115例真菌性角膜溃疡的诊断及药物治疗的临床分析

发布时间：2018-03-15 00:06

本文选题：真菌性角膜溃疡　切入点：诊断　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨真菌性角膜溃疡诊疗方法,比较、分析不同药物对真菌性角膜溃疡不同程度病情的临床疗效。材料及方法:选取吉林大学第一医院眼科2014年1月1日到2016年12月1日,共计115例真菌性角膜溃疡患者115只患眼。经检查明确诊断,按患者的角膜溃疡程度分类,分为单独那他霉素、单独伏立康唑及那他霉素联合伏立康唑三组进行局部药物治疗,比较、分析不同药物对真菌性角膜溃疡不同程度病情的临床疗效。结果:1)诊断及检查结果情况:入组115名患者115只患眼分别通过真菌培养及共聚焦显微镜检测。真菌培养结果显示:阳性81例(70.43%),阴性34例(29.57%);共聚焦显微镜检测结果显示:阳性101例(87.83%),阴性14例(12.17%)。比较两种检测方法,结果显示共聚焦显微镜阳性检出率优于真菌培养检出率,差异有统计学意义(χ~2=10.531,p=0.001)。2)药物治疗效果比较:不同病情程度分级时同种药物治疗效果比较,药物为那他霉素治疗时的效果,不同病情程度患者的治疗效果无统计学意义(H=5.061,p=0.061),有效率差异也无统计学意义(p=0.177);药物为伏立康唑治疗时的治疗效果,经比较不同病情程度患者的治疗效果差异无统计学意义(H=5.840,p=0.054),其中轻、中度的总有效率均高于重度,有统计学意义(p=0.038);药物为那他霉素联合伏立康唑用药治疗时的治疗效果经比较,不同病情程度患者的治疗效果无统计学意义(H=1.116,p=0.558),总有效率也无意义(p=0.403)。本文轻度患者17例,总有效率为100%;中度患者29例中,总有效率为100%;重度患者69例,总有效率为78.26%。轻、中度患者经比较不同药物治疗的效果差异无统计学意义(轻:H=0.813,p=0.666;中:H=0.011,p=0.995);重度真菌性角膜溃疡三种治疗方法的总有效率比较:那他霉素联合伏立康唑的总有效率高于单独应用那他霉素或伏立康唑,差异有统计学意义(H=9.118,p=0.010),总有效率有意义(p=0.037)。结论:1)真菌性角膜溃疡病情程度越轻,药物治疗效果越好,病情程度越重,药物治疗效果越差。2)真菌性角膜溃疡患者早期检测的阳性检出率,共聚焦显微镜检测高于真菌培养。3)轻、中度患者单一用药疗效好,药物毒性反应低、患者承担的经济压力较小,与联合用药治疗效果无显著差异,临床建议单一用药。重度患者单独应用伏立康唑效果较差,而那他霉素治疗重度与轻、中度患者效果无显著差异,但联合用药有效率高于单独使用那他霉素,差别有统计学意义,临床上建议早期联合用药。4)对于药物治疗无效的患者,应行手术治疗。
[Abstract]:Objective: to explore the methods of diagnosis and treatment of fungal corneal ulcer. To analyze the clinical effect of different drugs on fungal corneal ulcer. Materials and methods: the first Hospital of Jilin University from January 1st 2014 to December 1st 2016. 115 eyes of 115 patients with fungal corneal ulcer were divided into three groups according to the degree of corneal ulcer. To compare, The clinical effect of different drugs on fungal corneal ulcer was analyzed. Results: 115 eyes of 115 patients with fungal corneal ulcer were examined by fungal culture and confocal microscope. The results showed that 81 cases were positive and 34 cases were negative. The results of confocal microscopy showed that 101 cases were positive in 87.83%, 14 cases were negative in 12.17%. The results showed that the positive rate of confocal microscope was better than that of fungal culture, and the difference was statistically significant (蠂 ~ 2 ~ 2 ~ (10.531) P ~ (0.001) 路2). The effect of drug treatment was compared with that of natamycin at different grade of illness, compared with that of natamycin, and the positive rate of confocal microscope was better than that of fungal culture (蠂 ~ (2 +)). There was no statistical significance in the treatment effect of patients with different degree of illness. There was no significant difference in the effective rate and the effective rate was 0.1770.The drug was the treatment effect of Vriconazole, and there was no significant difference in the effective rate between the patients and the patients with different degrees of illness, and there was no significant difference in the effective rate between the two groups. There was no significant difference in the therapeutic effect between patients with different degree of illness. The total effective rate of mild and moderate patients was higher than that of severe patients, and there was statistically significant difference between the two groups. There was no statistical significance in the treatment effect of patients with different degree of illness. The total effective rate was 0.558, and the total effective rate was neither significant nor significant. In this paper, 17 patients were mild, the total effective rate was 100; in 29 patients, the total effective rate was 100; in 69 patients with severe disease, the total effective rate was 78.26. There was no significant difference in the effect of different drug treatment in moderate patients (light: H0. 813 p0. 666; moderate: HU 0. 011 p0. 995; total effective rate of severe fungal corneal ulcer: the total effective rate of natamycin combined with voleconazole was higher than that of single) in moderate patients with severe fungal corneal ulcers: the total effective rate of natamycin combined with voleconazole was higher than that of single. Taking natamycin or voleconazole alone, The difference was statistically significant. The total effective rate was significant. Conclusion: the degree of fungal corneal ulcer is lighter, the better the therapeutic effect is, the more serious the disease is. The worse the drug treatment was, the lower the positive rate of early detection in fungal corneal ulcer patients was. Confocal microscopy was higher than fungal culture. 3) mild, moderate patients had good efficacy and low drug toxicity. The patients were under less economic pressure and had no significant difference with the combination therapy. The clinical recommendations were single use. The severe patients were poor in the effect of single use of voliconazole, while natamycin had no significant difference in the treatment of severe, mild and moderate patients, and no significant difference was found in the treatment of severe, mild and moderate patients. However, the effective rate of combined use of natamycin was higher than that of natamycin alone, the difference was statistically significant.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R772.21

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