真菌性角膜炎预后的影响因素研究

发布时间：2018-01-27 15:09

本文关键词： 真菌性角膜炎预后危险因素　出处：《浙江大学》2013年博士论文　论文类型：学位论文

【摘要】：目的：对真菌性角膜炎病例的临床特征进行研究,以期发现影响真菌性角膜炎预后的主要危险因素。研究设计：回顾性队列研究。方法：研究对象为2009年1月至2012年12月期间来我院就诊的病原培养阳性的真菌性角膜炎病例。将仅用抗真菌药物治疗即达到感染清除、获得角膜疤痕愈合结果者归为预后好组；除药物外还需联合治疗性角膜移植术,达到感染清除,且角膜疤痕愈合后不合并难治性并发症者归为预后中等组；在积极的药物和/或治疗性角膜移植治疗后出现无光感、难治性并发症或视网膜脱离,甚至眼球摘除者归为预后差组。用Pearson卡方检验分别对真菌性角膜炎病例的人口统计学资料、发病经过、角膜病灶特征和微生物学检查结果等可能的影响因素进行单因素分析,进一步用多分变量Logistic回归对上述筛选出的影响因素进行多因素分析以发现影响预后的主要危险因素。结果：共154例154眼被纳入本研究。所有患者均接受口服伊曲康唑治疗,必要时联合0.15%两性霉素B滴眼液和/或2%伏立康唑滴眼液。预后好组有126例(81.8%),预后中等组有18例(11.7%)预后差组则有10例(6.5%)。Pearson卡方检验单因素分析结果提示人口统计学资料和发病情况包括性别(p=0.998)、年龄(p=0.175)、是否合并其他眼病(p=0.504)、系统性疾病(p=0.178)、有无异物外伤诱因(p=0.372)、有无近期激素使用史(p=0.195)与真菌性角膜炎的预后均无明显相关性；而来我院就诊前的发病天数(p=0.054)与疾病预后有明显相关性,达到边缘显著。角膜病灶的特征如浸润病灶的直径(p0.001)、浸润深度(p0.001)、有无前房积脓(p0.001)、病灶位置(p=0.004)与疾病预后显著相关。微生物学检查结果致病真菌菌属(p=0.046)及其体外药物敏感性(p=0.016)与真菌性角膜炎的预后亦显著相关。多分变量Logistic回归多因素分析发现浸润病灶直径大于6mm(p=0.003)、浸润至角膜基质后2/3(p=0.011)、伴有前房积脓(p=0.044)、体外对3种药物均耐药或仅对1种药物敏感(p=0.002)、致病菌属为镰刀菌或曲霉菌(p=0.059,边缘显著)均是真菌性角膜炎预后的主要危险因素。结论：在用口服伊曲康唑、必要时联合0.15%两性霉素B滴眼液和/或2%伏立康唑滴眼液治疗真菌性角膜炎时,大的浸润病灶、浸润至角膜后2/3、伴有前房积脓、致病菌属为镰刀菌或曲霉菌以及体外药物敏感性差等是真菌性角膜炎预后的主要危险因素。
[Abstract]:Objective: To investigate the clinical features of fungal keratitis, in order to find out the main risk factors affecting the prognosis of fungal keratitis.
Study design: retrospective cohort study.
Methods: the research object for the period from January 2009 to December 2012 were positive for fungal keratitis in our hospital. The pathogen culture only with antifungal treatment to obtain clearance of infection, corneal scar healing results were classified as good prognosis group; in addition to drugs still need combined treatment keratoplasty, achieve infection cleared and corneal scar after healing with refractory complications were classified as middle prognosis group; there no light perception in the positive drug and / or treatment of corneal transplantation, refractory complications or retinal detachment, and enucleation were classified as poor prognosis group. Using Pearson chi square test respectively for the cases of fungal keratitis the demographic data, the incidence, influencing factors of corneal lesion features and the microbiological examination may be carried further by single factor analysis, multiple Logistic regression. The selected factors were analyzed by multifactor analysis to find the main risk factors affecting the prognosis.
Results: a total of 154 eyes of 154 patients were enrolled in this study. All patients received oral itraconazole treatment when necessary, combined with 0.15% amphotericin B and / or 2% voriconazole eye drops. The good prognosis group had 126 cases (81.8%), intermediate risk group had 18 cases (11.7%) and poor prognosis group had 10 cases (6.5%).Pearson chi square test of single factor analysis showed that the incidence and demographic data including gender, age (p=0.998) (p=0.175), whether or not combined with other eye disease (p=0.504), systemic disease (p=0.178), there is no foreign body injury (p=0.372), there is no incentive for the recent history of steroid use (p=0.195) and prognosis fungal keratitis were not significantly related to the incidence of days; in our hospital before (p=0.054) have significant correlation with the prognosis of the disease and is marginally significant. The characteristics of corneal diameter of lesions such as infiltration lesions (p0.001), depth of invasion (p0.001), there is no hypopyon (p0. 001), location (p=0.004) was significantly correlated with the prognosis of the disease. The microbiological examination of pathogenic fungi bacteria (p=0.046) and the in vitro drug sensitivity (p=0.016) and the prognosis of fungal keratitis was also significantly related. Multiple Logistic regression multivariate analysis showed that infiltration lesions larger than 6mm in diameter (p=0.003), infiltrating into the corneal stroma after 2/3 (p=0.011), with hypopyon (p=0.044) in vitro, to 3 kinds of drugs were resistant or sensitive only to 1 kinds of drugs (p=0.002), pathogenic bacteria for Fusarium or Aspergillus (p=0.059 edge significant) are main risk factors of fungal keratitis.
Conclusion: in oral itraconazole, when necessary, combined with 0.15% amphotericin B and / or 2% voriconazole eye drops in the treatment of fungal keratitis, large infiltration lesions, infiltrating into the cornea after 2/3 with hypopyon, pathogenic bacteria for Fusarium or Aspergillus and in vitro drug sensitivity is a major risk prognosis fungal keratitis.

【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R772.21

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