苏皖地区105例真菌性角膜炎分析

Analysis of 105 cases of fungal keratitis in Suwan Area

目的分析苏皖地区真菌性角膜炎的流行病学特征及治疗方法。方法回顾性分析2012年1月至2017年12月105例（105眼）真菌性角膜炎的临床资料。结果均为单眼患病。其中左眼53例（50．5％），右眼52例（49．5％）。男70例（66．7％），女35例（33．3％）。40岁以上者92例（87．6％）。有明确外伤史者59例（56．2％），其它病因16例（15．2％），无明显诱因30例（28．5％）。初诊患者7例（6．7％），外院转诊98例（93．3％），转诊病例中24例曾给予抗真菌治疗，41例曾给予抗细菌、病毒或糖皮质激素治疗，33例治疗方法不详。105例角膜取材均做真菌培养，70例阳性（66．7％），其中镰刀菌属29例（41．4％），曲霉菌属18例（25．7％），青霉菌属5例（7．1％），枝顶孢5例（7．1％），链格孢4例（5．7％），弯孢菌3例（4．3％），毛霉菌2例（2．9％），其他未分类及杂菌4例（5．7％）。46例（43．8％）抗真菌药物治疗好转，8例（7．6％）药物治疗加重行溃疡清创术，37例（35．2％）给予角膜溃疡清创联合球结膜瓣遮盖术，术后感染控制；药物或加清创术无效选择角膜移植10例（9．5％），感染未控制行眼内容摘除术4例（3．8％）。结论苏皖地区真菌性角膜炎主要病因是外伤，主要致病菌为镰刀菌属和曲霉菌属。

Objective To analyze the epidemiological characteristics and treatment of fungal keratitis in Suwan Area. Methods The clinical data of 105 eyes of 105 patients with fungal keratitis from Jan. 2012 to Dec. 2017 were collected. The epidemiological, distribution characteristics and therapeutic schedules were analyzed retrospectively. Results All cases were monocular disease, including 53 cases （50. 5%） in the left eye and 52 eases （49.5%） in the right. There were 70 （66.7%） males, 35 （33.3%） females,and the age was≥40 years in 92 cases （87.6%）. There were 59 cases （56.2%） with elear history of trauma, 16 eases （ 15.2% ） with other causes, and 30 patients （28.5%） without obvious cause. Seven patients （6.7%） were newly diagnosed and 98 cases （93.3%） were referred by the external hospital. Of the referrals, 24 eases were given antifungal treatment, 41 eases were given antibacterial, viral, or glueosteroids therapy, and 33 eases were given unknown treatment. There were 70 positive （ 66.7% ） fungus cuhrues, among which 29 eases （41.4%） with Fusarium, 18 eases （25.7%） with Aspergillus, 5 eases （7.1%） with Penicillium and 5 cases （7.1%） with Acremoniumin, 4 eases （5.7%） with Alternaria aheruata, 3 eases （4.3%） with Curvularia spp, 2 cases（2.9% ） with Mucor fungus and hybrid bacterium in 4 eases （11.4%）. Forty-six eases （43.8%） were improved through antifungal drug treatment,8 eases （7.6%） were aggravated and treated with ulcers debridement, 37 cases （35.2%） had infection eontroled through operation of corneal debridement eombined with conjunctival flap eoverage. Drugs or debridement were ineffeetive in 10 eases （9. 5% ） of corneal transplants. Four eases （3.8%） with uneontrolled infection received eyeball enucleation. Conclusion The main cause of fungal keratitis in Suwan Area is trauma. The main pathogens are Fusarium and Asoer^illus.