2型糖尿病患者角膜基质细胞形态学特征的共焦显微镜观察

Morphologic characteristics of cornea stroma in type 2 diabetics observed with confocal microscopy

目的探讨2型糖尿病患者在共焦显微镜下角膜基质细胞形态学特征。方法应用Confoscan3.0共焦显微镜对120例(146眼)2型糖尿病患者和36例(36眼)同年龄对照组的中央角膜进行检查,依据双目间接眼底镜和荧光素眼底血管造影(FFA)检查的结果,将糖尿病患者分为3组糖尿病无眼底改变(NDR)组、非增生型糖尿病视网膜病变(NPDR)组、增生型糖尿病视网膜病变(PDR)组,记录角膜基质细胞和基质神经的图像,并对其进行分析。结果与对照组比较,糖尿病各组角膜的中基质细胞密度均较对照组降低,而前基质细胞的密度只在PDR组有明显的减少,后基质细胞在糖尿病视网膜病变组均明显降低。角膜基质中形态异常的神经纤维在糖尿病组中出现的概率也明显高于对照组,两组间有显著统计学意义(χ2=36.450,P=0.000)。结论共焦显微镜是一种有效无创的角膜检查方法;2型糖尿病患者角膜基质细胞密度减少,基质细胞、基质神经均存在形态学的异常。

Objective Diabetes mellitus （DM） can cause multiple ocular complications, whereas the DM-associated corneal damage has less report. This paper evaluated the morphological changes of corneal stroma in patients with type 2 diabetes using confocal microscope. Methods 146 eyes of 120 patients with type 2 diabetes were chosen as the study group of diabetes. Other 36 eyes of 36 matched subjects were as control group. On the basis of indirect ophthalmoscopic examination and fluorescein angiography,the study group was divided into three age-,sex-and course-matched sub-groups according to the stage of retinopathy： non-diabetic retinopathy （NDRP）, non-proliferative diabetic retinopathy （NPDR） and proliferative diabetic retinopathy （PDR）. The central corneas were scanned with confoscan 3.0. The images of stromal cells and characteristics of nerve fibers were analyzed. Results The cell density in anterior, middle and posterior stroma was 695.63 ± 137.49,521.74 ± 113.97 and 490. 88 ± 93.04, respectively in control group. Compared with control group, the cell density of mid-stroma was significantly decreased in NDRP, NPDR and PDR groups（490. 88 ± 93.04,439. 56 ± 50. 68 and 451.02 ± 80. 45, P 〈 0.01, P 〈 0.05,P 〈 0. 05） ,and the cell density of anterior stroma in the PDR sub-group was significantly reduced （486.05 ± 150. 04, P 〈 0. 01 ） ;whereas that of posterior stroma in both NPDR and PDR group was considerably lower（414. 31 ± 55.57,377. 76 ± 81.95, P 〈 0. 05,P 〈 0. 01 ）. The proportion of patients with abnormal nerve fibers in mid-stroma in diabetes group was higher than that in control group with a statistically significant difference （x^2 = 36. 450, P = 0. 000）. Conclusion Corneal confocal microscope allows rapid, noninvasive in vivo evaluation of the cornea. The cell density of corneal stroma in patients with type 2 diabetes is decreased and stromal nerves are abnormal in micromorphology.