Sjgren综合征患者的角膜激光共焦显微镜活体观察

In vivo confocal laser microscopy of corneas in patients with Sjgren's syndrome

目的应用激光共焦显微镜观察Sjgren综合征(SS)患者角膜各层的形态改变。方法应用激光共焦显微镜对15例(30眼)SS患者和15例(30眼)同龄正常对照组的角膜进行检查,获取角膜全层图像,并进行比较、分析。结果与对照组相比,SS组角膜上皮各层细胞密度均明显下降,并出现炎性细胞和树突状细胞浸润。角膜基质细胞呈多突起星状,细胞体积增大,胞核反光减弱,胞质反光增强,浅基质出现炎性细胞浸润。SS组较对照组角膜上皮下神经纤维变细,弯曲度变大,走行方向明显改变,部分神经纤维断裂。结论SS患者不仅角膜上皮、浅基质细胞、上皮下神经出现明显改变,且角膜基质细胞形态与角膜免疫状态均出现异常。

Objective The confocal laser microscopy is a real-time, non-invasive examination way of cornea,which can give an more objective, accurate and comprehensive evaluation of corneal conditions. This study was to observe the corneal morphological abnormalities in patients with Sjoegren＇s syndrome（-SS） by laser confocal microscopy. Methods Thirty eyes of 15 patients with SS and 30 eyes of 15 control subjects were examined by confocal microscopy in vivo. Full-thickness images of the central and temporal corneas were recorded. Quantitative and morphological assessments of the corneal epithelium, subbasal nerves,stroma and endothelium were performed. Results The clinical data showed that the values of tear film break-up time （BUT） ,Schirmer I were significantly lower,and the values of Fluorescence and Rose Bengal staining were significantly higher in SS group compared with control group（ P 〈 0.01 ）. The superficial cells ,wing epithelial cell densities in both central and temporal corneas and basal epithelium cell densities in the central cornea in the SS group were significantly lower than in normal group （P 〈 0.01 ,P 〈 0.05）. Inflammatory cells and dendritic cells infiltration were seen in the corneal epithelium of SS patients. The high reflectivity,visible cytoplasmic processes,increased volume and reflective weakened nucleus in keratocytes could also be found in SS patients. Infiltration of inflammatory cells in the anterior stroma of cornea was exhibited in SS patients. The subbasal nerves were thinner and more anfractous in the SS patients than in normal controls, and some of the subbasal nerves were disrupted. Conclusion The SS patients are demonstrated obvious abnormalities not only in corneal epithelium,anterior stroma and endothelium,but also in morphology of keratocytes and corneal immune status under the confocal laser microscopy.