共焦显微镜下真菌菌丝形态的观察分析

Observation and Analysis of Fungal Hyphae Form under Confocal Microscope

目的:通过对共焦激光显微镜下不同真菌菌丝形态分析总结,为真菌性角膜炎临床诊断治疗提供指导,并为进一步共焦激光显微镜下菌属菌种鉴定研究提供参考。方法:回顾性分析本院2014年8月-2015年10月在共焦激光显微镜下查到菌丝的75例真菌性角膜炎患者的临床资料,对比观察共焦显微镜下不同时期和不同患者的各种菌丝形态,总结其特点。结果:不同真菌性角膜炎患者在共焦显微镜下菌丝形态表现多样,感染早期菌丝数量少,不易查到,需要仔细观察。活动期菌丝量较多,排列密集,不同菌种形态不同,有呈水平分布,长线状、竹节样高反光,有节段或分支,有呈簇状垂直或斜行分布,分支较多、较细;菌丝旁也可见小点状、圆珠状、短棒状等真菌孢子样形态,呈高反光,也有呈低反光表现,共48例48眼。使用过抗真菌药物的部分病例可见断裂的菌丝节段、肿胀菌丝,有的菌丝变得僵直,有的形态奇特,粗细不一。抗真菌药物治疗后复查的2例显示菌丝减少或仅存少量节段,3例已查不到菌丝,病灶区上皮层完全修复,基质层纤维化瘢痕形成,呈高反光。结论:共焦激光显微镜检查是早期诊断真菌性角膜炎的一项有效手段,并能判断病情转归及指导药物治疗。

Objective：To summarize the different morphological features of fungal hyphae under confocal laser microscopy in order to provide guidance for clinical diagnosis and treatment of fungal keratitis and provide reference for further application of confocal laser microscope on the strains of fungi species identification.Method：The clinical data of75 patients who were confirmed with fungal infection by confocal microscopy in our hospital from August 2014 to October 2015 were retrospectively analyzed.The fungal hyphal morphology at different infection periods and different patients under confocal laser microscope were observed and analyzed,their characteristics were summarized.Result：In the early stage of infection,the hyphae amount was less,it was not easy to be found,which requiring careful observation.In the active stage of infection,the hyphal quantity was more and intensive,the forms were different in different strains.Some hyphae were with a horizontal distribution,long line,bamboo sample with high reflective,hyphal segments or branch.Some hyphae showed like clusters with vertical or diagonal line distribution,more branchs and finer.Near the hyphae,small dot,round bead shape and short rod shape fungal spores were visible,which showed highly reflective or low reflective,there were 48 eyes of 48 cases in this stage.some cases who once used antifungal drugs before the first time confocal laser microscopy examination showed fracture segment,swelling hyphae,some hyphae became rigid,some cases manifested strange shape and different thickness.After effective antifungal drug treatment,2 cases of the re-examination patients showed that the density of hypha were reduced or only remaining a small number of segments,3 cases of the reexamination patients were with no hyphae.Epithelium in the lesion area was completely repaired,fibrous scar formed in the stromal layer with high reflection.Conclusion：Confocal laser microscopy is an effective method of early diagnosis of fungal keratitis.It can evaluate the outcome and direct the treatment of antifungal medication.