真菌性角膜炎病原菌及炎症因子和TLRs家族水平

Pathogens, inflammatory factors and Toll like receptors of patients with fungal keratitis

目的探讨真菌性角膜炎感染病原特点及炎症因子、Toll样受体(Toll like receptors, TLRs)家族水平。方法选择山东第一医科大学附属眼科医院2018年11月-2019年10月收治的真菌性角膜炎患者80例(80眼)为研究对象,选择同期来医院进行视力检查的高度近视患者80例为对照组。通过角膜刮片检查及真菌培养确定感染病原分布。采用酶联免疫吸附法检测泪液中C-反应蛋白(CRP)、降钙素原(PCT)和Toll样受体2(TLR2)、TLR7、TLR9水平。结果 80例真菌性角膜炎患者(80眼)共检出真菌80株,其中镰刀菌属、曲霉菌属和链格孢霉属分别占47.50%、38.75%、6.25%;研究组泪液CRP、PCT、TLR2、TLR7水平高于对照组,TLR9水平低于对照组(P<0.05);重度组泪液CRP、PCT、TLR2、TLR7水平高于中度组及轻度组,TLR9水平低于中度组及轻度组,中度组泪液CRP、PCT、TLR2、TLR7水平高于轻度组,TLR9水平低于轻度组(P<0.05);复发组泪液CRP、PCT、TLR2、TLR7水平高于未复发组,TLR9水平低于未复发组(P<0.05)。结论山东省地域的真菌性角膜炎感染病原以镰刀菌属为主,泪液中CRP、PCT、TLR2、TLR7、TLR9对于反映病情严重程度和复发具有一定的临床价值。

OBJECTIVE To explore the etiological characteristics, inflammatory factors and Toll like receptors(TLRs)of the patients with fungal keratitis. METHODS A total of 80 patients with fungal keratitis(80 eyes) who were treated in the Ophthalmic Hospital Affiliated to Shandong First Medical University from Nov 2018 to Oct 2019 were recruited as the study subjects, meanwhile, 80 high myopia patients who underwent visual acuity examination were set as the control group. The pathogens isolated from the patients were identified by corneal smear test and fungal culture, and the levels of C-reactive protein(CRP), procalcitonin(PCT), toll like receptor 2(TLR2), TLR7 and TLR9 in tear specimens were detected by means of enzyme linked immunosorbent assay. RESULTS Totally 80 strains of fungi were isolated from the 80 patients with fungal keratitis(80 eyes), 47.50% of which were Fusarium, 38.75% were Aspergillus, and 6.25% were Alternaria. The levels of tears CRP, PCT, TLR2 and TLR7 of the study group were significantly higher than those of the control group, the TLR9 level of the study group was significantly lower than that of the control group(P<0.05);the levels of tears CRP, PCT, TLR2 and TLR7 of the severe group were significantly higher than those of the moderate group and the mild group, the TLR9 level of the severe group was significantly lower than that of the moderate group and the mild group;the levels of tears CRP, PCT, TLR2 and TLR7 of the moderate group were significantly higher than those of the mild group, and the TLR9 level of the moderate group was significantly lower than that of the mild group(P<0.05). The levels of tears CRP, PCT, TLR2 and TLR7 of the recurrence group were significantly higher than those of the no recurrence group, while the TLR9 level of the recurrence group was significantly lower than that of the no recurrence group(P<0.05). CONCLUSION Fusarium is dominant among the pathogens isolated from the patients with fungal keratitis in Shandong province. The CRP, PCT, TLR2, TLR7 and TLR9 in tears have certain clinical value in reflecting the severity and recurrence of the disease.