片中显示,角膜表层真菌菌丝数量较少、有较多的坏死物质或真菌位于深部实质层.病理学所见显示,真菌性角膜溃疡为化脓性炎症,多数伴有角膜浅层组织坏死;真菌菌丝主要位于角膜浅层,部分病例中真菌菌丝扩展到角膜中层或全层,甚至会穿透后弹力层进入前房内.结论 真菌性角膜炎的临床检查中,角膜刮片少许组织,采用直接涂片观察真菌菌丝和真菌培养仍然是比较有效的实验室检查;与组织病理学结果比较,少数假阴性结果可能与角膜刮片的部位、角膜溃疡面积、角膜浅层组织坏死及真菌菌丝数量有关.

The relativity of laboratory pathogens examination with pathological diagnosis in fungal keratitis

Objective To analyze the pathological features and the relativity of microbiological pathogens with pathological examination. Methods The results of corneal scrapes and fungus culture of 77 cases with fungal corneal ulceration diagnosed by pathological examination from 2005 to 2007 were retrospec-tively analysis. The comparative evaluation of smear, fungus culture and pathological features was carried out.The paraffin section, HE and PAS staining were used in all the corneal specimens of pathological examination.Results In the 77 cases of corneal scrapes,58 cases (75.3%) showed fungal mycelia in 10% KOH smears,64 cases (83.1%) found fungal grow in fungus culture; among those cases,8 cases were yeast fungus,56 cases were mycelial fungus. The pathological specimens which were pseudo-negative cases in 10% KOH smears or fungus culture showed less fungal hyphae in the superficial corneal stroma,a lot of necrotic materials or the fungal hyphae in deep corneal stroma. The pathological characteristics of fungal corneal ulcers were purulent inflammation accompanying superficial tissue necrosis, which the fungal hyphae were usually situated in super-ficial stroma and could extended to deep or total stroma,occasioually penetrated Descemet's membrane into an-terior chamber. Conclusion In the clinical examination of fungal keratitis,corneai scrape with 10%KOH smears and fungus culture were more effective laboratory examination, comparing with the results of pathologi-cal examination,the pseudo-negative results would be responsible to the location of corneal scrape,size of corneal ulcers, more superficial tissue necrosis and the a amount of fungal hyphae.