真菌性角膜炎致病菌属与疾病预后的关系

The correlation analysis between genera and the prognosis in fungal keratitis

目的 探讨真菌性角膜炎不同致病菌属对疾病预后的影响.方法 回顾性系列病例研究.筛选2012年3月至2013年2月在河南省眼科研究所就诊的真菌性角膜炎患者324例,行裂隙灯、角膜刮片、真菌培养鉴定和角膜共聚焦显微镜检查.并按感染菌属分四组：镰刀菌组172例、交链孢霉组61例、曲霉菌组47例和其他菌属组44例.随访患者的治疗结局,记录药物治愈者的矫正视力及用药时间.采用彭检验、秩和检验和单因素方差分析对数据进行统计学分析.结果 镰刀菌组、曲霉菌组、交链孢霉组和其他菌属组的手术率分别为41.3％ （71/172）、44.7％ （21/47）、6.6％ （4/61）和11.4％（5/44）,四组手术率的差异比较有统计学意义（2=37.459,P＜0.001）;镰刀菌组和曲霉菌组的手术率高于交链孢霉组和其他菌属组.四组患者在预后水平的差异比较亦有统计学意义（Hc=38.879,P＜0.001）,显示镰刀菌组和曲霉菌组的预后水平差于交链孢霉组和其他菌属组.药物治愈的患者中,镰刀菌、曲霉菌、交链孢霉和其他菌属感染者的平均用药时间分别为（88±44）、（68±33）、（57±30）d和（59±37）d,四组用药时间的差异比较有统计学意义（F =10.221,P＜0.001）,镰刀菌组的用药时间长于交链孢霉组、曲霉菌组和其他菌属组.药物治愈的镰刀菌、曲霉菌、交链孢霉和其他菌属感染者平均恢复的视力分别为0.65±0.26、0.64±0.26、0.82±0.21和0.75±0.27,四组恢复的视力差异比较有统计学意义（F =6.210,P＜0.001）;交链孢霉组的视力恢复好于镰刀菌组和曲霉菌组.结论 镰刀菌和曲霉菌所致真菌性角膜炎的药物治疗效果差、周期长、视力恢复差,手术率高;交链孢霉和其他菌属引起的真菌性角膜炎预后相对较好.

Objective To study the relationship between genera and the prognosis in fungal keratitis.Methods Retrospective series case study.A total of 324 cases of fungal keratits from March 2012 to February 2013 in Henan Eye Institute were elected.Slit-lamp examination,corneal smears examination,confocal microscopy,fungal culture and identification were used to diagnose.According to the pathogenic genera,the patients were divided into four groups：fusaria group 172 cases,alternaria group 61 cases,aspergilli group 47 cases and other genera group 44 cases.Follow up the treatment outcomes and record the best corrected visual acuity and the period of treatment of the patients cured by medicines.x2 test,rank sum test and one-way analysis of variance were used to analyze data.Results The surgery rate of fusaria group,aspergilli group,alternaria group and other genera group was 41.3% （71/172）,44.7% （21/47）,6.6% （4/61） and 11.4% （5/44） respectively.The differences of the surgery rate among four groups were statistically significant （x2 37.459,P 〈0.001）.The surgery rate of fusaria group or aspergilli group was higher than alternaria group or other genera group.The differences of the prognosis among four groups were statistically significant （Hc 38.879,P 〈0.001）.The prognosis of fusaria group and aspergilli group was worse than alternaria group and other genera group.Among the patients cured by medicines,the average period of usingdrugs of the patients infected by fusaria,alternaria,aspergilli or other genera was （88＆#177;44）,（57＆#177;30）,（68＆#177;33） and （59＆#177;37）d respectively.The differences of the average period of using drugs among four groups were statistically significant （F 10.221,P 〈0.001）.The period of using drugs of the fusaria group was longer than the alternaria group,the aspergilli group and the other genera group.The average recovered visual acuity of the eyes infected by fusaria,aspergilli,alternaria or other genera was 0.65＆#177;0.26,0.64＆#177;0.26,0.82＆#177;0.21 and 0.75＆#177;0.27 respectively.The differences of the recovered visual acuity among four groups were statistically significant （F 6.210,P 〈0.001）.The recovered visual acuity of the alternaria group was better than the fusaria group and the aspergilli group.Conclusions The prognosis of fungal keratitis caused by fusaria or aspergilli is worse than alternaria or other genera,and has the characteristics of worse effects of drug treatment,lengthier drug treatment,worse recovered visual acuity and higher rate of surgery.