[1]赵振,张晓玉,王慧瑾,等.无孢霉菌性角膜炎患者的临床特征及治疗转归[J].眼科新进展,2021,41(5):438-441.[doi:10.13389/j.cnki.rao.2021.0091]
　ZHAO Zhen,ZHANG Xiaoyu,WANG Huijin,et al.Clinical characteristics and treatment outcome of patients with nonsporulating molds keratitis[J].Recent Advances in Ophthalmology,2021,41(5):438-441.[doi:10.13389/j.cnki.rao.2021.0091]
点击复制

无孢霉菌性角膜炎患者的临床特征及治疗转归/HTML
分享到：

《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
41卷
期数:
2021年5期
页码:
438-441
栏目:
应用研究
出版日期:
2021-05-05

文章信息/Info

Title:
Clinical characteristics and treatment outcome of patients with nonsporulating molds keratitis
作者:
赵振; 张晓玉; 王慧瑾; 鹿秀海; 亓晓琳; 高华
250022　山东省济南市,山东第一医科大学,山东省医学科学院(赵振);266071　山东省青岛市,山东省眼科研究所 山东省眼科学重点实验室-省部共建国家重点实验室培育基地(赵振，张晓玉，王慧瑾，亓晓琳，高华);250022　山东省济南市，山东第一医科大学附属眼科医院 (张晓玉，鹿秀海，亓晓琳，高华)
Author(s):
ZHAO Zhen1; 2; ZHANG Xiaoyu2; 3; WANG Huijin2; LU Xiuhai3; QI Xiaolin2; 3; GAO Hua2; 3
1.Shandong First Medical University & Shandong Academy of Medical Sciences,Jinan 250022,Shandong Province,China
2.State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,Shandong Eye Institute,Qingdao 266071,Shandong Province,China
3.Affiliated Eye Hospital,Shandong First Medical University,Jinan 250022,Shandong Province,China
关键词:
无孢霉菌性角膜炎; 临床特征; 治疗转归
Keywords:
nonsporulating molds keratitis;  clinical features;  treatment and outcome
分类号:
R772.2
DOI:
10.13389/j.cnki.rao.2021.0091
文献标志码:
A
摘要:
目的　探讨无孢霉菌性角膜炎患者的临床特征及治疗转归。方法　选择2009年3月至2019年3月在山东第一医科大学附属眼科医院诊断为无孢霉菌性角膜炎的患者64例（64眼），对患者的临床特征、实验室检查、治疗方法和转归进行分析。结果　64例（64眼）中，15例（23.4％）为中浅基质层溃疡和浸润，20例（31.3％）为深基质层溃疡和浸润，29例（45.3％）为深基质层溃疡和全层浸润。26例（40.6％）伴有前房积脓，5例（7.8％）伴有角膜穿孔，所有患者真菌培养均未见孢子生长。9例患者行药物治疗，11例患者接受角膜病灶切除术或结膜瓣遮盖术，17例患者行板层角膜移植术（LKP），24例患者行穿透性角膜移植术（PKP），3例患者行眼内容摘除术。总复发率为23.0％（14/61），其中药物治疗后复发率为22.2％（2/9），LKP后复发率为11.8％（2/17），PKP后复发率为41.7％（10/24），不同治疗方法之间复发率差异有统计学意义（χ2＝11.268,P<0.05；因行眼内容摘除术后无复发可能，统计中未计入眼内容摘除术患者），LKP组与PKP组患者复发率差异无统计学意义（P＞0.05）。术前合并穿孔的患者复发率为75.0％（3/4），高于无穿孔患者的复发率19.3％（11/57），差异有统计学意义（P<0.05）。前房积脓患者的复发率为30.4％（7/23），高于无前房积脓患者的复发率18.4％（7/38）（P＞0.05）。8例患者最终感染无法控制行眼内容摘除术，总治愈率为87.5％。复发患者总体治愈率为64.3%（9/14）。结论　无孢霉菌性角膜炎是一种严重的进行性感染性角膜疾病，角膜移植术后复发率高、预后差，应引起临床医师重视。
Abstract:
Objective　To evaluate the clinical characteristics, treatment outcome of patients with nonsporulating molds keratitis.Methods　Sixty-four patients (64 eyes) diagnosed with nonsporulating molds keratitis in the Shandong First Medical University Affiliated Eye Hospital from March 2009 to March 2019 were selected, and analyze the patient’s clinical characteristics, laboratory examinations, treatment methods, and treatment outcome.Results　Among the 64 patients(64 eyes)，fifteen patients(23.4%) had ulcers and infiltrations of superficial and middle stroma, 20 patients (31.3%) had ulcers and infiltrations of deep stroma,and 29 patients (45.3%) had deep stroma ulcers and full-thickness infiltration; 26 patients (40.6%) had hypopyon, and 5 patients (7.8%) were accompanied by corneal perforation. No spores grew during the fungal culture in all patients. Nine patients received medical treatment; 11 patients received corneal ulcer debridement or conjunctival flap covering cornea; 17 patients received lamellar keratoplasty (LKP); 24 patients received penetrating keratoplasty (PKP), 3 patients underwent extirpation of the eye content. The total recurrence rate was 22.9% (14/61), of which the recurrence rate after drug treatment was 22.2% (2/9), the recurrence rate after LKP was 11.8% (2/17), and the recurrence rate after PKP was 41.7% (10/24), and there was statistically significant difference in the recurrence rate of different treatment methods (χ2=11.268, P<0.05; Because there was no possibility of recurrence after eye evisceration, the eye evisceration patients was not included in the statistics). There was no difference in the recurrence rate of LKP group and PKP group (P>0.05). The recurrence rate of patients with preoperative perforation was 75% (3/4), which was higher than that of patients without perforation (19.3%, 11/57), and the difference was statistically significant (P<0.05). The recurrence rate of patients with hypopyon was 30.4% (7/23), which was higher than that of patients without hypopyon (18.4%, 7/38) (P>0.05). Eight patients with uncontrollable infection underwent extirpation of the eye content, and the total cure rate was 87.5%. The overall cure rate of recurrence patients was 64.3% (9/14).Conclusion　Nonsporulating molds keratitis is a serious progressive infectious corneal disease. The recurrence rate after corneal transplantation is high and the prognosis is poor, so it should be taken seriously by clinicians.

