长江中下游地区真菌性角膜炎发病特征及转归分析

Epidemiological features of fungal keratitis in middle and lower reaches of Yangtze river

目的:分析长江中下游地区真菌性角膜炎流行病学特征及治疗预后状况。方法:对2004-01/2009-12我院212例212眼确诊为真菌性角膜炎患者的完整资料进行回顾性分析,调查内容包括职业、发病时间、发病原因、就诊经过、治疗情况及转归等。结果:患者中男159例,女53例,平均年龄44.5岁。职业为农民者177例(83.5%)。98例(46.2%)患者有明确植物性外伤史或接触史。发病时间在10～12月份者136例(64.2%)。从发病到我院平均就诊时间为24.1d。就诊时视力<0.05者158眼(74.5%)。眼部标本真菌培养阳性者194例(91.5%),主要致病菌属为镰刀菌属144株(74.2%),其次为曲霉菌属16株(8.3%),暗色孢科真菌共32株(15.1%),念珠菌属2株(1.0%)。117例(55.2%)患者经药物治疗好转;59例(27.8%)患者行角膜移植术,植片透明率64.4%;20例(9.4%)行球结膜瓣遮盖术治愈。随访6～25mo,最终视力<0.05者63眼(29.7%);眼球保存率96.6%。结论:长江中下游地区真菌性角膜炎高发季节为10～12月份,高发人群为中青年农民,主要致病菌属为镰刀菌属,积极的药物和手术治疗是挽救眼球、保存视力的有效手段。

AIM： To determine the epidemiological features of fungal keratitis in middle and lower reaches of Yangtze river. METHODS： Two hundred and twelve fungal keratitis cases were evaluated and demographic data were recorded, including age, gender, occupation, whether or not they have a history of trauma or contact lens use and course of treatment. RESULTS： The cases of fungal keratitis were increased year after year. 159 patients were male, 177 （83.5%） were agriculture worker, the mean age was 44.5 years old, a history of trauma was present in 98 patients（46.2% ）. The interval between infection and presentation for examination was 3-160 days, with a mean time of 24. 1 days. 117（55. 2%）cases were healed after medical treatment. 59（27.8% ） cases received keratoplasty, with a clear graft rate of 64.4%. The most common spectrums were Fusarium sp. （74.2%） and Aspergillus sp. （8.3%）. CONCLUSION： In Hubei, the most common pathogenic spectrum of fungal keratitis is Fusarium sp. Fungal keratitis is a grave disease that causes blindness. It is significantly important to improve the diagnosis level and give perfect treatment.