糖尿病对真菌性角膜炎患者感染程度及预后的影响

Effects of diabetes mellitus on infection degree and prognosis of fungal keratitis

目的探讨糖尿病对真菌性角膜炎患者的感染程度及预后的影响。方法回顾性分析2005年1月至2014年12月在中山大学附属梅州市人民医院诊治的76例糖尿病真菌性角膜炎患者临床特征,包括44例血糖控制欠佳组（糖尿病未控制组,DNC组）及32例血糖控制良好组（糖尿病控制组,DWC组）患者;并与同期纳入的40例无全身病真菌性角膜炎（对照组）患者的感染程度及预后情况进行比较;分析糖尿病病程与角膜感染程度及预后的相关性。结果三组患者在角膜感染程度上,DNC组与DWC组以中度感染占比最多（65．9％、62．5％），对照组以轻度感染占比最多（57．5％）。在感染评分上，DNC组与对照组在轻、中、重度感染评分上差异均有统计学意义（均为P〈0.01），而DNC组与DWC组在中、重度感染评分上差异均有统计学意义（均为P〈0．05）。在预后上，DNC组与DWC组中无效分别为11例（25．0％）与3例（9．4％），有效（治愈和显效）分别为33例（75．0％）与29例（90．6％），两组有效率差异有统计学意义（x2=9．07，P〈0．01）。DNC组与对照组中，后者有效及无效分别为38例（95．0％）、2例（5．0％），两组有效率比较差异亦有统计学意义（x2=15．69，P〈0．01）。DWC组与对照组有效率差异无统计学意义（x2=1．23，P〉0．05）。在糖尿病病程与真菌性角膜炎感染程度及预后上，DNC组的糖尿病病程与角膜感染评分有相关性（r=0．37，P〈0．05），与预后亦有相关性（r=0．28，P〈0．05）；DWC组的糖尿病病程与角膜感染评分及预后均无相关性（均为P〉0．05）。结论糖尿病可加重真菌性角膜炎的感染程度并影响预后，积极控制血糖可能降低角膜感染程度及改善预后。

Objective To analyze the effects of diabetes mellitus on infection degree and prognosis of fungal keratitis. Methods The clinical data of 76 cases of fungal keratitis with diabetes mellitus（ D M）,including 44 cases with poor glycemic control（ diabetes non-control,D N C group） and 32 cases of well glycemic control（ diabetes well-control,D W C group）,and 40 cases of fungal keratitis without systemic disease（ control group）,were retrospectively review ed,and the infection degree,prognosis and the relevance betw een the D Mduration and the above tw o were analyzed and compared. Results Three groups on the corneal infection degree,D N C group and D W C group with moderate infection accounted for the most（ 65. 9% vs 62. 5%）,the control group with mild infection accounted for the most（ 57. 5%）. O n the infection score,D N C group and control group with the difference of mild,moderate and severe infection group were statistically significant（ all P 0. 01）,and D N C group and D W C group with the difference of moderate and severe infection group were statistically significant（ all P 〈 0. 05）. In prognosis,the ineffective rate of D N C group and D W C group were 11 cases（ 25. 0%） and 3 cases（ 9. 4%）,respectively,the effective rate（ cure rate and significant efficiency） were 33 cases（ 75. 0%） and 29patients（ 90. 6%）,respectively,the difference betw een tw o groups was significant（ χ2= 9. 07,P〈 0. 01）. The effective rate and non-ineffective rate of control group were 38 cases（ 95. 0%）,2cases（ 5. 0%）,respectively,the difference betw een D N C group and control group was statistically significant（ χ2= 15. 69,P 0. 01）. There was no significant difference in the effective rate betw een D W C group and control group（ χ2= 1. 23,P 〉 0. 05）. In infection degree,prognosis and the duration of D M,D Mduration and infection score was related in D N C group（ r = 0. 37,P 〈 0. 05）,and D Mduration and prognosis was also related（ r = 0. 28,P 〈 0. 05）; D Mduration and infection score,prognosis was not related in D W C group（ all P 〈 0. 05）. Conclusion D Mmay aggravate infection degree and prognosis,and positive control of blood glucose may reduce the severity of infection and improve the prognosis fungal keratitis.