糖尿病真菌性角膜炎患者临床特征、病原学特点及预后的回顾性分析

摘要

背景 真菌性角膜炎在中国的发病率较高,是感染性角膜病致盲的主要原因之一,而糖尿病真菌性角膜炎患者也随之逐年增多,其治疗和转归不同于单纯真菌性角膜炎患者,目前对于该病的研究相对缺乏. 目的 分析糖尿病真菌性角膜炎的临床特征、病原学特点及预后情况,为临床诊疗提供依据.方法 回顾性分析2000年1月至2012年1月在青岛大学医学院附属医院诊治的87例糖尿病真菌性角膜炎患者的临床资料,并与同期纳入的40例无全身病真菌性角膜炎患者的人口学特征、临床症状、病原学检查、预后情况进行比较.结果 糖尿病真菌性角膜炎患者多有血糖控制不良现象和外伤的诱因,其植物性外伤引起者占36.8％,与无全身病真菌性角膜炎组的57.5％相比所占比例下降,差异有统计学意义(x2=6.06,P＜0.05).糖尿病真菌性角膜炎组患者以61 ～70岁年龄段居多,无全身病真菌性角膜炎组以51 ～60岁年龄段居多.糖尿病真菌性角膜炎患者的职业分布仍然以从事农业生产人员和体力工人为主,分别占34.5％和26.4％,糖尿病病史平均为(13.0±4.9)年.实验室检查发现,糖尿病真菌性角膜炎患者感染的真菌种类以镰刀菌属最多,占60.0％,曲霉菌属和念珠菌属各占20.0％,其中念珠菌感染所占比例明显高于无全身病角膜炎患者组的10.0％,差异有统计学意义(x2=3.92,P＜0.05).根据病灶感染特征和辅助检查结果综合考虑进行个体化诊疗后,糖尿病真菌性角膜炎患者组的治愈率为46.0％,低于无全身病真菌性角膜炎组的62.5％,差异有统计学意义(x2=5.48,P＜0.05),而无效率为14.9％,明显高于无全身病真菌性角膜炎组的5.0％,差异有统计学意义(x2=5.47,P＜0.05).结论 糖尿病真菌性角膜炎患者有其自身的特点,糖尿病可能是真菌性角膜炎发病的一个重要危险因素,持续的高血糖水平影响了该病的人口学特征、临床症状、病原菌类型及预后.%Background The incidence of fungal keratitis is increasing and it is one of the leading causes of infectious corneal blindness.Fungal keratitis with diabetes mellitus (DM)also has an increasing trend,but the study on the disease is still relatively scarce.Objective This study was to analyze the clinical characteristics,etiology and prognosis of fungal keratitis with DM.Methods The clinical data of 87 cases of fungal keratitis with DM and 40 cases of fungal keratitis without systemic disease were retrospectively reviewed,and the demographic characteristics,clinical symptoms,pathologic examination and the prognosis of the patients were analyzed and compared.Results Poor glycemic control and trauma were more likely precipitating factors of fungal keratitis with DM.The proportion of vegetable injury was 36.8％ in the fungal keratitis with DM group,and it was lower than 57.5％ in the fungal keratitis without systemic disease group(x2 =6.06,P＜0.05).The age at onset for fungal keratitis in the fungal keratitis with DM group was higher than that in the fungal keratitis without systemic disease group.The majority of patients in the fungal keratitis with DM group was farmers (34.5％)and physical workers (26.4％),with a mean history of DM for (13.0±4.9) years.Laboratory examination showed that Fusarium was the primary pathogenic fungi for the fungal keratitis with a proportion of 60.0％ and next was Aspergillus (20.0％) and Candida (20.0％).The proportion of Candida infection was higher in the fungal keratitis with DM group than that in the fungal keratitis without systemic disease group(20.0％ versus 10.0％) (x2 =3.92,P＜0.05).The cure rate for fungal keratitis with DM patients was 46.0％,and that for fungal keratitis without systemic disease patients was 62.5％,showing a significant difference between them (x2 =5.48,P＜0.05).In addition,the ineffective rate of treatment for fungal keratitis with DM patients was 14.9％,which was higher than that of fungal keratitis without systemic disease patients(5.0％) (x2 =5.47,P＜ 0.05).Conclusions Fungal keratitis with DM possesses its own characteristics.DM is an important risk factor of pathogenesis of fungal keratitis.Sustained high blood glucose levels might affect the demographic characteristics,clinical symptom,pathogenic types and prognosis of fungal keratitis patients.