参考文献/References:

［1］　THOMAS P A,KALIAMURTHY J.Mycotic keratitis epidemiology,diagnosis and management［J］.Clin Microbiol Infect,2013,19:210-220.
［2］　刘欣,吴尚操,戎佳燕,秦姣,金晓丽,曾庆延.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.
LIU X,WU S C,RONG J Y,QIN J,JIN X L,ZENG Q Y.Clinical characteristics and outcomes of keratitis caused by different fungal species［J］.Rec Adv Ophthalmol,2016,36(3):250-254.
［3］　SANGEETHA B A,ABDEL-HADI A,HASSAN A S,SHOBANA C S,SURESH S,ABIRAMI B,et al.Evaluation of in vitro activities of extracellular enzymes from Aspergillus species isolated from corneal ulcer keratitis［J］.Saudi J Biol Sci,2020,27(2):701-705.
［4］　SHARMA S,BALNE P K,MOTUKUPALLY S R,SUJATA D,GARG P,SAHU S K,et al.Pythium insidiosum keratitis clinical profile and role of DNA sequencing and zoospore formation in diagnosis［J］.Clin Sci,2015,34(4):438-442.
［5］　GOPINATHAN U,SHARMA S,GARG P,RAO G N.Review of epidemiological features,microbiological diagnosis and treatment outcome of microbial keratitis:experience of over a decade［J］.Indian J Ophthalmol,2009,57(4):273-279.
［6］　AN N,LIU X N,WANG Y N,ZHU J L,YANG H,WU J,et al.The pathogenic spectrum of fungal keratitis in northwestern China［J］.Int J Ophthalmol,2016,9(12):1846-1848.
［7］　JAYASUDHA R,SHARMA S,KALRA P,MISHRA D K.Exserohilum keratitis:clinical profile of nine patients and comparison of morphology versus ITS-based DNA sequencing for species identification of the fungal isolates［J］.Indian J Med Microbiol,2018,36(4):564-568.
［8］　BALAJEE S A,LINDSLEY M D,IQBAL N,ITO J,PAPPAS P G,BRANDT M E.Nonsporulating clinical isolate identified as Petromyces alliaceus (anamorph Aspergillus alliaceus) by morphological and sequence-based methods［J］.J Clin Microbiol,2007,45(8):2701-2703.
［9］　BAGYALAKSHMI R,THERESE K L,PRASANNA S,MADHAVAN H N.Newer emerging pathogens of ocular non-sporulating molds (NSM) identified by polymerase chain reaction (PCR)-based DNA sequencing technique targeting internal transcribed spacer (ITS) region［J］.Curr Eye Res,2008,33(2):139-147.
［10］　尚红,王毓三,申子瑜.全国临床检验操作规程［M］.4版.北京:人民卫生出版社，2015.
SHANG H,WANG Y S,SHEN Z Y.National Clinical Laboratory Procedures［M］.4th ed.Beijing：People’s Medical Publishing House，2015.
［11］　HE H,YANG J,CHEN X L,ZHONG X W.Identification of pathogenic nonsporulating molds in eyes by internal transcribed spacer sequences alignment［J］.Int Eye Sci,2018,18(10):1826-1829.
［12］　SINGH P K,KATHURIA S,AGARWAL K,GAUR S N,MEIS J F,CHOWDHARY A.Clinical significance and molecular characterization of nonsporulating molds isolated from the respiratory tracts of bronchopulmonary mycosis patients with special reference to basidiomycetes［J］.J Clin Microbiol,2013,51(10):3331-3337.
［13］　安娜,王亚妮,刘先宁,朱娟莉,朱秀萍,吴洁.真菌性角膜炎致病菌种属的PCR鉴定［J］.眼科新进展,2010,30(11):1017-1020.
