张家口地区角膜溃疡病原菌的流行病学调查研究

Epidemiological Features of Bacterial and Fungal Corneal Ulcers in Zhangjiakou Area

目的分析张家口地区与角膜溃疡相关的病原体流行病学特点和危险因素,为其临床诊治提供一定的依据。方法选取2010年12月至2012年6月万全县中医院、河北北方学院第一附属医院及解放军251医院收治的367例角膜溃疡患者作为研究对象,对取得的溃疡组织进行细菌和真菌鉴定,分析病原体构成及相关风险因素。结果 367例角膜溃疡患者中,218例病原体培养阳性,以中年男性劳动者居多,54.1%培养阳性的患者为农民,植物性外伤是最主要的诱发因素。218例患者中,真菌性感染130例,分离出的真菌分属以镰刀菌属最多(49.2%),其次为曲霉菌属(13.1%)和假丝酵母属(9.2%);细菌性感染88例(40.4%),以肺炎双球菌为主(28.4%),其次为葡萄球菌(21.6%)。结论张家口地区角膜溃疡的病原体复杂,以真菌为主,存在与细菌的复合感染,诱发较多,临床过程中应分清病因,针对病原体不同而选用相应的敏感药物进行治疗。

Objective To determine the epidemiological pattern and risk factors associated with corneal ulcers in Zhangjiakou area, and provide a basis for clinical diagnosis and treatment of corneal ulcers. Methods A total of 367 patients with corneal ulceration from Wanquan County Hospital of Traditional Chinese Medicine, the First Affiliated Hospital of Hebei North University and the 251st Hospital of PEA during Dec. 2010-Jun. 2012 were included. Corneal scrapings obtained from these patients were processed for bacterial/ fungal agents test. The pathogen composition and risk factors were analyzed. Results Among the 367 patients studied,218 were culture positive. A majority of the culture-positive patients were middle aged men, mainly were farmers （54.1% ）, and vegetative trauma was the most common predisposing factor. Among these patients, fungal isolates （130 cases） were more frequent than bacterial isolates （88 cases ,40.4% ）. The most common fungal isolate was Fusarium spp. （49.2%） followed by Aspergillus slop. （13. 1% ） and Candida spp. （9.2%）. Streptococcus pneumoniae was the predominant bacterial isolates（28.4% ） followed by Staphy- lococcus spp. （21.6%）. Conclusion The pathogen infection was complicated in Zhangjiakou area,fungal is the main pathogen, and bacteria compound infection exist, and the risk factors are complex. Careful diagnosis and proper identification of aetiological agents are necessary for the seletion of appropriate therapy.