行大植片角膜移植的真菌性角膜炎患者病原学及临床特征分析  

The etiology and clinical manifestations of large-diameter penetrating keratoplasty for the treatment of fungal keratitis

作　　者：王黛[1] 王月新[2] 贾艳妮[3] 刘冬乐 向德猛 王君怡[2] 高华[3] 

机构地区：[1]济南大学山东省医学科学院医学与生命科学学院山东省眼科研究所,250022 [2]青岛大学山东省眼科研究所青岛眼科医院,266071 [3]山东省眼科研究所山东省眼科医院,济南250021

出　　处：《中华眼视光学与视觉科学杂志》2016年第3期174-177,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：国家自然科学基金（81370989）;青岛市科技计划基础研究项目（13-1-4-169-jch）;山东泰山学者计划（20081148）;山东省优秀创新团队资助项目（TD201208）

摘　　要：目的分析行大植片穿透性角膜移植的真菌性角膜炎患者的致病菌菌属、危险因素及临床特征．为临床严重真菌性角膜炎的诊断和治疗提供客观依据。方法回顾性系列病例研究。选取2005年1月至2013年12月在青岛眼科医院确诊为真菌性角膜炎并接受大直径角膜移植（植片直径〉9mm）患者132例（132眼），其中男82例，女50例。职业农民76例，工人10例，其他46例。统计感染的菌种、发病来院就诊时间、就诊时病变严重程度、感染的临床特征（包括伪足、卫星灶、内皮斑、苔被、前房积脓、溃疡面积）等情况，分别就菌属差异与临床特征差异的关系进行分析，应用x2检验分析数据。结果感染菌种中镰刀菌属85例（64．4％），曲霉菌属10例（7．6％），其他菌属37例（28．0％）。132例患者发病至接受LDPK术的平均时间为（23．7±11．2）d。镰刀菌属感染前3位临床特征是伪足、前房积脓、卫星灶；曲霉菌属感染前三位临床特征使前房积脓、苔被、伪足。镰刀菌属和曲霉菌属感染角膜溃疡面积分别为（48．3±12．3）mm：和（44．8±20．2）mm2，镰刀菌属感染的29例患者溃疡累及全层角膜。结论镰刀菌属和曲霉菌属是常见致病真菌，可以引起严重的真菌感染。大量前房积脓出现是严重真菌感染的重要指标．对于药物控制不佳的患者及早选择角膜移植手术控制病情是积极的治疗策略。Objective To observe and analyze the fungal species, risk factors and clinical characteristics in patients with fungal keratitis who underwent large-diameter penetrating keratoplasty （LDPK） in order to provide an objective basis for the diagnosis and treatment of fungal keratitis. Methods This was a retrospective case series study. Patients with fungal keratitis who were admitted to Qingdao Eye Hospital from January 2005 to December 2013 and underwent LDPK （graft diameter〉 9 mm）, were selected for follow-up to monitor fungal species infections. One hundred and thirty-two cases （132 eyes） with fungal keratitis, including 82 males and 50 females, underwent LDPK. Of them, there were 76 farmers, 10 workers and 46 in other occupations. Data on the duration from the onset to the hospital visit, severity at diagnosis and clinical features of infection （including pseudopodia, satellite lesions, endothelial plaque, moss cover, hypopyon, ulcer area） were recorded. A descriptive and statistical analysis （x2 test） was performed on the differences in species and the relationship between the differences in clinical features. Results The infectious fungal species included 85 cases of Fusarium （64.4%）, 10 cases of genus Aspergillus （7.6%）, and 37 other cases. The mean duration from onset to LDPK surgery in all 132 cases was 23.7±11.2 days. The first three clinical features of Fusarium spp. were pseudopodia, hypopyon and satellite lesions; the first three clinical features of Aspergillus spp. were hypopyon, moss cover and pseudopodia. Compared with Aspergillus spp. （44.8± 20.2 mm2）, the ulcer area of Fusarium spp. （48.3±12.3 mm2） was larger, and occupied the entire cornea in 29 patients with Fusarium spp. Conclusion Fusarium spp. and Aspergillus spp. are common pathogenic fungi and may cause serious fungal infections that threaten eyeball preservation. The large amount of hypopyon is an important indicator of serious fungal infections. For patients poorly controlled with drugs, the early s

关 键 词：真菌性角膜炎 菌属 临床表现 危险因素 

分 类 号：R779.65[医药卫生—眼科]