荆州地区真菌性角膜炎176例临床分析
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2019年荆州市科技计划项目(No.2019HC18)


Clinical analysis of 176 cases of fungal keratitis in Jingzhou
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Jingzhou Science and Technology Plan Project in 2019(No.2019HC18)

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    摘要:

    目的:分析荆州地区真菌性角膜炎(FK)患者的感染特征和临床治疗转归等,为本地区FK的临床诊疗提供依据。

    方法:收集2015-01/2020-07在荆州市中心医院眼科就诊并病原学确诊为FK的176例患者资料,对患者的流行病学特征、真菌菌种鉴定结果、药物敏感性及临床治疗经过及转归等进行分析。

    结果:FK患者176例中,男118例,女58例,男女比例为2.03:1。发病年龄以50~59岁及60~69年龄段的患者人数最多,发病高峰季节为4~6月及10~12月。危险因素包括外伤及可能外伤史、眼表疾病、眼科术后、配戴角膜接触镜及长期局部药物使用。主要致病菌为镰刀菌属(39.8%)、曲霉菌属(30.7%)、链格孢菌属(15.9%)和念珠菌属(5.1%),药敏结果示伏立康唑和两性霉素B均比较敏感,而氟康唑的耐药率非常高。125眼经药物保守治疗后病情好转或治愈,12眼行角膜基质内注药,15眼行结膜瓣遮盖或羊膜移植,21眼行角膜移植术,8眼行眼内容物剜除术,包括5眼行结膜瓣遮盖后严重眼内炎的患者。

    结论:荆州地区FK的发病人群多为中老年男性,多为农业劳动过程中角膜外伤后导致,以镰刀菌及曲霉菌多见,根据药敏结果选择合理的抗真菌药物及治疗方式非常重要。

    Abstract:

    AIM: To analyze the infection characteristics and clinical treatment outcome of patients with fungal keratitis(FK)in Jingzhou area, so as to provide basis for clinical diagnosis and treatment of FK.

    METHODS: The data of 176 patients with FK diagnosed by etiology in Jingzhou Central Hospital from January 2015 to July 2020 were collected, and the epidemiological characteristics, identification results of fungal strains, drug sensitivity and clinical treatment outcome of the patients were analyzed.

    RESULTS:Among the 176 patients with FK, 118 were male and 58 were female, and the ratio of male to female is 2.03:1. The age of onset was the largest number of patients in 50-59 years old and 60-69 years old. The peak seasons of onset were April to June and October to December. Risk factors include trauma and possible history of trauma, ocular surface diseases, post ophthalmic surgery, wearing corneal contact lenses and long-term local drug use. The main pathogens were Fusarium(39.8%), aspergillus(30.7%), alternaria(15.9%)and candida(5.1%). The results of drug sensitivity showed that voriconazole and amphotericin B were sensitive, while the drug resistance rate of fluconazole was very high. There were 125 eyes improved or cured after conservative treatment, 12 eyes were injected into corneal stroma, 15 eyes were covered with conjunctival flap or amniotic membrane transplantation, and 21 eyes were treated with corneal transplantation. Enucleation of ocular contents was performed in 8 eyes, including 5 eyes with severe endophthalmitis after conjunctival flap covering.

    CONCLUSION:The incidence of FK in Jingzhou area is mostly middle-aged and elderly men, mostly caused by corneal trauma in the process of agricultural labor. The main pathogens were fusarium and aspergillus. It is very important to select reasonable antifungal drugs and treatment methods according to the drug sensitivity results.

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伍志琴,王晓琴,陈瑶,等.荆州地区真菌性角膜炎176例临床分析.国际眼科杂志, 2022,22(8):1373-1376.

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  • 收稿日期:2021-12-01
  • 最后修改日期:2022-07-12
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  • 在线发布日期: 2022-07-27
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