角膜基质内注射不同药物治疗不同病原菌感染所致真菌性角膜炎

Clinical study of corneal intrastromal injection with different drugs in the treatment of fungal keratitis caused by different nosophyte

目的观察角膜基质内注射不同药物治疗不同病原菌感染所致真菌性角膜炎的疗效。方法将2013年1月至2017年2月在冀中能源邢台矿业集团总医院诊治的180例真菌性角膜炎患者分为3个组,每组包含镰刀菌、曲霉菌、念珠菌感染者各20例,分别给予5%那他霉素滴眼液点眼、0.005%二性霉素B和0.05%伏立康唑角膜基质内注射,观察各组的疗效。结果对于镰刀菌所致真菌性角膜炎患者:伏立康唑组的治愈率高于二性霉素B组和药物点眼组,差异均有统计学意义(P<0.05)。对于曲霉菌所致真菌性角膜炎患者:二性霉素B组和伏立康唑组的治愈率分均高于药物点眼组,差异均有统计学意义(P<0.05)。对于念珠菌所致真菌性角膜炎患者:二性霉素B组的治愈率为高于伏立康唑组的和药物点眼组,差异均有统计学意义(P<0.05)。结论建议对镰刀菌感染者首选伏立康唑,念珠菌感染者首选二性霉素B,曲霉菌感染者可选择伏立康唑或二性霉素B作为角膜基质内注射用药。

Objective To investigate the efficacy of corneal stroma injection of different drugs for treating fungal keratitis caused by infection from different pathogens. Methods A total of 180 cases were prospectively collected of from January 2013 to February 2017, who were diagnosed with fungal keratitis and treated in （Fusari- urn, Aspergillus, and Candida were found in each of 60 cases） of Jizhong energy Xingtai Mining Group General Hospital. The patients were divided into three groups according to the random number table of patients who are infected with the same pathogens, with each group containing Fusarium, Aspergillus and Candida infection of 20 cases. The drug treated group received 5% Natamyein eye drops, based on which that 0.005% Amphotericin B group and 0.05% Voriconazole group received 0.005% Amphotericin B and 0.05% Voriconazole respectively injec- tion in corneal stroma. Each group curative effect and adverse reactions were observed. Results For patients with fungal keratitis caused by Fusarium, the cure rate of voriconazole group was higher than that of Amphotericin B group and drug treated group, the differences were statistically significant （P 〈 0.05）. The cure rate between am- photericin B group and drug treated group, the difference was not statistically significant （P 〉 0.05）. For patients with AspergiUosis caused by fungal keratitis, amphotericin B group and voriconazole group were higher than the drug treated group, the differences were statistically significant （P 〈 0.05 ）. Amphotericin B group and voriconazole group had no statistically significant difference （P = 0.724）. For patients of fungal keratitis caused by Candida, the cure rate of Amphoteriein B group was higher than that of voriconazole group and drug treated group, the differ- ences were statistically significant （P 〈 0.05 ）. The cure rate between vorieonazole group and drug treated group , the difference was not statistically significant （P 〉 0.05）. Fusarium and Aspergillus infections in fungal keratitisas were more severe than Monilia infection, the differences were statistically significant （P 〈 0.05 ）.The comparison of Fusarium and Aspergillus was no statistically significant difference （P 〉 0.05 ）. Conclusion Corneal stromal in- jection of amphotericin B and voriconazole is an effective method for the treatment of fungal keratitis. It is suggested that voriconazole is the first choice for the patients with Fusarium infection. Candida albicans is the first choice for amphotericin B. Aspergillus infection can choose voriconazole or amphoteficin B as intrastromal injection.