真菌性角膜炎的分类、药敏试验及临床转归的分析

发布时间：2018-03-30 03:13

本文选题：真菌性角膜炎　切入点：药敏试验　出处：《郑州大学》2016年博士论文

【摘要】：目的研究本地区真菌性角膜炎流行病学特征和致病危险因素,纸片扩散法研究常用抗真菌药物对主要致病真菌性敏感性,分析影响真菌性角膜炎临床转归的主要危险因素。材料与方法收集2014年3月至2015年12月我院眼科就诊的真菌性角膜炎患者,均进行裂隙灯显微镜检查、角膜刮片、真菌培养、纸片扩散法药敏试验及共焦显微镜检查。详细采集病史,包括眼部外伤史、病程、眼部用药史、是否佩带角膜接触镜、眼部患病史。第1周联合抗真菌药物治疗,然后根据药敏试验选择应用两性霉素B、酮康唑、那他霉素、伏立康唑及特比萘芬滴眼液。如药物治疗效果不佳,根据病灶不同情况选择行病灶切除+结膜瓣移植、板层角膜移植或穿透角膜移植术。每周随访,至药物治愈后1月或手术治愈后3个月,查最佳矫正视力。了解本地区真菌性角膜炎的年龄及性别分布,分析真菌性角膜炎致病的主要危险因素,比较不同年龄组致病因素的区别。纸片扩散法体外药敏试验检测那他霉素、伏立康唑、特比萘芬、两性霉素B和酮康唑对常见致病真菌的敏感性。比较不同致病菌种所致角膜炎临床转归的情况,分析体外药敏试验对药物治疗的指导意义及抑菌圈与药物治疗效果的关系,回归法分析影响真菌性角膜炎预后的主要危险因素。结果本地区真菌性角膜炎患者年龄集中在19~59岁的劳动力人群,外伤史为中年及未成年组人群的主要危险因素,老年患者的主要危险因素为眼表疾病及眼部手术史。本地区主要致病真菌为镰刀菌(19.59%)和曲霉菌(54.1%)。镰刀菌对伏立康唑及那他霉素最敏感,抑菌圈明显大于其他抗真菌药物(F=81.26,P0.000)。曲霉菌对特比萘芬最敏感(F=532.78,P0.000)。镰刀菌曲霉菌之外的其他真菌对特比萘芬最敏感(F=70.45,P0.000)。两性霉素B及酮康唑对所有致病真菌的抑菌圈均明显小于伏立康唑、那他霉素、那他真及特比萘芬(P0.000)。采用药物治疗联合手术治疗后,视力较就诊时视力明显提高(t=3.84,P=0.00)。所有感染菌种中,曲霉菌角膜炎药物治疗效果最差,药物治愈率为64.94%。曲霉菌和镰刀菌角膜炎药物治愈率和临床转归均明显差于其他菌种角膜炎,差异有统计学意义(P0.05)。有药敏指导患者药物治愈率明显高于无药敏指导者(χ2=8.75,P0.01)。药敏试验对2种及以上抗真菌药物敏感者药物治愈率高于药敏试验对2种以下抗真菌药物敏感者(χ2=9.63,P0.01),两组临床预后等级比较差异也有统计学意义(He=24.281,P=0.021)。药敏试验那他霉素及那他真的抑菌圈与药物治疗效果有明显相关性。病灶面积16 mm2、前房积脓2 mm、药敏试验敏感药物数2及致病菌种为镰刀菌或曲霉菌均对真菌性角膜炎临床转归有独立的预测价值。结论1.镰刀菌和曲霉菌为真菌性角膜炎的主要致病真菌;外伤是劳动力人群的主要致病危险因素,眼表疾病和眼部手术史为老年患者的主要危险因素。2.那他霉素、伏立康唑及特比萘芬对常见致病真菌敏感,曲霉菌和镰刀菌角膜炎药物治疗效果及临床转归较其他真菌性角膜炎差。其中曲霉菌角膜炎药物治疗效果最差。体外药敏试验指导可提高真菌性角膜炎的药物治愈率。3.药敏试验那他霉素抑菌圈与临床药物治疗效果明显相关,抑菌圈越大,药物治愈可能性越大。病灶面积16mm2、前房积脓2mm、药敏试验敏感药物数2及致病菌种为镰刀菌或曲霉菌时,真菌性角膜炎临床预后较差。
[Abstract]:Study on local fungal keratitis epidemiology and risk factors, method of commonly used antifungal agents on main pathogenic fungal susceptibility disk diffusion, analysis of the impact of major risk factors of clinical outcome of fungal keratitis. The ophthalmology clinic materials and methods from March 2014 to December 2015 in our hospital with fungal keratitis, were examined by slit lamp microscope, corneal scraping, fungal culture, antibiotic sensitivity test and confocal microscopy. Detailed history, including the history of ocular trauma, disease, eye medication history, whether or not to wear contact lenses, eye disease history. First weeks combined with antifungal drugs, and then chosen according to drug susceptibility test by amphotericin B, ketoconazole. Natamycin, voriconazole and terbinafine eye drops. Such as drug treatment ineffective, according to the different situation for lesion resection In addition, conjunctival flap transplantation, lamellar keratoplasty and penetrating keratoplasty. Weekly follow-up, 3 months in January to cure or cure after check the best corrected visual acuity. Understand the age and sex distribution in the region of fungal keratitis, risk analysis of main pathogenic fungal keratitis risk factors, pathogenic differences between different the age group of factors. Disk diffusion susceptibility test in vitro detection of natamycin, terbinafine, voriconazole, amphotericin B and ketoconazole on sensitivity of pathogenic fungi. Pathogenic fungal keratitis caused by the clinical outcome of different circumstances, analysis of the relationship between the in vitro susceptibility test of significance and effect of bacteriostatic ring and drug treatment