温州某医院258例真菌性角膜炎诊疗分析

目的：通过分析温州地区真菌性角膜炎患者的病原学、药敏、实验室检查及治疗方式等，进一步为 真菌性角膜炎的诊疗及预后评估提供依据。方法：回顾性研究。收集2017年1月至2019年12月在温 州医科大学附属眼视光医院拟诊为真菌性角膜炎患者共258例（258眼），将患者分别按性别、年龄、 职业、致病因素、致病菌属分为男性组和女性组，老年组（≥65岁）和非老年组（<65岁），农民组和非 农民组，植物伤组和非植物伤组，镰刀菌属组和非镰刀菌属组，分别统计各组的手术率。采用χ2检 验对各因素与手术率之间的关系进行分析比较，同时对病原学检查的阳性检出率做比较，并统计主 要致病菌的药敏情况。结果：9─11月份是真菌性角膜炎的高发期，占全年的48.1%，其中农民（60.5%） 为主要的患病人群。植物伤（34.5%）为首要致病因素。镰刀菌属（45.3%）是主要的致病菌。真菌培 养的阳性率为68.6%，高于涂片检查的43.0%（χ2 =4.522，P=0.033）。镰刀菌属对两性霉素B、伊曲康 唑、伏立康唑的最小抑菌浓度值的几何均数分别为4.283、17.290、1.105 μg/ml；曲霉菌属分别为3.389、 2.661、0.125 μg/ml；链格孢属分别为0.604、0.531、0.258 μg/ml；假丝酵母菌属分别为0.317、0.552、 0.047 μg/ml。258例真菌性角膜炎患者中，44例（17.0%）接受了手术治疗，进一步分析发现老年患者 （χ2 =5.293，P=0.036），植物伤患者（χ2 =11.386，P=0.001），镰刀菌属感染患者（χ2 =3.939，P=0.044）的 手术概率较高。结论：镰刀菌属是温州地区真菌性角膜炎的主要致病菌，而植物伤为首要致病因素。 老年患者、植物伤以及镰刀菌属感染导致的真菌性角膜炎较严重，需要手术治疗的概率更高。

Retrospective Analysis of Patients with Fungal Keratitis in a Hospital in Wenzhou

Objective: To analyze the etiology, drug sensitivity, laboratory examinations and treatment of patients with fungal keratitis in a hospital in Wenzhou, thus providing evidence for the diagnosis and prognosis of fungal keratitis. Methods: This was a retrospective case. Data from 258 patients (258 eyes) who were diagnosed with fungal keratitis at the Eye Hospital,Wenzhou Medical University, from January 2017 to December 2019 were collected. Patients were divided into different groups: Males and females, older and younger patients, farmers and non-farmers, plant injuries and non-plant injuries, fusarium and non-fusarium infections. The respective operation rates were calculated for gender, age, occupation, pathogenic factors and pathogenic bacteria. χ2 analysis was performed for the difference in operation rates in each group. Further, the positive detection rate of the pathogenic examination method was compared and analyzed, and the drug sensitivity of the main pathogenic bacteria was also included. Results: September to November was the highest incidence period for fungal keratitis, accounting for 48.1% for the entire year. Most of the patients (60.5%)were farmers. Plant injury was the leading pathogenic factor while fusarium was the main pathogen accounting for 34.5% and 45.3%, respectively. The positive rate of fungal culture was 68.6%, which was higher than the smear test (χ2 =4.522, P=0.033). Of the 258 patients with fungal keratitis, 44(17.0%) underwent surgery. Further analysis revealed that elderly (≥65 years) patients (χ2 =5.293, P=0.036), plant injury patients (χ2 =11.386, P=0.001), and fusarium infection patients (χ2 =3.939, P=0.044) had a higher probability of surgery. Additionally, the geometric mean values of the minimum inhibitory concentrations (MIC) of fusarium to amphotericin B, itraconazole and voriconazole were 4.283, 17.290 and 1.105 μg/ml, respectively; those of aspergillus were 3.389, 2.661 and 0.125 μg/ml, respectively; those of alternaria were 0.604, 0.531 and 0.258 μg/ml, respectively; and those of candida were 0.317, 0.552 and 0.047 μg/ml. Conclusions: Fusarium is the main pathogen of fungal keratitis in Wenzhou, and plant injury is the main pathogenic factor. Elderly patients, plant injuries, and fungal keratitis caused by fusarium infections are more serious and are more likely to require surgical treatment.