肺炎克雷伯菌性肝脓肿继发内源性眼内炎6例临床特征及转归分析  

Clinical features and prognosis of endogenous endophthalmitis secondary to klebsiella pneumoniae liver abscess:An analysis of six cases

作　　者：李瑛 李清华 刘桂波[1] 尹晓妮[1] 何宏[2] 陈秋卢 段凝 魏向阳[1] 杜兆东[1] LI Ying;LI Qinghua;LIU Guibo;YIN Xiaoni;HE Hong;CHEN Qiulu;DUAN Ning;WEI Xiangyang;DU Zhaodong(Department of Ophthalmology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院眼科,山东青岛266003 [2]青岛大学附属医院检验科,山东青岛266003

出　　处：《精准医学杂志》2024年第1期44-47,共4页Journal of Precision Medicine

基　　金：国家自然科学基金资助项目(81900824);山东省自然科学基金资助项目(ZR2017MH055);青岛市中医药科研计划项目(2020-ZYY052)。

摘　　要：目的探讨肺炎克雷伯菌性肝脓肿(KPLA)继发内源性眼内炎(endogenous endophthalmitis,EE)患者的眼部临床特征及诊疗方案。方法选取2019年1月-2020年12月就诊于我院的KPLA继发EE患者6例(7眼),分析患者的临床表现、检查结果、治疗方案及预后。结果6例患者均为男性,5例伴有发热,所有患者均有视力下降,初诊时视力无光感者4例(5眼),手动视力者1例(1眼),光感者1例(1眼)。所有患者均具有视力下降、结膜充血水肿、眼球胀痛、前房炎症反应等典型眼内炎临床表现,术后眼内液微生物培养均为肺炎克雷伯菌阳性。末次就诊时丧失视力者4例(4眼),视力检查不配合者1例(1眼),失访者1例(2眼)。结论KPLA继发EE对眼球结构和视功能破坏性强,KPLA患者出现发热等全身症状或视力下降、眼红、眼痛等眼部不适时,应建议患者立即去眼科门诊就诊并定期随诊,以警惕眼内炎的发生。Objective To investigate the ocular clinical features and diagnostic and therapeutic protocol of patients with endogenous endophthalmitis(EE)secondary to Klebsiella pneumoniae liver abscess(KPLA).Methods Six patients(seven eyes)with EE secondary to KPLA who attended our hospital from January 2019 to December 2020 were enrolled and analyzed in terms of clinical manifestation,examination findings,treatment regimen,and prognosis.Results All six patients were male,among whom five had pyrexia.All patients had impaired vision,and at initial diagnosis,there were four patients(five eyes)with no light perception,one patient(one eye)with manual vision,and one case(one eye)with light perception.All patients had the typical clinical manifestations of endophthalmitis such as impaired vision,conjunctival congestion and edema,ocular swelling and pain,and inflammatory response in the anterior chamber,and postoperative microbial culture of intraocular fluid showed positive Klebsiella pneumoniae.At the last visit,four patients(four eyes)had loss of vision,one patient(one eye)did not cooperate in vision check,and one patient(two eyes)was lost to follow-up.Conclusion EE secondary to KPLA is highly destructive to eyeball structure and visual function,and patients with KPLA who develop systemic symptoms(such as fever)or ocular discomfort(such as loss of vision,eye redness,and eye pain)should attend the outpatient service of ophthalmology department and receive regular follow-up examination to be alert to the development of endophthalmitis.

关 键 词：眼内炎 肺炎克雷伯菌 肝脓肿 诊断 预后 

分 类 号：R771.2[医药卫生—眼科] R575.4[医药卫生—临床医学]