细菌性角膜溃疡误诊原因及预后分析

The retrospective analysis of causes of misdiagnosis and the prognosis of bacterial corneal ulcer

目的研究细菌性角膜溃疡的特点,分析引起误诊的原因,探讨影响患者预后的相关因素。方法回顾性分析。以2011年1月至2013年12月间山东省眼科医院收治的83例(83只眼)确诊为细菌性角膜溃疡的患者作为研究对象。通过统计患者误诊疾病、发病诱因、眼部临床表现、就诊医院、所行辅助检查等,分析误诊原因。通过统计不同确诊时间的患者药物、手术治疗的情况,分析误诊患者确诊前病程与其预后的关系。结果 83例患者的发病诱因中49例有各种角膜外伤史,包括植物性外伤22例(占26.5%)。42例患者眼部临床表现为病史迁延、病灶边界不清,伴类似伪足或类似卫星灶、类似内皮斑等。33例患者于首诊医院误诊,误诊疾病分别为真菌性角膜炎28例(占33.7%)、病毒性角膜炎5例(占6.0%)。首诊医院为省市级医院的误诊率为29.3%,县级及以下医院的误诊率为50.0%。省市级医院行角膜刮片及培养者占70.7%,刮片阳性率27.6%。县级及以下医院行实验室检查者仅占30.1%,刮片阳性率15.4%。预后:误诊患者中确诊前病程≤2周者药物治愈6例(占30.0%),行角膜病灶切除治愈4例(占20.0%),行角膜移植治愈10例(50.0%),总治愈率100%。病程大于2周者,药物治愈2例(占15.4%),行角膜病灶切除治愈3例(占23.1%),行角膜移植治愈6例(46.1%),行眼内容剜除2例(占15.4%),总治愈率84.6%。结论目前细菌性角膜溃疡的误诊率仍较高,普及严格、规范的实验室检测结合其他辅助检查能有效降低误诊率。早确诊、早治疗有助于改善误诊患者预后。

Objective To study the characteristics of bacterial comesl ulcer, analyze the causes of misdiagnosis and factors affecting the prognosis of patients. Methods This was a retrospective analysis. Eighty-three patients diagnosed with bacterial corneal ulcer and treated in Shandong Eye Hospital between January 2011 and December 2013 were included. We analyzed the causes of misdiagnosis by reviewing the etiologies, clinical manifestations, the examination results, etc. Based on the results of drug therapy and surgical treatment for patients diagnosed at different times, we analyzed the rela- tionship between the diagnosis time and the prognosis. Results Corneal trauma, including plant injury （n = 22, 26.5% ） was found to be the etiology for 49 patients. In 42 patients, the corneal ulcer progressed slowly, presented with vague mar- gin, pseudopadia or satellite lesions, or mimicked endothelial spots. Thirty-three patients were misdiagnosed in their initial hospital visit. Among them, 28 （33.7% ） were diagnosed as fungal corneal ulcer, 5 were diagnosed as viral keratifis （6. 0% ）. The misdiagnosis rate was 29.3% in provincial and municipal hospitals and was 50.0% in county hospitals. Corneal scraping and culture was done in provincial and municipal hospitals for 70.7% patients, and the positive rate was 27.6%. The rates were 30.1% and 15.4%, respectively, in county hospitals. The total cure rate was 100% among the patients whose definite diagnosis was made within 2 weeks, while 84.6% among the patients who were diagnosed more than 2 weeks after the presentation. Conduslon Currently, the misdiagnosis rate of bacterial corneal ulcer is still high. Prac- flee of standard laboratory tests and other examinations can reduce the misdiagnosis rate. Early definite diagnosis and treat- ment improve the prognosis of patients.