老年人真菌性角膜炎流行病学及病原学特征分析

Epidemiological and etiological characteristics offungal keratitis in the elderly

目的分析老年人真菌性角膜炎病人的流行病学及病原学特征。方法对2004年1月至2008年12月经培养确诊为真菌性角膜炎的101例60岁以上病人进行回顾性分析，对其流行病学及病原学特征进行分析。结果老年人真菌性角膜炎发病呈上升趋势，年发病高峰集中在9月和10月。男性患者约占68．32％，年龄在60—69岁患者占所有患者的70．30％，100％为农民，36．63％病人有明确外伤史，最终行手术治疗病人数为50例（49．50％），其中行穿透性角膜移植17例（16．83％），眼内容物剜除16例（15．84％）。分离出致病菌属共5种，依次为镰孢菌属46例（45．54％）、曲霉菌属27例（26．73％）、互隔交链孢属15例（14．85％）、无孢菌11例（10．89％）和青霉菌属2例（1．98％）。其中镰孢菌属感染病人最终手术干预率最高（63．03％），平均病程为22d，60—64岁年龄段的平均病程最长（28．13d），80岁以上年龄段平均病程最短（10．50d），KOH刮片阳性率为83．17％。结论镰孢菌属以毒性强、手术率高在老年人真菌性角膜炎病原学中依然占据重要地位。老年人真菌性角膜炎有其自身特点，应加强对该年龄段真菌性角膜炎的认识和研究，提高疾病预后。

Objective To investigate the epidemiological and etiological characteristics of fungal keratitis in the elderly.Methods All 101 culture-proven cases of fungal keratitis in the elderly aged 60 years and older fi＇om January 2004 to December 2008 were retrospectively reviewed.Results The cases of fungal keratitis in the elderly were increased year by year, the highest monthly prevalence was during September and October, 69 patients were male （68.32%）, all of the 101 patients were farmers, and 37 patients （36.63%） had a definite history of trauma.Surgical intervention was performed on 50 patients （49.50%）, with acute penetrating keratoplasty in 17 cases （ 16.83% ） and 16 cases required evisceration （ 15.84% ）.Most of the isolated fungi were Fusarium species （46 cases, 45.54% ）, followed by Aspergillus species （27 cases, 26.73% ）, Altemaria species （ 15 cases, 14.85% ）, Mycelia species （ 11 cases, 10.89% ）, Penicillium species （2 cases, 1.98% ）.The Fusarium species had the highest surgical intervention rate （63.03%）.The mean duration from the onset of symptoms to presentation to our institution was 22 days, the 60-64 years stage had the longest mean duration （ 28 days）, and the patients aged older than 80 had the shortest one （ 1 ldays）.Potassium hydroxide wet-mount preparation was positive in 83.17% cases.Conclusions Fusarium species play an important role in the fungal keratitis in the elderly with their powerful toxicity and high surgical intervention rate.Fungal keratitis in the elderly has its own feature and should be known and studied more to improve its prognosis.