of drug treatment the main risk factors affecting prognosis, regression analysis of fungal keratitis. The results of local fungal keratitis were concentrated in the age 19~59 years of the workforce, trauma The history of middle age and risk factors of minor groups, the main risk factors for elderly patients with ocular surface diseases and eye surgery. The main pathogenic fungi region for Fusarium and Aspergillus (19.59%) (54.1%). Fusarium to voriconazole and natamycin most sensitive antibacterial circle is greater than that of other antifungal drugs (F=81.26, P0.000). Aspergillus is most sensitive to terbinafine (F=532.78, P0.000). In addition to other fungi Aspergillus Fusarium most sensitive to terbinafine (F=70.45, P0.000). Amphotericin B and ketoconazole on Bacteriostasis of pathogenic fungi were all significantly less than voriconazole, natamycin, he and terbinafine (P0.000). The drug treatment combined with surgery, visual acuity presenting visual acuity significantly improved (t=3.84, P=0.00). All the infected strains of Aspergillus keratitis, effect of drug treatment is the worst, the cure rate of drug 64.94%. Niger Fungi and Fusarium keratitis cure rate and clinical outcomes were significantly worse than other bacterial keratitis, the difference was statistically significant (P0.05). With the guidance of drug sensitivity in patients with cure rate was significantly higher than that of non drug sensitivity Guide (x 2=8.75, P0.01). Drug sensitivity test of 2 kinds of drug sensitive and antifungal drug cure rate higher fungi susceptibility test of 2 kinds of drug sensitivity following anti (x 2=9.63, P0.01), there were significant differences in clinical outcomes in two groups (He=24.281, P=0.021). The drug sensitivity test of natamycin and that he really bacteriostatic ring and drug treatment. There was significant correlation between the lesion area of 16 mm2 2 mm, hypopyon, drug sensitive test of drug sensitivity of pathogenic bacteria and the number of 2 for the predictive value of Fusarium or Aspergillus were independent of the clinical outcome of fungal keratitis. Conclusion 1. Fusarium and Aspergillus were the main pathogenic fungi of fungal keratitis; external Injuries are the main risk factors of labor force, ocular surface disease and surgery are the main risk factors of elderly patients with.2. natamycin, voriconazole and terbinafine are sensitive to common pathogenic fungi, Aspergillus and Fusarium keratitis drug treatment effect and clinical outcome compared with other fungal keratitis. The treatment effect of Aspergillus keratitis drugs the worst. The drug sensitivity test in vitro guidance can improve the drug of fungal keratitis cure rate of.3. was significantly related to drug sensitivity test of natamycin bacteriostatic ring and clinical effect of drug treatment, the greater the inhibition zone, the greater the likelihood of drug cure. Lesion area of 16mm2 2mm, hypopyon drug sensitivity test, drug sensitivity and pathogenicity of number 2 strains for Fusarium or Aspergillus, fungal keratitis clinical prognosis.

【学位授予单位】：郑州大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R772.21

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