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共聚焦显微镜评估聚合酶链式反应阳性的棘阿米巴角膜炎:一项病例对照研究

De Craene S, Knoeri, J., Georgeon, C., Kestelyn, P., Borderie, V.M

期刊名称:De Craene S, Knoeri, J., Georgeon, C., Kestelyn, P., Borderie, V.M.

卷期:2018年第125卷第2期

摘要

摘要:目的:用聚合酶链反应(PCR)作为参考诊断技术,确定体内共聚焦显微镜诊断标准,诊断棘阿米巴角膜炎(AK)

设计:回顾性病例对照研究。对数据进行前瞻性分析,并进行回顾性分析。

参与者:棘阿米巴角膜炎聚合酶链反应阳性50(研究组)和细菌,真菌,病毒,或免疫角膜炎,棘阿米巴角膜炎聚合酶链反应阴性反应50(对照组)

方法:在角膜炎急性期进行体内共聚焦显微镜观察。

主要结果测量:在体内共聚焦显微镜图像显示棘阿米巴角膜炎(AK)。采用多变量逻辑回归来确定图像类型与棘阿米巴角膜炎聚合酶链反应阳性(对照组)的关系。

结果:以下4种类型的图像与棘阿米巴角膜炎聚合酶链反应阳性 (P < 0.05)有显著相关性(P < 0.05):亮斑(圆形或卵形超反射物,无双壁);直径,< 30μm);目标图像(具有hyporeflhalo的超反射物体;直径,< 30μm);集群超级反射对象(直径,< 30μm);和类滋养体对象(直径、> 30μm)。目标和滋养体图像的特异性为100%。这一数字为98.2%,亮点为48.2%。如果对棘阿米巴角膜炎的诊断是在目标图像、星系团或滋养体图像(至少3个特征之一)的情况下进行的,共聚焦显微镜的阳性预测值为87.5%,阴性预测值为58.5%

结论:棘阿米巴角膜炎是一种严重的视力威胁疾病。在体内共聚焦显微镜可以帮助诊断这一困难,特别是当聚合酶链反应被延迟,显示阴性结果,或不可用。目标图像和滋养体图像是棘阿米巴角膜炎的特异功能。高反射物体的簇是棘阿米巴角膜炎的高度特异性。然而,体内共聚焦显微镜的整体灵敏度较低。除了临床特征,微生物检查(直接检查和角膜擦伤的培养)和聚合酶链反应在共聚焦显微镜下依然活着,允许更快速的诊断和治疗开始,有可能得到更好的结果。

PURPOSE:To determine in vivo confocal microscopy diagnostic criteria to diagnose Acanthamoeba keratitis (AK) using polymerase chain reaction (PCR) as the reference diagnostic technique.DESIGN:Retrospective case-control study. Data were recorded prospectively and analyzed retrospectively.PARTICIPANTS:Fifty patients with PCR-positive AK (study group) and 50 patients with bacterial, fungal, viral, or immune keratitis featuring negative Acanthamoeba PCR results (control group).METHODS:In vivo confocal microscopy performed at the acute stage of keratitis.MAIN OUTCOME MEASURES:Presence of in vivo confocal microscopy images suggestive of AK. Multivariate logistic regression was used to determine the relationship between types of images and presence of PCR-positive AK.RESULTS:The following 4 types of images were associated significantly with PCR-positive AK (P < 0.05): bright spots (round or ovoid hyperreflective objects with no double wall; diameter, <30 μm); target images (hyperreflective objects with hyporeflective halo; diameter, <30 μm); clusters of hyperreflective objects (diameter, <30 μm); and trophozoite-like objects (diameter, >30 μm). Specificity of both target and trophozoite images was 100%. This figure was 98.2% for clusters and 48.2% for bright spots. If the diagnosis of AK was made on presence of target images, clusters or trophozoite images (at least 1 of the 3 features), the positive predictive value of confocal microscopy was 87.5% and the negative predictive value was 58.5%.CONCLUSIONS:Acanthamoeba keratitis is a serious vision-threatening disease. In vivo confocal microscopy can help in this challenging diagnosis, especially when PCR is delayed, shows negative results, or is not available. Target images and trophozoite-like images are pathognomonic of AK. Clusters of hyperreflective objects are highly specific of AK. However, the overall sensitivity of in vivo confocal microscopy features of AK is low. In addition to the clinical features, microbiological tests (direct examination and cultures of corneal scrapings), and PCR, in vivo confocal microscopy allows for more rapid diagnosis and treatment initiation, potentially leading to an improved outcome.


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