239例真菌性角膜炎流行病学特征分析  

Analysis of the epidemiological characteristics in 239 cases of fungal keratitis

作　　者：吴松一[1] 李晓霞[1] 王蓉[1] 刘书枫 方一明[1] 

机构地区：[1]福建医科大学教学医院,泉州市儿童医院·妇幼保健院·眼科医院,福建泉州362000

出　　处：《中国病原生物学杂志》2015年第9期822-824,829,共4页Journal of Pathogen Biology

摘　　要：目的分析真菌性角膜炎致病菌谱及其耐药性，了解临床治疗效果及流行病学特征，为该病的预防和治疗提供科学依据。方法对2012—2014年泉州市眼科医院收治的疑似真菌性角膜炎患者采角膜刮片标本，显微镜初检并培养真菌，对主要真菌进行耐药性试验。对照组采用1：1与病例组进行匹配，对照组和病例组进行危险因素分析。结果实验室培养出239株真菌，菌株数居前5位的分别是茄病镰刀菌97株，占40．59％；烟曲霉48株，占20．08％；链格孢霉35株，占14．64％；光滑假丝酵母24株，占10．04％；梨孢廉刀菌10株，占4．18％。239例真菌性角膜炎患者中，男女比为1．91：1，38～58岁人群共195例，占病例总数的81．59％，农民发病169例，占70．71％，发病高峰呈单峰分布，集中在每年9～11月；单因素Logistic回归分析显示，农作物损伤，佩戴角膜接触镜，眼部疾病史和激素、抗生素的滥用是该病发病的危险因素；多因素Logistic回归分析显示，农作物损伤，佩戴角膜接触镜和激素、抗生素的滥用是真菌性角膜炎发病的危险因素。结论镰刀菌属是真菌性角膜炎中最主要的病原，真菌性角膜炎致盲率极高，应加强高危人群的健康教育工作，同时做好该病的早期诊断，针对病原菌类型选择特效药物治疗。Objective To analyze the pathogens responsible for fungal keratitis, their drug resistance, the effectiveness of clinical treatment, and the epidemiological characteristics of those pathogens in order to provide scientific evidence for the prevention and treatment of that disease. Methods Corneal scrapings were collected from patients with suspected fungal keratitis seen by Ophthalmology in the City of Quanzhou from 2012-2014. Specimens were microscopically exam- ined and fungi were cultured. The drug resistance of predominant fungi was tested. Patients were matched 1 ： 1 with controls. Risk factors in the control group and patients were analyzed. Results Laboratory cultures yielded 239 strains of fungi. Of those strains, 97 （40. 59%） were Fusarium solani, 48 （20.08%） were Aspergillus fumigatus, 35 （14.64%） were Alternaria alternata, 24 （10. 04%） were Candida glabrata, and 10 （4.18%） were F. poae. The ratio of male and female patients with fungal keratitis was 1.91：1. By age group, 195 patients were ages 38-58, accounting for 81.59 % of all patients. By occupation, 169 patients were farmers, accounting for 70.71% of all patients. Incidence peaked once, and cases of fungal keratitis were concentrated in September-November each year. Univariate logistic regression analysis indi- cated that crop damage, wear of contact lenses, a history of ocular disease and misuse of hormones or antibiotics were risk factors for developing the disease. Multivariate logistic regression analysis indicated that crop damage, wear of contact lenses, and misuse of hormones or antibiotics were risk factors for the development of fungal keratitis. Conclusion Fu sarium spp. were the primary pathogens responsible for fungal keratitis. Fungal keratitis was likely to lead to blindness. Health education for high-risk groups should be enhanced, the disease should be diagnosed early on, and efficacious drug therapies should be selected depending on the pathogen responsible for the disease.

关 键 词：真菌性角膜炎 病原学 耐药性 危险因素 

分 类 号：R379[医药卫生—病原生物学] R772.2[医药卫生—基础医学]