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探讨角膜移植术后免疫排斥反应的共焦显微镜特征 ,在细胞水平为该症的基础和临床研究提供活体、三维与实时的科学依据。方法 :应用 NIDEK公司提供的共焦显微镜 ,对 11例 (11眼 )发生角膜移植免疫排斥反应的患眼角膜在不同时期行三维实时扫描成像 ,并用计算机作定性与定量分析。结果 :角膜移植免疫排斥反应的共焦显微镜呈现如下特征 :1上皮排斥线是由较小的炎症细胞与受损的较大的上皮细胞混合形成的结构 ;2上皮下浸润表现为体积较小、折射率高的炎症细胞的聚集 ,上皮下神经纤维水肿呈串珠状改变 ,浅基质层细胞水肿 ;3基质排斥反应可见角膜基质细胞水肿 ,胞体变形 ,数量减少 ,并见炎症细胞浸润 ,后者于缝线周围较明显 ;4内皮排斥线则是由较小的明亮的炎症细胞与核固缩胞体形态异常的内皮细胞混合而成 ,随着内皮排斥线的发展 ,内皮细胞数量减少 ,体积变大呈伪足状 ;5以上排斥反应均见新生血管长入植片 ,并于血管壁可见游动的炎症细胞。结论 :应用共焦显微镜可在活体上为角膜移植术后免疫排斥反应提供早期诊断与鉴别诊断的科学依据 ,并在细胞水平对排斥反应的触发与转归进行活体的动态观察
To investigate the characteristics of confocal microscopy of immunological rejection after keratoplasty and to provide living, three-dimensional and real-time scientific basis for the basic and clinical research of the disease at the cellular level. Methods: Confocal microscopy provided by NIDEK was used to evaluate the corneal graft rejection in 11 eyes (11 eyes). Three-dimensional real-time scanning imaging of corneal allograft was performed at different times and qualitatively and quantitatively analyzed by computer. RESULTS: Confocal microscopy of corneal graft rejection showed the following characteristics: 1. The epithelial exclusion line is a structure formed by the mixing of smaller inflammatory cells with impaired larger epithelial cells. 2 Subepithelial infiltrates appear to be smaller, High refractive index of inflammatory cell aggregation, subepithelial nerve fiber edema was beaded change, shallow stromal cell edema; 3 stromal rejection showed corneal stromal cell edema, cell body deformation, the number decreased, and see inflammatory cell infiltration, the latter in the Suture around the more obvious; 4 Endothelial rejection line is formed by the small bright inflammatory cells and nuclear pyknosis cells morphological abnormalities of endothelial cells mixed with the development of endothelial repulsion line, reducing the number of endothelial cells, the volume becomes larger Was pseudopod-like; 5 rejection rejection were seen angiogenesis implants, and visible in the blood vessels swimming swimming inflammatory cells. Conclusion: Confocal microscopy can provide a scientific basis for early diagnosis and differential diagnosis of immunological rejection after corneal transplantation in vivo, and the dynamic observation of the rejection in the level of cells on the trigger and outcome of rejection