1054例化脓性角膜炎的回顾性分析

Retrospective study of suppurative keratitis in 1054 patients

目的探讨化脓性角膜炎的病原学和临床特征。方法对1999年1月至2004年12月间于山东省眼科研究所、青岛眼科医院诊治的1054例化脓性角膜炎住院患者的人口学特征、症状持续时间、疾病危险因素、就诊前接受的治疗及实验室检查结果等资料进行回顾性分析。结果化脓性角膜炎中真菌性角膜炎所占比例最高（61．9％），41～50岁的中年患者（27．3％）和农民（82．9％）最多见。角膜损伤是最常见的发病危险因素。氢氧化钾湿片直接镜检法诊断真菌性角膜炎的阳性率为88．7％，而革兰染色镜检法检查细菌性角膜炎的阳性率仅为43．4％。分离到的真菌中镰刀菌属占73．3％，其次为曲霉菌属（12．1％）。分离到的细菌病原谱中，以铜绿假单胞菌居多（35．7％），其次为表皮葡萄球菌（22．5％）。结论真菌性角膜炎在严重的化脓性角膜炎中最常见且呈现逐年递增的趋势。氢氧化钾湿片直接镜检法是一种快速、简便及有效的真菌性角膜炎诊断工具。

Objective To analyze the etiological and clinical characteristics of 1054 cases with suppurative keratitis. Methods Medical records of 1054 inpatients with suppurative keratitis at the Qingdao Eye Hospital, Shandong Eye Institute from January 1999 to December 2004 were retrospectively reviewed for the analysis of demographic features, duration of symptoms, risk factors, previous therapy and laboratory findings. Results Fungal keratitis （61.9%） was the most common type in suppurative keratitis inpatients. Middle aged patients （between 41-50 years, 27.3% ） and farm workers （82. 9% ） were the most common groups. Corneal trauma was noted as the most common risk factor. The positive rate of direct microscopic examination of potassium hydroxide （KOH） wet mounts was 88.7% for the diagnosis of fungal keratitis, but the positive rate of microscopic examination of Gram staining was only 43.4% in detecting bacterial keratitis. The most common type of fungi isolated was fusarium species （437 cases, 73.3% ）, followed by aspergillus species （72 cases, 12. 1% ）. Pseudomonas aeruginosa was the most commonly isolated bacteria （35.7%）, followed by staphylococcus epidermidis （22. 5% ）. Conclusions Fungal keratitis is the most common type in severe supprative corneal ulcers and its incidence shows an increasing tendency progressively. As a rapid, simple and effective diagnostic method of fungal keratitis, the application of direct microscopic examination of KOH wet mounts should be used more extensively. A rapid and effective detecting technique of bacterial keratitis is required urgently.