棘阿米巴性角膜炎120例临床特征及治疗转归  

Clinical features and treatment outcome of 120 cases with acanthamoeba keratitis

作　　者：朱智勇[1] 王敬亭 董燕玲[3] 李素霞[2] Zhu Zhiyong;Wang Jingting;Dong Yanling;Li Suxia(School of Medicine and Life Sciences,Jinan University,Shandong Academy of Medical Sciences,Jinan 250021,China;Shandong Eye Institute,Shandong Eye Hospital,Jinan 250022,China;Shandong Eye Institute,Qingdao Eye Hospital,Qingdao 266071,China)

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,山东省医学科学院,250022 [2]山东省眼科研究所,山东省眼科医院,250021 [3]山东省眼科研究所青岛眼科医院,266071

出　　处：《临床眼科杂志》2020年第3期228-232,共5页Journal of Clinical Ophthalmology

基　　金：国家自然科学基金(81530027)。

摘　　要：目的探讨棘阿米巴性角膜炎的临床特征及治疗转归。方法收集2004年1月至2018年12月就诊于山东省眼科医院和青岛眼科医院的棘阿米巴性角膜炎120例(122只眼),回顾性分析患者年龄、发病时间、危险因素以及误诊情况,根据发病时间及溃疡严重程度进行临床分期,分析不同时期患者的治疗转归情况。结果棘阿米巴性角膜炎多发生于36~60岁患者(80/120)。角膜外伤是该病首要危险因素(31/61),其次是污水入眼(13/61),角膜接触镜仅占14.8%(9/61)。仅13.1%的患者于首诊确诊(16/122),县及县以下医院误诊率较高(86/90);误诊诊断以病毒性角膜炎最多(46/122),其次是细菌性角膜炎(23/122)和真菌性角膜炎(14/122)。角膜激光共聚焦显微镜的检出率(90.3%)远高于角膜刮片(75.9%)等方法。本研究中35只眼为初期(28.7%),80只眼为中期(57.4%),17只眼为晚期(13.9%)。57.1%初期病眼(20/35)和5.7%中、晚期病眼(5/87)可通过药物治疗治愈,有效性差异有统计学意义(P<0.05)。88.2%行角膜移植术治疗的病眼为中、晚期(67/76),因复发或病灶扩散而无法保存眼球行眼内容剜出术的有7只眼(5.7%),均为晚期患者。结论角膜外伤和污水入眼是我国棘阿米巴性角膜炎的主要危险因素,本病在基层医院误诊率仍然较高,共焦显微镜可提高检出率;药物治疗对本病初期患者效果较好,而中、晚期患者往往需要通过角膜移植术治疗。Objective To investigate analyze the clinical features and treatment outcome of acanthamoeba keratitis.Methods A total of 120 cases(122 eyes)with acanthamoeba keratitis were collected from 2004 to 2018 in Shandong Eye Hospital and Qingdao Eye Hospital.Patients'age,disease onset time,risk factors and presence of misdiagnosis were retrospectively analyzed.Clinical stages were assessed according to onset time and severity of ulcer,and treatment outcomes of patients at different stages were analyzed.Results Acanthamoeba keratitis most commonly occurred in patients aged 36 to 60 years(80/120).Corneal trauma was the primary risk factor(31/61),followed by sewage into the eye(13/61),and corneal contact lens only accounted for 14.8%(9/61).Only 13.1%of the patients were diagnosed at the first time of hospital presentation(16/122),and the misdiagnosis rate was high in basic-level or inferior hospitals(86/90).Viral keratitis was most frequently misdiagnosed(46/122),followed by bacterial keratitis(23/122)and fungal keratitis(14/122).The detection rate of corneal confocal microscopy(90.3%)was much higher than that of corneal blade(75.9%).In this study,35 eyes were in primary stage(28.7%),80 eyes were in intermediate stage(57.4%)and 17 eyes were in late stage(13.9%).57.1%of the eyes in primary stage(20/35)and 5.7%of the eyes in intermediate and late stage(5/87)can be cured by drug treatment,with statistically significant difference in treatment effectiveness(P<0.05).88.2%of the eyes treated with keratoplasty were in the intermediate or late stage(67/76),and 7 eyes(5.7%)treated with corneal contusion were in the late stage.Conclusions Corneal trauma and sewage into the eye are the main risk factors of acanthamoeba keratitis in China.Although the misdiagnosis rate of the acanthamoeba keratitis is still high in the basic-level hospital,confocal microscope can improve the detection rate.Drug therapy is effective at early stage of the disease,while keratoplasty is often needed in the intermediate and late stage.

关 键 词：棘阿米巴 角膜炎 共焦显微镜 

分 类 号：R772.21[医药卫生—眼科]