睑缘炎患者眼表微生物检测及相关临床分析

目的 探讨睑缘炎患者眼表微生物分布特征，分析睑缘炎抗菌治疗的疗效。设计 回顾性病例系列。研究对象 收集2015年2-9 月间在北京同仁医院眼科门诊临床诊断为睑缘炎的101例患者（101眼，睑缘炎组），正常志愿者85例（85眼，对照组）。方法 在睑缘炎和对照组患者的结膜囊、睑缘及睑板腺分别取材，做细菌、厌氧菌和真菌培养，对培养阳性的菌株进行鉴定，分析两组眼表菌群差异特征。进一步将睑缘炎患者分为抗菌组和非抗菌组，治疗前及治疗2周后分别对症状体征评分，并进行眼表微生物检测，分析疗效及细菌检测结果。主要指标 眼表细菌检测结果、血平皿菌落计数及睑缘炎的眼部症状及体征评分。结果 睑缘炎组睑板腺细菌培养阳性率为62%，而对照组为53%（P=0.015）；睑缘炎组和对照组睑板腺厌氧培养阳性率分别为19%和45%，差异有统计学意义（P<0.001）。睑缘炎组与对照组睑缘细菌阳性率分别是71%和76%（P=0.533），结膜囊细菌阳性率分别是48%和67%，两组间无统计学差异（P=0.062）。睑缘炎组睑缘、结膜囊及睑板腺血平皿菌落数量的均值均分别是（15.78±5.25）个、（13.62±6.27）个、（16.54±4.56）个， 对照组分别为（6.13±3.40）个、（4.75±3.82）个、（5.83±2.55）个，差异均有统计学意义（P均<0.001）。睑缘炎患者睑缘、结膜囊及睑板腺的培养菌群主要是革兰阳性球菌（构成比分别为：78.31%、71.15%和77.03%） ，与正常志愿者无差异（构成比分别为：76.71%、82.14%和76.74%）。睑缘炎组结膜囊和睑板腺革兰阳性球菌中，葡萄球菌属的阳性率（81%和88%）要低于正常对照组（96%和100%），差异有统计学意义（P=0.034和0.036）。抗菌组和非抗菌组治疗2周后睑缘的除菌率分别为44%和21%，且两组的症状及体征的差异也有统计学意义（P=0.034和P=0.012）。结论 睑缘炎患者与正常人相比，眼表细菌阳性率无差异，但眼表带菌量要高于正常人，且革兰阳性球菌菌群构成不同，而睑板腺的厌氧菌带菌量要低于正常人；抗菌治疗可减少眼表带菌量，并改善患者眼表症状及体征。（眼科，2016，25： 118-122）

Ocular surface microbial distribution and clinical analysis of blepharitis

Objective To investigate the ocular surface microbial distribution characteristics of blepharitis patients, and analyze of the efficacy of antimicrobial therapy for blepharitis. Design Retrospective case series. Participants The study involved 101 patients with clinical diagnosis of blepharitis presented to Beijing Tongren Hospital between February 2015 to September 2015, and 85 normal controls. Methods Microbial samples of the ocular surface, including conjunctiva sac, eyelid, and Meibomian gland of blepharitis patients and normal controls were taken for culture and analyzed  for bacteria, anaerobic bacteria and fungi. The differences between the two groups were recorded analyzed. Furthermore, to analyze the effect of antimicrobial treatment, the blepharitis patients were divided into groups of non-antimicrobial group and antimicrobial group. The symptoms and ocular surface flora were compared before and two-weeks after treatment between the two groups. Main Outcome Measures Ocular bacterial test results, blood plate colony counting and blepharitis related symptoms and signs score. Results In blepharitis group, the Meibomian gland bacterial culture positive rate was 62%, while it was 53% in the control group (P=0.015). For anaerobic culture, the positive rate was significantly lower in blepharitis group and control group (19% versus 45%, P<0.001). Blepharitis and control group eyelid bacterial positive rate was 71% and 76% (P=0.533), conjunctival bacterial positive rates was 48% and 67% (P=0.062). The mean number of colonies on blood plate for eyelid, conjunctival and Meibomian gland was 15.78±5.25, 13.62±6.27 and 16.54±4.56 for blepharitis group respectively, which was significantly higher than the control group 6.13±3.40, 4.75±3.82 and 5.83±2.55 respectively, (all P<0.001). The proportion of Gram-positive cocci of the eyelid, conjunctival and Meibomian gland flora culture was 78.31%, 71.15% and 77.03% respectively, which was not significantly different from normal controls (76.71%, 82.14% and 76.74% respectively), blepharitis group of among Gram-positive cocci positive participants, the proportion of Staphylococcus positive rate was 81% and 88% for  conjunctival and Meibomian gland respectively for blepharitis patients, which was lower than the control group (96% and 100%, P=0.034 and 0.036 respectively). After two weeks of treatment or observation, the eyelid sterilization rate was 44% and 21% (P=0.034) for antimicrobial and non-antimicrobial treatment group respectively, and the difference between the two groups of symptoms and signs were also statistically significant (P=0.012). Conclusion The ocular surface bacterial positive rate in patients with blepharitis was not significantly different from control group, but the amount of bacteria carried on the ocular surface was higher in blepharitis patients, and the composition of Gram-positive cocci bacteria was different between the two groups. The amount of anaerobic bacteria contaminated Meibomian gland was lower in blepharitis patients than normal controls. Ocular antibiotic therapy can reduce the amount of bacteria carried, and improve patients' blepharitis related symptoms and signs. (Ophthalmol CHN, 2016, 25: 118-122)