[1]刘欣,吴尚操,戎佳燕,等.不同真菌菌属所致角膜炎的临床特点及转归差异[J].眼科新进展,2016,36(3):250-254.[doi:10.13389/j.cnki.rao.2016.0067]
　LIU Xin,WU Shang-Cao,RONG Jia-Yan,et al.Clinical characteristics and outcomes of keratitis caused by different fungal species[J].Recent Advances in Ophthalmology,2016,36(3):250-254.[doi:10.13389/j.cnki.rao.2016.0067]
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不同真菌菌属所致角膜炎的临床特点及转归差异
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
36卷
期数:
2016年3期
页码:
250-254
栏目:
应用研究
出版日期:
2016-03-05

文章信息/Info

Title:
Clinical characteristics and outcomes of keratitis caused by different fungal species
作者:
刘欣; 吴尚操; 戎佳燕; 秦姣; 金晓丽; 曾庆延
410015　湖南省长沙市，中南大学爱尔眼科学院
Author(s):
LIU Xin ;  WU Shang-Cao;  RONG Jia-Yan;  QIN Jiao ;  JIN Xiao-Li;  ZENG Qing-Yan
Aier School of Ophthatmology , Central South University, Changsha 410015 , Hunan Province, China
关键词:
真菌性角膜炎; 临床特点; 转归
Keywords:
fungal keratitis ;  clinical characteristics ; prognosis
DOI:
10.13389/j.cnki.rao.2016.0067
文献标志码:
A
摘要:
目的　探讨不同真菌菌属所致角膜炎的临床特点及转归差异。方法　收集２０１１年８月至２０１５年３月我院真菌培养阳性的角膜炎患者共９６例（９６眼），其中，镰刀菌４３例，曲霉菌３１例，链格孢霉１７例，念珠菌５例，分别记录患者植物性外伤史、病程、临床特点、治疗方式及转归。对上述观察指标进行比较，采用ＳＰＳＳ１９．０软件进行统计学分析。结果　９６例患者中有植物性外伤史者３４例（３５．４％），其中镰刀菌感染患者中２５．６％有植物性外伤史，曲霉菌３５．５％，链格孢霉６４．７％，念珠菌２０．０％，不同菌属之间差异有统计学意义（χ２＝８．７１４，Ｐ＝０．０３３）。组间比较镰刀菌与链格孢霉间差异有统计学意义（χ２＝８．０３１，Ｐ＝０．００５）。患者病程按照菌属从短到长依次为：念珠菌（５．４０±３．３６）ｄ、镰刀菌（１６．７９±１３．９８）ｄ、曲霉菌（１９．３５±１３．１６）ｄ、链格孢霉（２７．５９±２０．６８）ｄ，不同菌属间差异有统计学意义（χ２＝１４．４０７，Ｐ＝０．００２），组间比较念珠菌病程与其他菌属差异均有统计学意义（均为Ｐ＜０．０５）；镰刀菌与链格孢霉差异亦有统计学意义（Ｐ＝０．０１０）。不同真菌菌属所致角膜炎的临床特征不同，链格孢霉角膜溃疡面积、深度、前房积脓发生率均小于其他菌属（均为Ｐ＜０．０５），其余各菌属间差异无统计学意义（均为Ｐ＞０．０５）。镰刀菌感染以单纯药物治疗与角膜板层切除术治疗为主，药物治愈率为７８．６％；曲霉菌感染以角膜板层切除术和角膜移植术治疗为主，药物治愈率６２．５％；链格孢霉和念珠菌感染主要以单纯药物治疗为主，药物治愈率分别为９０．０％、１００．０％。结论　链格孢霉感染多由植物性外伤引起，临床体征轻，药物治疗效果好；念珠菌感染发展快，药物治疗效果好；镰刀菌与曲霉菌感染临床体征重，镰刀菌常需尽早行角膜板层切除术，曲霉菌常需行角膜移植术治疗。
Abstract:
Objective To explore the differences of keratitis caused by four different fungal species in clinical characteristics and outcomes. Methods Ninety-six eyes of 96 patients diagnosed as fungal keratitis in our hospital were collected in this study ,in which 43 cases were Fusa7-ium spp , 31 cases were Aspergillus spp , 17 cases were Alterna7-ia spp ,5 cases were Candida spp. The plant trauma history , disease duration.clinical signs, treatment and prognosis were recorded. Those above indexes were statistically analyzed with SPSS 19. 0 software. Results The plant trauma history were found in 34 patients ( 35. 4% ) , in which Fusa7-ium accounted for 25. 6% ,Aspergillus for 35.5% ,Alterna7-ia for 64. 7% , Candida for 20% . the difference among those species was statistically significant (X2 = 8. 714 ,P = 0. 033 ) , and there was statistical difference between Fusa7-ium and Alterna7-ia (X2 = 8. 031 ,P = 0. 005 ) . From short to long duration as followed . Candida ( 5. 40 + 3. 36 ) days , Fusa7-ium ( 16. 79 + 13. 98 ) days , Aspergillus ( 19. 35 + 13. 16 ) days , Alterna7-ia ( 27. 59 + 20. 68 ) days , the difference was statistically significant(P = 0. 002) , and the duration of Candida spp was statistically shorter than that of other species ( all P < 0. 05 ) ; There was statistical difference between Fusarium and Alternaria ( P = 0. 010 ) . Clinical signs were different among those fungal species. Corneal ulcer area , depth of invasion , hypopyon incidence in Alternaria spp were statistically less than those of other species ( all P < 0. 05 ) , and there was no statistically significant difference in other clinical signs ( all P > 0. 05 ) . Fusa7-ium keratitis was mainly treated with medication and lamellar keratectomy, and the medication cure rate was 78. 6% . Aspergillus keratitis was mainly treated with lamellar keratectomy and penetrating keratoplasty, while the medication cure rate was 62. 5% . Alterna7-ia and Candida keratitis were mainly treated with medication , and the cure rate were 90. 0% , 100. 0% . respectively. Conclusion Alterna7-ia keratitis with mild clinical signs is often caused by plant trauma, and sensitive to medication. Candida keratitis is often with rapid progression and high medication cure rate. Fusa7-ium and Aspergillus keratitis are both with severe clinical signs , and often need lamellar keratectomy and penetrating keratoplasty , respectively.

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备注/Memo

备注/Memo:
武汉市卫计委临床医学科研项目（编号：ＷＸ１３Ｃ５０）；爱尔眼科医院集团科研基金项目（编号：ＡＦ２０１３００６）
更新日期/Last Update: 2016-03-08