恩施地区外伤性真菌性角膜炎回顾性分析

Retrospective analyse on traumatic fungal keratitis in Enshi Area

目的 了解恩施地区外伤性真菌性角膜炎临床流行病学特点.方法 回顾性分析2009年7月至2013年6月恩施州中心医院收治的外伤性真菌性角膜炎病例.记录患者人口学特征、病史、职业、致伤原因、病程、先前诊断用药情况,来院后裂隙灯检查、微生物学检查、治疗方法、转归及随访结果,对资料进行分析.结果 4年间,69例（69眼）根据患病诱因、微生物学检查结果诊断为外伤性真菌性角膜炎.随访时间1 ～14个月.男51例,女18例,年龄27 ～71岁.农民64例.主要诱因为植物外伤.外院曾经过微生物学检查诊断为真菌性角膜炎2例.来院后沙氏培养基培养阳性67例,其中镰刀菌属54例（80.6％）,曲霉菌属10例（14.9％）.59例用药物治愈,清创及板层切除术8例,穿透性角膜移植术1例,眼球摘除1例.结论 恩施地区外伤性真菌性角膜炎首位病原体是镰刀菌属,多见于青壮年男性农民,植物外伤是主要原因,可导致严重视力损害.

Objective To study the characteristics of clinical epidemiology of traumatic fungal keratitis in Enshi Area.Methods All cases of traumatic fungal keratitis admitted to the Central Hospital of Enshi Autonomous Prefecture from July 2009 to June 2013 were retrospectively reviewed.Data on patients＇ demographic characteristics,medical history,occupation,risk factors,presenting time,previous therapies, microbiological examination,treatments,results and follow-up results were recorded and analyzed.Results Based on the history of trauma and the microbiological examination,69 eyes of 69 patients were diagnosed as traumatic fungal keratitis,the follow-up time was 1 month to 14 months.51 patients were male.18 patients were female.The age of patients was 27-71 years old.64 patients were peasants.The number of positive culture by Sabourand culture medium was 67,among which 54 cases （80.6%） were the Fusarium sp.,and 10 cases （14.9%） were Aspergillus sp..59 eyes were cured with antifungal medicine treatment,8 eyes with debridement and lamellar keratectomy,1 eye with penetrating keratoplasty,1 eye had undergone ocular enucleation.Conclusion Fusarium sp.is the dominant pathogen of traumatic fungal keratitis in Enshi Area.Most of the patients are young male peasants and botanic trauma is the most common predisposing factor.Traumatic fungal keratitis can lead to severe visual impairment.