不同真菌菌属所致角膜炎的临床特点及转归差异

发布时间：2017-12-26 21:02

本文关键词：不同真菌菌属所致角膜炎的临床特点及转归差异　出处：《眼科新进展》2016年03期 　论文类型：期刊论文

【摘要】：目的探讨不同真菌菌属所致角膜炎的临床特点及转归差异。方法收集2011年8月至2015年3月我院真菌培养阳性的角膜炎患者共96例(96眼),其中,镰刀菌43例,曲霉菌31例,链格孢霉17例,念珠菌5例,分别记录患者植物性外伤史、病程、临床特点、治疗方式及转归。对上述观察指标进行比较,采用SPSS 19.0软件进行统计学分析。结果 96例患者中有植物性外伤史者34例(35.4%),其中镰刀菌感染患者中25.6%有植物性外伤史,曲霉菌35.5%,链格孢霉64.7%,念珠菌20.0%,不同菌属之间差异有统计学意义(χ~2=8.714,P=0.033)。组间比较镰刀菌与链格孢霉间差异有统计学意义(χ~2=8.031,P=0.005)。患者病程按照菌属从短到长依次为:念珠菌(5.40±3.36)d、镰刀菌(16.79±13.98)d、曲霉菌(19.35±13.16)d、链格孢霉(27.59±20.68)d,不同菌属间差异有统计学意义(χ~2=14.407,P=0.002),组间比较念珠菌病程与其他菌属差异均有统计学意义(均为P0.05);镰刀菌与链格孢霉差异亦有统计学意义(P=0.010)。不同真菌菌属所致角膜炎的临床特征不同,链格孢霉角膜溃疡面积、深度、前房积脓发生率均小于其他菌属(均为P0.05),其余各菌属间差异无统计学意义(均为P0.05)。镰刀菌感染以单纯药物治疗与角膜板层切除术治疗为主,药物治愈率为78.6%;曲霉菌感染以角膜板层切除术和角膜移植术治疗为主,药物治愈率62.5%;链格孢霉和念珠菌感染主要以单纯药物治疗为主,药物治愈率分别为90.0%、100.0%。结论链格孢霉感染多由植物性外伤引起,临床体征轻,药物治疗效果好;念珠菌感染发展快,药物治疗效果好;镰刀菌与曲霉菌感染临床体征重,镰刀菌常需尽早行角膜板层切除术,曲霉菌常需行角膜移植术治疗。
[Abstract]:Objective to investigate the clinical characteristics and the difference of the prognosis of keratitis caused by different fungal bacteria. A total of 96 cases of positive culture keratitis patients were collected from August 2011 to March 2015 in our hospital fungal (96 eyes), including 43 cases of Aspergillus, Fusarium, Alternaria in 31 cases, 17 cases, 5 cases were recorded in patients with Candida albicans, plant disease, trauma history, clinical features, treatment and prognosis. The above observation indexes were compared, and SPSS 19 software was used for statistical analysis. Results there were 34 cases (35.4%) of 96 patients with plant trauma history. Among them, 25.6% of them had botanical trauma history, Aspergillus 35.5%, Alternaria 64.7%, Candida 20%, and there was a statistically significant difference among different bacteria (chi ~2=8.714, P=0.033). The difference between Fusarium and sporospora was statistically significant (x ~2=8.031, P=0.005). The patient according to the bacteria from short to long as follows: Candida (5.40 + 3.36) d, Fusarium (16.79 + 13.98) d, Aspergillus (19.35 + 13.16) d, Alternaria (27.59 + 20.68) d, there were statistically significant differences between different genera (x ~2=14.407, P=0.002), difference there was statistically significant between two groups of Candida disease and other genera (P0.05); Fusarium and Alternaria also showed significant differences (P=0.010). The clinical features of fungal keratitis caused by different fungi of the genus Alternaria, corneal ulcer area, depth, hypopyon incidence rate was less than the other genera (P0.05), there was no significant difference between the rest of the genus (P0.05). Fusarium infection with the simple drug treatment and lamellar resection treatment, cure rate was 78.6%; Aspergillus infection to corneal lamina excision and corneal transplantation treatment, cure rate 62.5%; Alternaria and Candida infection mainly in simple drug treatment, cure rate were 90%, 100%. Conclusion Alternaria plant infection caused by trauma, clinical signs of light, the effect of drug treatment; Candida infection develops quickly, the effect of drug treatment; clinical signs of Fusarium and Aspergillus infection, Fusarium often need as early as possible corneal lamellar resection, Aspergillus often required for corneal transplantation treatment.
【作者单位】：中南大学爱尔眼科学院;武汉爱尔眼科医院;
【基金】：武汉市卫计委临床医学科研项目(编号:WX13C50) 爱尔眼科医院集团科研基金项目(编号:AF2013006)~~
【分类号】：R772.21
【正文快照】： 真菌性角膜炎是一种由真菌引起的致盲率极高的感染性角膜病变。随着糖皮质激素和抗生素的广泛使用、角膜接触镜的普及以及人们对真菌感染认识的深入,其发病率呈现逐年上升趋势。在我国某些地区高居感染性角膜炎的首位[1]。真菌性角膜炎治疗比较棘手,如果治疗不及时往往造成角

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