|本期目录/Table of Contents|

[1]叶霞,刘震,王施鲲.东南沿海地区外伤性真菌性角膜炎病因学及临床分析[J].医学研究与战创伤救治(原医学研究生学报),2022,24(5):495-499.[doi:10.3969/j.issn.1672-271X.2022.05.010]
　YE Xia,LIU Zhen,WANG Shi-kun.Etiology and clinical analysis of traumatic fungal keratitis in southeast coastal islands[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2022,24(5):495-499.[doi:10.3969/j.issn.1672-271X.2022.05.010]
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东南沿海地区外伤性真菌性角膜炎病因学及临床分析()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第24卷
期数:
2022年5期
页码:
495-499
栏目:
临床研究
出版日期:
2022-11-02

文章信息/Info

Title:
Etiology and clinical analysis of traumatic fungal keratitis in southeast coastal islands
作者:
叶霞; 刘震; 王施鲲
作者单位：316000舟山，东部战区海军医院眼科（叶霞、刘震、王施鲲）
Author(s):
YE Xia; LIU Zhen; WANG Shi-kun
(Department of Ophthalmology,Naval Hospital of Eastern Theater,Zhoushan 316000,Zhejiang,China)
关键词:
角膜炎; 真菌; 角膜移植术; 人口学特征
Keywords:
keratitis; fungus; keratoplasty; demographic characteristics
分类号:
R772.21
DOI:
10.3969/j.issn.1672-271X.2022.05.010
文献标志码:
A
摘要:
目的分析驻舟山岛某部队医院所属东南沿海区域外伤性真菌性角膜炎的病因学及临床诊疗。方法回顾性分析2014年1月至2021年12月东部战区海军医院确诊的有明确外伤史的真菌性角膜炎157例患者的临床资料，分析其致病原因、就诊时间、人口学特征、实验室检查、临床表现、治疗方案及预后。结果157例患者中，男性97例（61.8%），女性60例（38.2%），年龄（52.25±10.72）岁，受伤原因中植物外伤史占比最高共69例（43.9%），渔船作业中等异物外伤史41例（24.8%）。通过氢氧化钾湿片直接镜检法查出菌丝者共117眼，诊断阳性率达到74.5%，通过角膜溃疡刮片培养出真菌者共107眼，诊断阳性率68.2%，其中最多见的为镰刀菌65例（60.7%），其次为链格孢霉属20例（18.7%），曲霉菌13例（12.1%），假丝酵母菌6例（5.6%），其余3例发现真菌菌丝，但无法明确菌属。单纯药物治疗22眼（14.0%），行角膜溃疡清创术59眼（44.0%），行结膜瓣覆盖术31眼（23.0%），转上级医院行角膜移植术29眼(21.5%)，行眼内容物剜除术12眼（8.9%）。结论舟山岛地区外伤性真菌性角膜炎主要发生在中老年男性，植物性外伤是主要原因，其次为渔业劳动中角膜异物外伤及轻微擦伤。病原学检查镰刀菌属占比最高，药物+角膜溃疡清创术+结膜瓣覆盖术对于浅、中基质浸润的患者疗效确切，但对于深层基质浸润患者，角膜移植术仍为首选的治疗方案。
Abstract:
ObjectiveTo evaluate and analyze the basis for the diagnosis and treatment of traumatic fungal keratitis in Zhoushan Island.MethodsThrough a retrospective study of 157 patients with fungal keratitis diagnosed with a clear history of trauma in Naval Hospital Of Eastern Theater from January 2014 to December 2021, the pathogenic causes, treatment time, demographic characteristics, laboratory examinations, clinical manifestations, treatment plan and prognosis were analyzed.ResultsAmong the 157 patients, 97 (61.8%) and 60 (38.2%) cases were male and female, respectively. The average age was (52.25±10.72) years old. Among the causes of injury, 69 (43.9%) cases had a history of plant trauma, and 41 (24.8%) cases had a history of foreign body trauma such as rust, steel wire and fishing net. 117 eyes were found hyphae by direct microscopic examination of potassium hydroxide wet film, and the positive rate was 74.5%. 107 eyes were cultured fungi by corneal ulcer scraping, and the positive rate was 68.2%. Among them, 65 cases (60.7%) were the most common, followed by 20 cases (18.7%) of Alternaria, 13 cases (12.1%) of Aspergillus and 6 cases (5.6%) of Candida, Fungal hyphae were found in the other 3 cases, but the genus could not be determined. 22 eyes (14.0%) were treated with drugs alone, 59 eyes (44.0%) underwent corneal ulcer debridement, 31 eyes (23.0%) underwent conjunctival flap coverage, 29 eyes (21.5%) were transferred to superior hospital for corneal transplantation, and 12 eyes (8.9%) underwent enucleation of eye contents.ConclusionTraumatic fungal keratitis in Zhoushan island mainly occurs in middle-aged and elderly men. Plant trauma in agricultural labor is still the main cause, followed by corneal foreign body trauma and slight abrasion in fishery labor. Pathogenic examination shows that the proportion of Fusarium is the highest. Drug + corneal ulcer debridement + conjunctival flap coverage is effective for patients with shallow and medium stromal infiltration, but corneal transplantation is still the first choice for patients with deep stromal infiltration.

