摘要目的:探讨影响供体角膜内皮质量的因素。方法:回顾性病例系列研究。收集2020年7月1日至2021年6月30日山东省眼库获取的568枚供体角膜资料进行分析。采用角膜内皮显微镜对供体角膜的内皮进行观察，检测其角膜内皮细胞密度（ECD）、变异系数和六边形细胞比例（HEX），并收集角膜供体捐献者的相关因素，包括性别、年龄、死亡原因、死亡季节，以及捐献者死亡至获取角膜的时间和遗体保存方式。其中年龄因素分为5个年龄段：0~20岁、21~40岁、41~60岁、61~80岁、>80岁；获取供体角膜的时间按捐献者死亡后取角膜的时间分为3个时间段：<6 h、6~12 h、>12 h。分析各个因素与角膜内皮情况的关系。结果:568枚供体角膜来自288名捐献者，其中男性225名（78.13%），女性63名（21.87%）；年龄（51.77±18.48）岁；捐献者死亡原因及占比分别为心脑血管疾病54.58%（275人）、癌症17.96%（74人）、器官衰竭14.26%（49人）、意外13.20%（64人）。供体角膜获取时间为捐献者死亡后140（76，400）min（30 min至45 h）。145枚（25.53%）供体角膜初次行角膜内皮显微镜检查时内皮成像不清晰，经充分复温后仍有106枚（18.7%）成像不清晰无法进行分析。462枚（81.3%）图像清晰的供体角膜ECD为（2 602.23±318.40）个/mm 2，变异系数为36.61%±4.81%，HEX为52.73%±7.15%。高龄捐献者的ECD较年轻者低，各年龄段之间的差异有统计学意义（ P<0.001）；死因为意外的捐献者ECD为（2 829.88±313.90）个/mm 2，高于死因为癌症、心脑血管疾病和器官衰竭者，差异有统计学意义（ P<0.001），死亡后在6 h内获取角膜者ECD最高，差异有统计学意义（ P<0.001）。捐献者年龄大则变异系数大，但HEX低（均 P<0.05）。死亡后获取角膜时间长者变异系数大，差异有统计学意义（ P<0.05），但HEX的差异无统计学意义（ P>0.05）。器官衰竭、冷冻保存、死亡后获取角膜时间>12 h是角膜内皮成像不清晰的危险因素（均 P<0.001）。136张（23.94%）角膜内皮图像中可见圆形、类圆形或带状暗区，有黑区者ECD低（ P<0.05）。死亡后获取角膜的时间长则黑区数量越多（ P<0.001）；黑区对变异系数和HEX无影响（ P>0.05）。 结论:捐献者高龄、死因为慢性疾病、死亡后获取角膜时间长、遗体经过冷冻保存会导致供体角膜内皮质量下降。

abstractsObjective:To explore the factors influencing the quality of donor corneal endothelium.Methods:A retrospective case series study was conducted. Data from 568 donor corneas obtained from the Shandong Eye Bank between July 1, 2020, and June 30, 2021, were collected for analysis. The corneal endothelium of the donor corneas was observed using corneal endothelial microscopy to assess corneal endothelial cell density (ECD), coefficient of variation, and hexagonal cell ratio (HEX). Relevant factors of corneal donors were collected, including gender, age, cause of death, season of death, time from death to corneal retrieval, and methods of corpse preservation, to investigate their impact on the quality of donor corneal endothelium. The age factor was divided into five age groups: 0-20 years, 21-40 years, 41-60 years, 61-80 years, and >80 years. The time of corneal retrieval was divided into three periods based on the time elapsed since the donor's death: <6 hours, 6-12 hours, and >12 hours. The relationship between these factors and corneal endothelial conditions was analyzed.Results:The 568 donor corneas were obtained from 288 donors, including 225 males (78.13%) and 63 females (21.87%). The mean age was 51.77±18.48 years. The causes of death among donors were as follows: cardiovascular diseases 54.58% (275 individuals), cancer 17.96% (74 individuals), organ failure 14.26% (49 individuals), and accidents 13.20% (64 individuals). The mean time of corneal retrieval after donor death was 140 (76, 400) minutes (ranging from 30 minutes to 45 hours). Among the 145 corneas (25.53%) that had their initial corneal endothelial microscopy examination, the images were not clear, and after thorough rewarming, 106 corneas (18.7%) still had unclear images and could not be analyzed. Among the 462 corneas (81.3%) with clear images, the ECD was (2 602.23±318.40) cells/mm2, the coefficient of variation was 36.61%±4.81%, and the HEX was 52.73%±7.15%. The ECD of corneas from older donors was lower compared to younger donors, and the differences between age groups were statistically significant ( P<0.001). Corneas from donors who died due to accidents had a higher ECD [(2 829.88±313.90) cells/mm2] compared to those who died from cancer, cardiovascular diseases, and organ failure, and the differences were statistically significant ( P<0.001). The ECD was highest when corneas were retrieved within 6 hours after death, and the difference was statistically significant ( P<0.001). Older donors had higher coefficients of variation but lower HEX values (both P<0.05). Corneas retrieved after a longer time from death had higher coefficients of variation, and the difference was statistically significant ( P<0.05), but there was no statistically significant difference in HEX ( P>0.05). Organ failure, cryopreservation, and corneal retrieval time >12 hours were risk factors for unclear corneal endothelial imaging (all P<0.001). Among the 136 corneal endothelial images (23.94%), circular, oval, or band-shaped dark areas were observed, and corneas with dark areas had lower ECD ( P<0.05). The longer the time elapsed from death to corneal retrieval, the more dark areas were observed ( P<0.001). The presence of dark areas did not affect the coefficient of variation and HEX ( P>0.05). Conclusion:Advanced donor age, death due to chronic diseases, longer time elapsed from death to corneal retrieval, and cryopreservation of the body lead to a decrease in the quality of donor corneal endothelium.