共焦显微镜观察糖尿病性视网膜病变患者角膜细胞的变化

Changes in the corneal cell density and morphology in patients with diabetic retinopathy by in vivo confocal microscopy

目的观察糖尿病性视网膜病变（DR）患者角膜细胞密度及形态的变化。方法选用以激光为光源的眼科用HRT—III共焦显微镜对55例（110只眼）DR患者（DR组）和20例（40只眼）无糖尿病的老年性白内障患者（对照组）的中央角膜进行观察，依据国际DR分期标准，充分散瞳眼底检查将DR组患者分为五组：DR-1期（1组）、DR-2期（2组）、DR-3期（3组）、DR-4期（4组）、DR-5期（5组），记录角膜上皮基底层、基质层及内皮层细胞的图像，并对DR组与对照组及DR组之间的结果进行比较、分析。结果共焦显微镜下可以观察到DR组与对照组以及DR组各组之间角膜各层细胞的变化，结果显示，DR各组与对照组相比，角膜上皮基底细胞、浅基质细胞、中基质细胞、深基质细胞以及内皮细胞的密度均有变化，内皮细胞变异率（CV）以及内皮细胞中六边形细胞比率（Hexagonality）差异有统计学意义（P〈0．05）；DR各组之间相比，角膜基底细胞密度除4组与5组之间（P=0．081）差异没有统计学意义外，其余各组间比较差异均有统计学意义。浅基质细胞密度各组间相比，差异有统计学意义并呈递减趋势。中基质细胞密度各组间相比差异有统计学意义并呈递减趋势。深基质细胞密度各组间除2组与3组之间（P=0．086）差异没有统计意义外，其余各组间比较均有显著差异呈递减趋势。内皮细胞密度除2组与3组（P=0．595）、4组与5组之间（P=0．638）差异没有统计意义外，其余各组间比较差异均有统计学意义。内皮细胞变异率除3组与4组之间（P=0．273）差异没有统计意义外，其余各组问比较差异均有统计学意义。内皮细胞中六边形细胞比率各组间比较差异均有统计学意义。结论共聚焦显微镜能够对活体角膜组织进行无创、实时动态和四维（三维加时间）观察，DR患者角膜各层细胞密度、内皮细胞变异率及内皮细胞六边形细胞比率均有变化。

Objective To observe the corneal cell density and morphological changes in patients with diabetic retinopathy. Methods A total of 110 eyes （55 patients） with DR were enrolled in the study group and 40 eyes of 20 ＇matched patients with age-related cataract and without diabetes mellitus as the control group, the study group was divided into five sub-groups according to the International Clinical Diabetic Retinopathy Scale： DR-1 （group 1）, DR-2 （group 2）, DR-3 （group 3）, DR-4 （group 4）, DR-5 （group 5）. The mean corneal cell density and morphology were evaluated and statistical analyzed. Results The changes in the corneal cell density and morphology between the study group and the control group and the difference in the DR groups were observed with confocal microscopy. The decreased density of corneal basal epithelium, stromal cell and endothelial cell were observed, compared with the control group, the same result with the coefficient of variation （CV） and the percentage of Hexagonal ceils （Hexagonality） of the endothelial cell. The difference between the DR groups： the difference of the density of the corneal basal epithelium was statistically signifi- cant except the group 4 and 5, the anterior and the mid-stromal cell density was statistically signifi- cant, the posterior stromal cell density was statistically significant except the group 2 and 3, the den- sity of the endothelium cell was statistically significant except the group 2 and 3 and the group 4 and 5, the CV was statistically significant except the group 3 and 4 and the Hexagonality was statistically significant. Conclusions Corneal confocal microscopy is a growing technique for the study of the cornea at the cellular level, providing images comparable to ex vivo histochemical methods, the study show the changes in the corneal cell density and morphology in patients with diabetic retinopathy.