AN N,WANG Y N,LIU X N,ZHU J L,ZHU X P,WU J.Identification of Genus anD species of fungal keratitis pathogens by PCR［J］.Rec Adv Ophthalmol,2010,30(11):1017-1020.
［14］　HOTTA F,EGUCHI H,NISHIMURA K,KOGISO M,ISHIMARU M,KUSAKA S,et al.A super-infection in the cornea caused by Stemphylium,Acremonium,and alpha-Streptococcus［J］.Ann Clin Microbiol Antimicrob,2017,16(1):11.
［15］　何键,程钧,董燕玲,谢立信.真菌性角膜炎1414例临床分析［J］.中华眼科杂志,2020,56(4):285-293.
HE J,CHENG J,DONG Y L,XIE L X.A clinical analysis of 1414 cases of fungal keratitis［J］.Chin J Ophthalmol,2020,56(4):285-293.
［16］　郝静华,王廉,潘志强.化脓性角膜溃疡角膜移植术后感染复发的临床分析［J］.眼科,2018,27(6):410-413.
HAO J H,WANG L,PAN Z Q.Clinical characteristics of recurrent of pyogenic corneal ulcer after keratoplasty ［J］.Ophthalmol CHN,2018,27(6):410-413.
［17］　李慧平,赵靖,史伟云,臧新杰,谢立信.穿透性角膜移植术治疗真菌性角膜炎术后复发的治分析［J］.临床眼科杂志,2009,17(1):9-12.
LI H P,ZHAO J,SHI W Y,ZANG X J,XIE L X.Treatment of recurrent fungal keratitis after penetrating keratoplasty［J］.J Clin Ophthalmol,2009,17(1):9-12.
［18］　SHI W,WANG T,XIE L,LI S,GAO H,LIU J,et al.Risk factors,clinical features,and outcomes of recurrent fungal keratitis after corneal transplantation［J］.Ophthalmology,2010,117(5):890-896.
［19］　谢立信.真菌性角膜炎［J］.中华眼科杂志,2003,39(10):638-640.
XIE L X.Fungal keratitis［J］.Chin J Ophthalmol,2003,39(10):638-640.
［20］　史伟云,王婷.我国真菌性角膜炎诊断和治疗中的几个问题［J］.中华眼科杂志,2013,49(1):2-5.
SHI W Y,WANG T.Several problems of treatment in fungal keratitis in China［J］.Chin J Ophthalmol,2013,49(1):2-5.
［21］　韦振宇,梁庆丰.真菌性角膜炎诊治新进展［J］.中华眼科杂志,2020,56(8):631-636.
WEI Z Y,LIANG Q F.Progress of clinical diagnosis and treatment in fungal keratitis［J］.Chin J Ophthalmol,2020,56(8):631-636.
［22］　郑洋,乔一平,张熙伯,廖光荣,黄朝霞.真菌性角膜炎70例早期临床诊断分析［J］.国际眼科杂志,2010,10(4):662-664.
ZHENG Y,QIAO Y P,ZHANG X B,LIAO G R,HUANG Z X.Clinical analysis of early diagnosis of 70 cases of fungal keratitis［J］.Int J Ophthalmol,2010,10(4):662-664.
［23］　PANG X J,JIANG T,ZHU H,LIU P P,ZHU Z Y,MAO A J.Corneal infection in Shandong peninsula of China：a 10 year retrospective study on 578 cases［J］.Int J Ophthalmol,2016,9(1):53-57.
［24］　ROGERS G M,GOINS K M,SUTPHIN J E,KITZMANN A S,WAGONER M D.Outcomes of treatment of fungal keratitis at the university of Iowa hospitals and clinics a 10-year retrospective analysis［J］.Cornea,2013,32(8):1131-1136.
［25］　ROSEN M J,BAUER J J,HARMATY M,CARBONELL A M,COBB W S,MATTHEWS B,et al.Multicenter,prospective,longitudinal study of the recurrence,surgical site infection,and quality of life after contaminated ventral hernia repair using biosynthetic absorbable aesh:the COBRA Study［J］.Ann Surg,2017,265(1):205-211.
［26］　高华,王婷,张菊,李素霞,史伟云.前房冲洗在严重前房积脓性角膜溃疡的角膜移植术中应用［J］.中华眼科杂志,2010,46(5):400-404.
GAO H,WANG T,ZHANG J,LI S X,SHI W Y.Clinical application of irrigation in therapeutic keratoplasty for suppurative keratitis with severe hypopyon［J］.Chin J Ophthalmol,2010,46(5):400-404.

