中国华南地区真菌性角膜炎致病菌谱变化

Spectrum of fungal keratitis change in South China

背景真菌性角膜炎发病率高，临床治疗比较困难，其病原学诊断和鉴定是改善疾病预后的前提。近年来随着地区环境和气候的不断变化，真菌性致病菌的菌属分布是否发生改变值得关注。 目的分析近年来华南地区真菌性角膜炎致病菌的分布状况。 方法对2009年1月至2014年12月在中山大学中山眼科中心收集和培养的化脓性角膜溃疡刮取标本3 350份进行回顾性分析，对真菌培养阳性率及致病真菌株的种属分布进行鉴定，并评估不同年段和不同季节的变化。 结果培养的3 350份标本中真菌培养阳性者1 050株（1 050例），每年平均175株，阳性率为31.34%，其中镰刀菌属337株，占32.10%；曲霉菌属270株，占25.71%；禾草蠕孢霉菌属150株，占14.29%；毛霉菌属96株，占9.14%；弯孢霉属与青霉菌属各65株，各占6.19%。2009—2010年培养的阳性菌株367株，占36.05%；2011—2012年阳性菌株329株，占32.45%；2013—2014年阳性菌株354株，占26.86%。各年段真菌检出阳性率的差异有统计学意义（χ2＝22.37，P〈0.01）。1～3月培养的阳性菌株261株，占31.15%；4～6月阳性菌株182株，占25.53%；7～9月阳性菌株237株，占30.00%；10～12月阳性菌株370株，占36.67%；各季度间阳性菌株检出率的差异有统计学意义（χ2＝25.19，P〈0.01），各种致病真菌的检出率以10～12月最高，4～6月最低。 结论中国华南地区真菌性角膜溃疡的致病菌以镰刀菌属居首位，其次依次为曲霉菌属、禾草蠕孢霉菌属、毛霉菌属、膝曲弯孢霉菌属和青霉菌属。真菌感染率最高的季节是10～12月。2009—2014年真菌性角膜溃疡仍处于高发期，但在华南地区发病率呈下降趋势。

BackgroundFungal keratitis has a high incidence in China and its clinical treatment is very difficult, and its etiology diagnosis and appraisal is the premise to improve the prognosis of disease.With the changes of regional environment and climate in recent years, whether the spectrum of fungal keratitis change in South China is remarkable. ObjectiveThe purpose of this study was to investigate recent pathogenic distribution of fungal keratitis in South China area. MethodsThe consecutive fungal culture resultsof 3 350 purulent keratitis at Zhongshan Ophthalmic Center from January 2009 to December 2014 were retrospectively reviewed.The positive rate of fungal culture, genus or species distribution, seasonal distribution and different term distribution were analyzed. Results The culture-positive rate was 31.34% in this study （1 050/3 350）, and the average culture-positive number was 175 strains per year.In the positive fungus, the highest positive rate was Fusarium SP （32.10%, 337/1 050）, and followed by Aspergillus SP （25.71%, 270/1 050）, Heminthosporium SP （14.29%, 150/1 050） and Mucor SP （9.14%, 96/1 050）. The fungal culture-positive rate was 36.05% （367/1 018） in 2009 to 2010, 32.45% （324/1 014） in 2011 to 2012, and 26.86% （354/1 318） in 2013 to 2014, respectively, with a significant difference among the three periods （χ2=22.37, P〈0.01）, showing a decreasing tendency of incidence.Two hundreds and sixty-one strains were isolated from January to March （31.15%, 261/838）, 182 strains from April to June （25.53%, 182/713）, 237 strains from July to September （30.00%, 237/790）, 370 strains from October to December （36.67%, 370/1 009）, showing a statistically significant difference among them （χ2=25.19, P〈0.01）. The number of infectious strains was most during October to December and fewest during April to June. ConclusionsThe leading pathogenic fungi of fungal keratitis is Fusarium SP and followed by Aspergillus SP, Helminthosporium SP, Mucor SP in turn.Fungal keratitis is usually prevalent from October to December, and its incidence is still rising in Chinese mainland recently.However, the increasing tendency in South China has been prevented in recent six years.