48例真菌性角膜炎患者的临床分析

发布时间：2018-01-04 10:46

本文关键词：48例真菌性角膜炎患者的临床分析　出处：《山东大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究背景：真菌性角膜炎(Fungai Keratitis, FK)是一种在我国危害较为严重的致盲性眼病,尤其好发于以农业经济为主的发展中国家。随着近年来临床上抗生素及糖皮质激素的滥用、角膜接触镜的使用人群曰益增多、免疫抑制剂药物的广泛应用等原因,其发病率有逐渐上升的趋势。在我国,有统计显示真菌性角膜炎占感染性角膜病致病原因的首位(约34.8%--61.9%),因此提高对真菌性角膜炎的临床诊治水平对防盲治盲意义重大。目的：本文对48例真菌性角膜炎患者的流行病学特征、检查结果、治疗结局等进行回顾性分析,以探讨该病住院治疗期间的疾病特点及评价诊疗效果,并为指导今后的临床用药和选择治疗方案提供依据。方法：对2011年至2015年间在我科拟诊为真菌性角膜溃疡的48例(48眼)住院患者进行回顾性分析,患者入院第1天,首先行角膜共聚焦显微镜检查、角膜刮片镜检、真菌培养,随后给予常规抗真菌药物治疗,每日进行裂隙灯检查,且每隔1周左右复查角膜共聚焦显微镜,对比观察治疗期间患者角膜溃疡灶的范围、深度、局部菌丝数量、前房积脓及角膜愈合情况的变化,总结48例患者的流行病学特征、检查结果、治疗结局等,以此评价该病的疾病特征及住院期间的药物治疗反应。结果：48例患者中,男性30例,女性18例,男女比5：3；患者平均年龄47.8岁,以40-49岁年龄组的患者最多(17例,35.4%),50-59岁年龄组次之(10例,20.1%)；职业因素中,农民37例,占所有患者的77.1%；诱因以植物性角膜外伤史最多(19例,39.6%),继发于其他眼部疾病、穿透性角膜移植术后的患者8例。入院后48例患者角膜共聚焦显微镜均查见菌丝,阳性率1000%；角膜刮片镜检查见真菌31例,阳性率64.6%；真菌培养检查示7例患者查见真菌,阳性率14.6%,其阳性患者中镰刀菌属5例、曲霉菌属2例,其他致病菌属未见。所有患者的共聚焦检查显示：菌丝浸润深度为41-217um,平均浸润深度135.9umm；根据治疗1周后27例共聚焦复查者中18例阳性结果统计,治疗前菌丝平均浸润深度137.1um,治疗后,菌丝平均浸润深度109.4um,平均减少27.7um。同应用伏立康唑及氟康唑、那他霉素、两性霉素B等治疗,发现所有患者平均住院天数为14.6天(中位数12天,众数7、8天),其中住院天数为1-2w天者21例(43.8%),2-3w者11例(22.9%),另小于1w者4例(8.3%)、超过4w者5例(10.4%)。所有患者中39例(81.25%)好转出院,9例患者因角膜穿孔或病情严重而行角膜移植术(PKP或LKP)。患者的病情严重程度与共聚焦菌丝侵犯深度之间的关系,具有统计学差异(P0.05),认为患者的病情严重程度(角膜溃疡的范围、前房积脓的情况)与菌丝侵犯深度之间相关；而患者是否伴有前房积脓与菌丝侵犯深度相关(P0.05),则推断前房积脓并不能决定患者的病情严重程度。同样方法分析,病程严重程度与住院天数之间具有统计学差异(P0.05),可以推断患者的病情越重,住院天数越长,其药物治疗反应越差。结论：真菌角膜炎是临床上常见的角膜感染疾病之一,其临床特征较为明显,结合多种诊断方法均可确诊。共聚焦显微镜是诊断真菌角膜炎的高效、特异、无创的诊断技术有效手段,其阳性率高、易于操作、实时动态评估临床疗效,在真菌性角膜炎临床早期诊断、治疗及预后中发挥重要作用,具有不可忽视的优势。共聚焦发现菌丝侵犯深度与病情严重程度相关,而伴或不伴前房积脓与菌丝深度无明显相关。所有患者平均住院天数约2W,大部分患者经药物保守治疗后达到临床痊愈。分析该病的临床特征及治疗结局可为反馈诊疗疗效提供一定依据,指导和调整实际临床用药剂量、调整治疗方案,从而在今后开展更多研究、减少住院天数、提高治疗水平方面具有重要意义。
[Abstract]:Background: fungal keratitis (Fungai Keratitis FK) is a serious cause of blindness in our country, especially good in the agricultural economy of the developing countries. With the abuse in recent years clinical antibiotics and corticosteroids, contact lens users increasingly more widely used etc. immunosuppressive drugs, its incidence is rising gradually. In our country, the statistics show that the fungal keratitis accounted for infectious corneal diseases cause the first (about 34.8%--61.9%), so as to improve the diagnosis and treatment of fungal keratitis in the prevention of blindness is significant. Objective: the epidemiological characteristics of 48 cases of fungal keratitis patients examination results and treatment outcome were retrospectively analyzed, the characteristics of the disease and the evaluation of diagnosis and treatment to explore the effect of the disease during hospitalization, and to guide future Provide the basis for clinical medication and treatment. Methods: from 2011 to 2015 in our hospital diagnosed 48 cases of fungal corneal ulcer (48 eyes) were retrospectively analyzed in hospitalized patients, patients admitted to the hospital for first days, first by corneal confocal microscopy, corneal scraping and microscopic examination, fungal culture, followed by the conventional antifungal treatment, daily slit lamp examination, and every 1 weeks after corneal confocal microscope observation range during treatment of patients with corneal ulcer depth, local mycelium quantity, changes of hypopyon and corneal healing, summarize the epidemiological characteristics of 48 cases of patients with the examination results, treatment outcome the response to drug treatment, and to evaluate the characteristics of diseases in the hospital during the disease. Results: in 48 cases, 30 cases were male, 18 were female, male to female ratio was 5:3; the mean age was 47.8 years, with 40-49 age group Most patients (17 cases, 35.4%), the 50-59 age group (10 cases, 20.1%); occupation factors, farmers in 37 cases, accounted for 77.1% of all patients; incentive to plant corneal trauma history the most (19 cases, 39.6%), secondary to other ocular diseases after penetrating keratoplasty 8 patients after admission. 