相似文献/References:

[1]王莎莎 汪昌运.正常眼压性青光眼的研究进展[J].眼科新进展,2013,33(10):000.
[2]任明玉 刘立民 高宇 高占国. 眼部上皮性囊肿组织病理学分类和临床特点[J].眼科新进展,2014,34(3):272.
[3]罗晓阳,张良,孟倩丽,等.恶性青光眼的临床特征和危险因素分析[J].眼科新进展,2016,36(9):835.[doi:10.13389/j.cnki.rao.2016.0223]
　LUO Xiao-Yang,ZHANG Liang,MENG Qian-Li,et al.Analysis of clinical characteristics and risk factors of malignant glaucoma[J].Recent Advances in Ophthalmology,2016,36(5):835.[doi:10.13389/j.cnki.rao.2016.0223]
[4]李志强,刘桂琴,祝天辉,等.伴或不伴下直肌箝闭的trapdoor眼眶骨折的临床特征[J].眼科新进展,2016,36(10):953.[doi:10.13389/j.cnki.rao.2016.0255]
　LI Zhi-Qiang,LIU Gui-Qin,ZHU Tian-Hui,et al.Clinical features of orbital-floor trapdoor fracture with or without inferior rectus muscle incarceration[J].Recent Advances in Ophthalmology,2016,36(5):953.[doi:10.13389/j.cnki.rao.2016.0255]
[5]许领先,王晨光,苏冠方.急性黄斑旁中心中层视网膜病变研究进展[J].眼科新进展,2020,40(8):784.[doi:10.13389/j.cnki.rao.2020.0179]
　XU Lingxian,WANG Chenguang,SU Guanfang.Research progress on paracentral acute middle maculopathy[J].Recent Advances in Ophthalmology,2020,40(5):784.[doi:10.13389/j.cnki.rao.2020.0179]
[6]林诗群,尹心恺,陈有信,等.视盘周围脉络膜肥厚综合征研究进展[J].眼科新进展,2023,43(5):417.[doi:10.13389/j.cnki.rao.2023.0084]
　LIN Shiqun,YIN Xinkai,CHEN Youxin,et al.Research progress in the peripapillary pachychoroid syndrome[J].Recent Advances in Ophthalmology,2023,43(5):417.[doi:10.13389/j.cnki.rao.2023.0084]

备注/Memo

备注/Memo:
国家自然科学基金项目（编号：82070923、81870639）；泰山学者计划项目（编号：201812150）
更新日期/Last Update: 2021-05-05