春季角结膜炎活动期眼表和泪液蛋白的临床研究

Clinical research on ocular surface condition and tear protein alteration in active vernal keratoconjunctivitis patients

目的对比观察春季角结膜炎(vernal keratoconjunctivitis,VKC)活动期患者眼表症状、泪膜、泪液蛋白以及角膜神经改变的特点。方法收集南昌大学第一附属医院2010年8月至2014年3月眼科门诊确诊为VKC活动期患者20例(40眼),分别对患者行眼表症状评分、泪膜四项检查、泪液蛋白测定、角膜知觉检查与中央角膜共聚焦显微镜检查,并与20例40眼健康对照组研究对象的检查结果进行对比分析。结果 VKC活动期患者左右两眼间和正常对照组研究对象的左右两眼间的眼表症状评分、泪膜四项、泪液蛋白、乳铁蛋白、溶菌酶、神经纤维密度及角膜敏感度差异均无统计学意义(均为P>0.05);VKC活动期患者右眼较对照组右眼干眼症状眼数增多,眼表疾病指数评分增高、泪膜破裂时间减短、基础泪液分泌试验结果增高、泪河高度降低、角膜荧光素染色增强,泪液总蛋白、乳铁蛋白、溶菌酶、角膜神经纤维密度及角膜敏感度值较对照组均明显降低,且差异均有统计学意义(均为P<0.05);VKC活动期患者左眼检查结果较对照组改变与右眼改变一致,差异也均有统计学意义(均为P<0.05)。共聚焦显微镜检查结果发现,VKC活动期患者中央角膜可见角膜上皮细胞部分结膜化,其上皮层存在大量炎症细胞浸润并伴有少量朗格汉斯细胞浸润,角膜上皮下有大量非成熟型朗格汉斯细胞浸润;角膜上皮下神经纤维纤细,呈盘旋、弯曲异常分布。结论 VKC活动期患者眼表及泪液改变明显,多表现为泪膜稳定性降低,泪液蛋白含量降低,角膜敏感度降低且角膜神经纤维密度下降、纤细及走形异常等特点。

Objective To observe the symptom of ocular surface,tcharacteristics of tear film,tear protein and corneal nerve fiber alteration in active vernal keratoconjunctivitis（VKC） patients.Methods Between August 2010 and March 2014,20 cases with active VKC and 20 control people were collected in the first Affiliated Hospital of Nanchang University.The results of tear film,tear protein and corneal nerve fiber which studied with ocular surface disease index,examination for tear film,tests for tear proteins,corneal perception check and corneal confocal microscopy examination were compared between active vernal keratoconjunctivitis group and control group.Results There was no difference in ocular surface disease index,break-up time,Schirmer I test,tears meniscus height,fluorescein staining,tear proteins,lactoferrin,lysozyme,density of nerve fibers and corneal sensitivity between left eyes and right eyes of VKC group and control group（all P〉0.05）.But the results of these examination of right eyes in VKC group were different from right eyes in control group（all P〈0.05）.And the analysis in left eyes between these two groups was consistent with right eyes（P〈0.05）.The results of VKC group with confocal microscope showed the size of corneal epithelial cells increased glance of unclear enhanced,part of the corneal epithelium got the features of conjunctiva,the number of high reflective surface cells and inflammatory cells with a small amount of langerhans cell increased on and under the surface of corneal epithelium.Besides,slender and the abnormal distributing nerve fibers under cornea could be found in VKC group.Conclusion Stability of tear film reduce and tear protein content decrease in most of active VKC patients.Also,corneal susceptibility weaken as well the slender and the abnormal distributing nerve fibers which is under and on cornea should be the main feature of active vernal keratoconjunctivitis patients.