48 patients with corneal confocal microscopy were found in mycelia, the positive rate was 1000%; corneal scraping and microscopic examination showed 31 cases of fungus, fungal culture positive rate was 64.6%; in 7 cases were found in fungi, the positive rate was 14.6%, the positive patients in 5 cases of Fusarium, Aspergillus 2 with no other pathogenic bacteria. All patients with confocal examination showed that hypha infiltration depth is 41-217um, the average infiltration depth of 135.9umm; according to the positive results of the 18 patients after 1 weeks of treatment, 27 cases of confocal review in statistics, the average infiltration depth of 137.1um hyphae before treatment, after treatment, the average infiltration depth of mycelium 109.4um, an average reduction of 27.7um. with voriconazole and fluconazole, natamycin, amphotericin B therapy, all patients found the average hospital stay was 14.6 days (median 12 days, the 7,8 days), including 21 cases of hospitalization was 1-2W days (43.8%), 11 cases of 2-3W (22.9%), 4 cases other than 1W (8.3%), 5 cases of more than 4W (10.4%). All patients in 39 cases (81.25%) were discharged, 9 patients with corneal perforation or serious illness and corneal transplantation (PKP or LKP). The severity and confocal mycelium relationship between depth of invasion, statistically the difference (P0.05), that the severity (range, corneal ulcer hypopyon case) correlation between mycelium and depth of invasion; and whether patients with hypopyon and hyphal invasion related (P0.05), push off hypopyon does not determine the severity . the same method analysis, with statistical difference between disease severity and duration of hospitalization (P0.05), can be inferred in patients with more serious illness, hospitalization time is longer, the response to drug treatment is worse. Conclusion: fungal keratitis is one of the common clinical diseases of corneal infection, its clinical feature is obvious, can be combined with a variety of diagnostic methods confirmed. Confocal microscopy in diagnosis of fungal keratitis is efficient, specific, no effective means of invasive diagnostic techniques, the high positive rate, easy operation, real-time dynamic assessment of clinical efficacy in fungal keratitis, early clinical diagnosis, treatment and prognosis play an important role, can not be ignored. The advantages of confocal mycelium invasion the depth and severity of the disease, but no significant correlation with or without hypopyon and hyphae depth. All patients average hospitalization time is about 2W, most of the patients with drug conservative After treatment to clinical cure. Analysis of clinical characteristics and outcomes of the disease can provide certain basis for the diagnosis and treatment effect of feedback, guidance and adjustment of the actual clinical dosage, adjust the treatment plan, to carry out more research in the future, reduce the number of hospitalization days, has important significance to improve the level of treatment.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R772.21

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