真菌性角膜炎654例感染谱分析

目的 对654例真菌性角膜炎的流行病学特征和实验室检查结果进行分析,以提高临床真菌性角膜炎的诊治效果。方法 对1999年1月至2004年12月间真菌性角膜炎住院患者的人口学特征、疾病危险因素、季节变化、临床特征、实验室结果和治疗策略进行回顾性分析。结果 真菌性角膜炎患者在感染性角膜溃疡住院患者中所占比例最高（61．9％）。角膜损伤（51．4％）特别是植物性物质损伤（25．7％）为最常见的危险因素。真菌性角膜炎的发生率在秋冬季比春夏季更高,并呈逐年递增趋势。氢氧化钾湿片直接镜检法的诊断阳性率为88．7％。分离到的真菌中镰刀菌属最多见（73．3％）。604例（92．4％）患者接受了手术干预,包括穿透性角膜移植399例（66．0％）,板层角膜移植177例（29．3％）。结论 镰刀菌属是真菌性角膜炎中最主要的病原。氢氧化钾湿片直接镜检法以其快速、简便和高特异性值得进一步推广。角膜移植术仍然是治疗严重真菌性角膜炎的最有效方法,建议早期实施。

Spectrum of infection of fungal keratitis: analysis of 654 cases

OBJECTIVE: To investigate the spectrum of infection and epidemiological features of fungal keratitis (FK). METHODS: The demographic data, risk factors, clinical features, laboratory findings, and treatment strategies of 654 patients with FK in Qingdao area, 396 males and 258 females, aged 44.9 +/- 12.5 (7 - 80), hospitalized January 1999 - September 2004 were collected and analyzed. RESULTS: FK patients accounted for 61.9% of the patients hospitalized for infectious keratitis. The ratio between the FK male and female patients was 1.5:1. The age distribution was as follows: 31.0% of the patients were aged 41 - 50, 26.5% of them were aged 31 - 40, 21.1% aged 51 - 60, 9.3% aged 61 - 70, etc. 89.9% of the FK patients were peasants. Corneal trauma was the most common risk factor (51.4%), especially injury by plant mater (25.7%). The incidence of FK was higher in the harvest seasons (autumn and winter) and showed a tendency to increase year by year. The positive rate of direct microscopic examination of potassium hydroxide (KOH) wet mounts was 88.7%. Most of the isolated fungi were Fusarium species (73.3%). followed by Aspergillus species (12.1%). Surgical intervention was performed on 604 eyes (92.4%), including therapeutic penetrating keratoplasty (66.0%, 399 cases) and therapeutic lamellar keratoplasty (29.3%, 177 cases). Global integrity was preserved in 626 cases (95.7%). CONCLUSION: Fusarium species are the most predominant pathogens of FK in Qingdao area. Rapid, simple, and high specific, direct microscopic examination of KOH wet mounts is worth spreading. Corneal transplantation remains the most effective approach to cure severe FK and is proposed to be performed at the early stage of FK.