参考文献/References:

[1]Lin I, Lan W,Lou B,et al.Genus distribution of bacteria and fungi associated with Keratitis in a large eye center located in Southern China[J].Ophthalmic Epidemiol，2017,24(2):90-96.
[2]An N, Liu XN, Wang YN, et al. The pathognic spectrum of fungal keratitis in northwestern China[J].Int J Ophthalmol,2016,9(12):1846-1848.
[3]Ghosh AK,Gupta A,Rudramurthy SM,et al.Fungal keratitis in North India:spectrum of agents,risk factors and treatment[J].Mycopathologia,2016, 181(11-12):843-850.
[4]Pan XJ,Jiang T,Zhu H,et al.Corneal infection in Shangdong peninsula of China:a 10-Year retrospective study on 578 cases[J]. Int J Ophthalmol,2016,9(1):53-57.
[5]何健, 程钧，董燕玲，等. 真菌性角膜炎14114例临床分析[J]. 中华眼科杂志, 2020, 56(4):286-293.
[6]金丽丽,秦晓怡,陈鹏飞,等. 温州某医院258例真菌性角膜炎诊疗分析[J]. 中华眼视光学与视觉科学杂志，2020,22（12）:928-933.
[7]罗顺荣, 吴护平，林志荣，等. 重视真菌性角膜炎个性化手术治疗的研究[J]. 中华眼科医学杂志, 2018, 8(1):1-8.
[8]中华医学会眼科学分会角膜病学组. 感染性角膜病临床诊疗专家共识(2011年)[J]. 中华眼科杂志, 2012, 48(1):72-75.
[9]吴思腾, 赵泽林, 潘瑜,等. 深基质真菌性角膜炎综合治疗方案的疗效评估[J]. 中华眼视光学与视觉科学杂志, 2020, 22(10):750-755.
[10]Prakash G,Sharma N,Goel M,et al.Evaluation of intrastromal injection of voriconazole as a therapeutic adjunctive for the management of deep recalcitrant fungal keratitis[J].Ophthalmol,2008,146(1):56-59.
[11]陈舒怿. 188例重症真菌性角膜炎患者病原学及临床特征分析[J]. 中国病原生物学杂志, 2016, 11(4):366-368.
[12]龚桦, 谭奕炜, 龚向明,等. 中国华南地区真菌性角膜炎致病菌谱变化[J]. 中华实验眼科杂志, 2017，35(2):161-164.
[13]陈晓莲, 刘红山, 何宏,等. 中国热带地区真菌性角膜溃疡致病菌种类及药物敏感性分析[J]. 中华实验眼科杂志，2017，35(2)：156-160.
[14]刘素媛, 张岸平, 单秀水,等. 唐山地区真菌性角膜炎的病原学分析及诊断[J]. 中国实用眼科杂志, 2013, 31(7):884-886.
[15]王倩, 罗丹, 陈华波,等. 3759例角膜炎患者真菌检测与耐药性分析[J]. 中国真菌学杂志, 2019, 14(1):16-19.
[16]Kunimoto DY, Sharma S, Garg P, et al.Corneal ulceration in the elderly in Hyderabad,south India[J]. Br J Ophthalmol,2000,84(1):54-59.
[17]Tanure MA, Cohen EJ, Sudesh S, et al.Spectrum of fungal keratitis at wills eye hospital,Philadelphia,Pennsylvania[J].Cornea,2000,19(3):307-312.
[18]窦新岩, 王丽娅, 孙声桃,等. 真菌性角膜炎临床常用诊断方法比较分析[J]. 中国实用眼科杂志, 2016, 34(6):564-568.
[19]吴艳, 石尧, 薛春燕. 激光共焦显微镜观察真菌性角膜炎治疗效果的研究[J]. 东南国防医药, 2012, 14(3):227-229.
[20]陈鹏飞,秦晓怡，毛丽萍，等. 实验室诊断技术在真菌性角膜炎诊断敏感性的对比研究[J]. 国际眼科杂志,2015,15(8):1322-1326.
[21]金丽丽, 郑美琴. 浙南地区外伤性真菌性角膜炎的人口学及临床特征[J]. 中华眼外伤职业眼病杂志, 2022, 44(1):24-30.
[22]朱佩文,梁荣斌. 顽固性真菌性真菌性角膜炎现代治疗技术[J]. 眼科学报,2021,36(4):282-287.
[23]白利广, 夏建朴. 412例真菌性角膜炎的回顾性分析[J]. 中华眼视光学与视觉科学杂志, 2019, 21(11):865-870.
[24]韦振宇, 梁庆丰. 真菌性角膜炎诊治新进展[J]. 中华眼科杂志, 2020, 56(8):631-636.

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更新日期/Last Update: 2022-11-16