角膜共焦显微镜在真菌性角膜炎诊疗中的应用价值探讨

Application of corneal confocal microscope in diagnosis and treatment of fungal keratitis

目的探讨角膜共焦显微镜检查在真菌性角膜炎患者诊疗中的价值。方法选取2016年1月至2017年1月在安徽省第二人民医院诊治的真菌性角膜炎患者21例(21只眼),分别行角膜刮片实验室镜检和共焦显微镜检查,对比2种检查方法的检出阳性率。结果 21例(21只眼)患者中,实验室检查与共焦显微镜检查双阳性患者11例(52.38%),单共焦显微镜阳性患者7例(33.33%),单实验室检查阳性患者1例(4.76%)。共焦显微镜检出率为85.71%,实验室检出率为57.14%,差异有统计学意义(P=0.043)。8例(38.10%)患者药物治疗效果不佳,治疗好转13例(61.90%)。4例(19.05%)患者在症状体征阴性时,角膜共焦显微镜检查仍可见基质层菌丝残留。结论共焦显微镜检查可提高真菌性角膜炎的诊断率,并可根据共焦显微镜实时检查结果指导用药。

Objective To investigate the value of corneal confocal microscopy in the diagnosis and treatment of patients with fungal keratitis. Methods From January 2016 to January 2017,21 patients（ 21 eyes） with typical manifestations of fungal keratitis were treated at the Second People＇s Hospital of Anhui Province. The corneal scraping laboratory microscopy and confocal microscopy were performed. The positive rates of the two inspection methodswere compared. Results Among the 21 patients（ 21 eyes）,11 patients（ 52. 38%） were positive for laboratory tests and confocal microscopy,7 patients（ 33. 33%） were positive for single confocal microscopy,and 1 patient（ 4. 76%） was positive for single-laboratory test. The detection rate by confocal microscopy was 85. 71%,and the laboratory detection rate was 57. 14%.The difference was statistically significant（ P = 0. 043）. Eight patients（ 38. 10%） had poor drug treatment and the treatment improved in 13 patients（ 61. 90%）. In 4 patients（ 19. 05%）,corneal confocal microscopy still showed residual stroma of the stroma in the absence of symptomatic signs. Conclusion In patients with suspected fungal keratitis,the application of confocal microscopy can improve the diagnostic rate of the disease,andguide the use of drugs according to real-time results of confocal microscopy.