412例真菌性角膜炎的回顾性分析

目的：对真菌性角膜炎患者的流行病学特征、实验室检查方法和结果及治疗效果进行分析，为真菌 性角膜炎诊治提供依据。方法： 回顾性系列病例研究。对2012年1月至2017年12月在冀中能源邢 台矿业集团总医院诊治的412例（412眼）真菌性角膜炎的流行病学特点、临床体征、病原学诊断方式、 结果及治疗效果采用Kruskal-Wallis H检验等统计学方法进行分析。结果：9-12月份是真菌性角膜 炎高发期，占全年患者总数的61.2%（252/412）。患病人群以农民为主，占59.5%（245/412），植物性 外伤为首要病因者185例（44.9%），其次为非植物性外伤86例（20.9%）。男女比例为1.82∶1。年龄 14～81（45.6±14.3）岁，41～60岁患者占53.9%（222/412）。真菌培养阳性率为88.8%（366/412），高 于氢氧化钾湿片法77.2%（318/412）]，2种检测方式比较差异有统计学意义（χ2 =31.14，P<0.001）。 前几位的致病菌依次是镰刀菌属167例（40.5%），链格孢菌属75例（18.2%），曲霉菌属62例（15.0%）， 青霉菌属28例（6.9%）。真菌性角膜炎所致典型临床体征中以菌丝苔被最为常见（366例，88.8%）， 其次为伪足（224例，54.4%）、前房积脓（111例，26.9%）。镰刀菌属、链格孢菌属、曲霉菌属及青 霉菌属所致真菌性角膜炎的病情分级和预后水平比较差异均有统计学意义（Hc=40.676，P< 0.001； Hc=40.109，P<0.001），显示镰刀菌属和曲霉菌属的病情分级重于链格孢菌属和青霉菌属，预后水平 也差于链格孢菌属和青霉菌属。结论：真菌性角膜炎患者呈逐年增多趋势；氢氧化钾湿片法和真菌 培养都是有效的诊断方法，镰刀菌属和曲霉菌属所致的真菌性角膜炎较链格孢菌和青霉菌引起的真 菌性角膜炎病情相对较重，且预后较差。

Retrospective Study of Fungal Keratitis in 412 Patients

Objective: To analyze the epidemiological features, laboratory examination methods and results and prognosis of fungal keratitis, in order to provide evidence for the diagnosis and treatment. Methods: This was a retrospective analysis review. The medical records of 412 cases (412 eyes) of fungal keratitis at Jizhong Energy Xingtai Mine Industrial Group General Hospital from January 2012 to December 2017 were analyzed with Kruskal-wallis H and so on of for epidemiological characteristics, clinical signs, etiology, diagnostic methods and results and prognosis, and the effect of treatment. Results: The peak period of fungal keratitis occurred in September to December, which accounted for 61.2% (252/412)of the annual total number of patients. The patients were mainly farmers, which accounted for 59.5% (245/412). One hundred eighty-five patients (44.9%) had an injury history related to plant injury, which was the primary cause, followed by non-plant injury in 86 patients (20.9%). The ratio of male to female was 1.82:1, the age was 14 to 81 years, the average age was 45.6±14.3 years, with 41-60 years accounting for 53.9% (222/412). The positive rate of fungal cultures was 88.8% (366/412), which was higher than the KOH wet-mount of 77.2% (318/412). The difference between the two detecting methods was statistically significant (χ2 =31.14, P<0.001). The pathogenic bacteria were identified as follows: 167 cases (40.5%) of fusarium, 75 cases (18.2%) of alternaria genus, 62 cases (15.0%) of aspergillus genera, and 28 cases (6.9%) of penicillium. Typical clinical signs of fungal keratitis caused by mycelium moss were the most common (366 cases, 88.8%), followed by pseudopodia (224 cases, 54.4%) and hypopyon (111 cases, 26.9%). The differences in the severity classifications and prognosis of fungal keratitis caused by fusarium spp., alternaria spp., aspergillus spp. and penicilium spp. were statistically significant (Hc=40.676, P<0.001; Hc=40.109, P<0.001), and the disease classifications in fusarium and aspergillus were heavier than in alternaria and penicilliun. The prognosis was poor in alternaria and penicilliun. Conclusions: Fungal keratitis increases year by year, KOH wet-mount and fungal culture are effective diagnostic methods and fungal culture results are more reliable. In the first few pathogenic fungi, fungal keratitis caused by fusarium and aspergillus are serious, and the prognosis is not good, while cases of alternaria and penicillium are relatively mild with a good prognosis.