真菌性角膜炎临床常用诊断方法比较分析  

Comparative analysis of commonly clinical diagnostic method of fungal keratitis

作　　者：窦新岩 王丽娅[1] 孙声桃[1] 韩雷[1] 李金[1] 余晓菲[1] 张红敏[1] 

机构地区：[1]河南省眼科研究所河南省立眼科医院郑州大学人民医院,450003

出　　处：《中国实用眼科杂志》2016年第6期564-568,共5页Chinese Journal of Practical Ophthalmology

基　　金：河南省医学科技攻关计划项目（201203171）;河南省科技创新人才计划项目（144100510015）;郑州市国际科技合作与交流项目（141PGJHZ532）.

摘　　要：目的分析真菌性角膜炎三种常用诊断方法，为早期快速准确诊断提供依据。方法回顾性临床病例研究。对2013年9月至2014年1在河南省眼科研究所就诊的993例真菌性角膜炎患者，均做角膜刮片、真菌培养及共焦显微镜，比较三种检查方法的阳性率，分析性别、年龄及病程对三种诊断阳性率的影响。结果993例真菌性角膜炎患者中角膜刮片阳性率为79．5％（789／993），真菌培养阳性率为43．2％（429／993），共焦显微镜检查阳性率为82．1％（815／993）。角膜刮片与共焦显微镜诊断阳性率差异无统计学意义（P〉0．05），二者较真菌培养诊断阳性率差异有统计学意义（P〈0．05）；在993例患者中男638例，女355例，无论男女角膜刮片与共焦显微镜诊断阳性率差异无统计学意义（P〉0．05），二者较真菌培养诊断阳性率差异有统计学意义（均P〈0．05）；每种诊断方法男女比较，差异无统计学意义（P〉0．05）；在三种方法诊断阳性者中，年龄均集中在41—70岁，在各年龄段，角膜刮片与共焦显微镜诊断阳性率差异无统计学意义（P〉0．05），二者较真菌培养诊断阳性率差异有统计学意义（P〈0．05）；在各个年龄段内，每种诊断方法差异无统计学意义（P〉0．05）；在993例真菌性角膜炎患者中，最短时间在角膜感染当天即来诊，最长时间在三个月以上。在各个病程来诊的患者，角膜刮片与共焦显微镜诊断阳性率差异无统计学意义（P〉0．05），二者较真菌培养诊断阳性率差异有统计学意义（P〈0．05）。角膜刮片在3个月内的三个时间段，诊断阳性率差异无统计学意义（P〉0．05），较3个月以上诊断阳性率高；真菌培养随着病程的延长，培养阳性率逐渐降低差异有统计学意义（均P〈0．05）；共焦显微镜在各病程差异无统计学意义（均P〉0．05）。结论真菌性Objective To analyze the three diagnostic methods for fungal keratitis, to provide the basis for rapid, accurate and early diagnosis. Methods Retrospectively reviewed 993 cases of fungal keratitis patients who were treated in Henan eye institute from September 2013 to January 2014. Cornea scrapings, fimgal culture and corneal confocal microscope were performed. The positive rate, impact of gender, age and duration on the three diagnostic methods were compared and analyzed. Results The positive rate by corneal scrapings was 79.5% （789/993）, fungal culture was 43.2% （429/993） and confocal microscope was 82.1% （815/993）; the positive rate comparison difference was not statistically significant between corneal scrapings and confocal microscope （P 〉0.05）, both positive rate were higher than fungal culture （all P 〈0.05）; Among the 993 patients suffering fungal keratitis, there were 638 male and 355 female; the positive rate comparison difference was not statistically significant between corneal scrapings and confocal microscope （all P 〉0.05）, both positive rate were higher than fungal culture （all P 〈0.05）. In the three methods of diagnosis positive persons, their age was concentrated in 41-70, in each age, the positive rate comparison difference was not statistically significant between corneal scrapings and confocal microscope （all P 〉0.05）, both positive rate were higher than fungal culture （all P 〈0.05）. Among the 993 patients suffering fungal keratitis, The minimum time of them coming to treatment was the same day that they infected the cornea, the lon- gest was more than three months, in each course of the patients, the positive rate comparison difference was not statistically significant between corneal scrapings and confocal microscope （all P 〉 0.05）, both positive rate were higher than fungal culture （all P 〈0.05）; Corneal scraping within three months of the three time periods, the diagnostic positive rate was not significant difference （P 〉 0.05�

关 键 词：真菌性角膜炎 角膜刮片 真菌培养 共焦显微镜 

分 类 号：R772.21[医药卫生—眼科]