角膜激光共聚焦显微镜在单眼感染性角膜炎疾病诊断中的应用

Application of Corneal Laser Confocal Microscope in the Diagnosis of Monocular Infectious Keratitis

目的:探讨角膜激光共聚焦显微镜在单眼感染性角膜炎疾病诊断中的应用价值。方法:回顾性研究2020年6月到2021年6月选择在本院诊治的单眼感染性角膜炎疾病患者62例,所有患者都给予角膜激光共聚焦显微镜检查,记录影像学特征并判断诊断价值(以病原学诊断为金标准)。结果:真菌性角膜炎在角膜激光共焦显微镜下的病变区纵横交错的高反射的真菌菌丝或高反光细长颗粒状的孢子,细菌性角膜炎的病变处会聚集活化的树突状细胞及大量的炎症细胞,病毒性角膜炎的基底膜下神经纤维密度、神经主干的分支数减少,棘阿米巴性角膜炎的包囊表现为圆形高反光厚壁结构。角膜激光共聚焦显微镜判断为病毒性角膜炎17例,诊断病毒性角膜炎的敏感性与特异性为94.4%和100.0%;角膜激光共聚焦显微镜判断为棘阿米巴性角膜炎4例,诊断棘阿米巴性角膜炎的敏感性与特异性为94.4%和100.0%;角膜激光共聚焦显微镜判断为细菌性角膜炎21例,诊断细菌性角膜炎的敏感性与特异性为95.5%和97.5%;角膜激光共聚焦显微镜判断为真菌性角膜炎20例,诊断真菌性角膜炎的敏感性与特异性为94.4%和93.2%。ROC曲线分析显示角膜激光共聚焦显微镜诊断细菌性角膜炎、真菌性角膜炎、病毒性角膜炎、棘阿米巴性角膜炎的曲线下面积分别为0.525、0.579、0.777、0.731。结论:角膜激光共聚焦显微镜在单眼感染性角膜炎疾病诊断中的应用能较好的区分细菌性角膜炎、真菌性角膜炎、病毒性角膜炎、棘阿米巴性角膜炎,具有良好的诊断敏感性与特异性。

Objective:To explore the application values of corneal laser confocal microscope in the diagnosis of monocular infectious keratitis.Methods:From June 2020 to June 2021,Retrospective study of 62 cases of patients with monocular infectious keratitis disease,all patients were given corneal laser confocal microscopy,and were to record the imaging characteristics and judged the diagnostic value(Based on pathogenic diagnosis as the gold standard).Results:In fungal keratitis,there were highly reflective fungal hyphae or highly reflective slender granular spores criss-crossed in the lesion area under corneal laser confocal microscope,and activated dendritic cells gather in the lesion of bacterial keratitis.And there were large number of inflammatory cells,the density of nerve fibers under the basement membrane and the number of branches of the nerve trunk of viral keratitis are reduced,and the cysts of acanthamoebic keratitis show round,high-reflective,thick-walled structure.The corneal laser confocal microscope judged 17 cases of viral keratitis,the sensitivity and specificity of diagnosing viral keratitis were 94.4%and 100.0%;corneal laser confocal microscope judged 4 cases of acanthamoebic keratitis,diagnosis The sensitivity and specificity of acanthamoebic keratitis were 94.4%and 100.0%;21 cases of bacterial keratitis were judged by corneal laser confocal microscope,and the sensitivity and specificity for the diagnosis of bacterial keratitis were 95.5%and97.5%;20 cases of fungal keratitis were judged by corneal laser confocal microscope,and the sensitivity and specificity of diagnosing fungal keratitis were 94.4%and 93.2%.ROC curve analysis showed that the area under the curve for the diagnosis of bacterial keratitis,fungal keratitis,viral keratitis,and Acanthamoebic keratitis by corneal laser confocal microscope were 0.525,0.579,0.777,0.731,respectively.Conclusion:The application of corneal laser confocal microscope in the diagnosis of monocular infectious keratitis can distinguish bacterial keratitis,fungal keratitis,viral keratitis,and acanthamoebic keratitis,and have good diagnosis.Sensitivity and specificity.