糖尿病真菌性角膜炎患者临床特征及病原学分析

摘要

目的 调查与探讨糖尿病真菌性角膜炎患者临床特征及病原学状况,发现影响糖尿病真菌性角膜炎患者预后的主要危险因素.方法 采用回顾性研究方法,选择2013年2月～2016年5月在我院眼科确诊的,具有完整病例资料和随访资料的真菌性角膜炎患者120例作为研究对象,包括合并糖尿病的真菌性角膜炎60例(糖尿病组)和无糖尿病的真菌性角膜炎60例(非糖尿病组),调查所有患者的人口学特征、临床症状、病原学检查结果,同时记录患者的预后情况并进行危险因素分析.结果 两组患者的性别、体重指数、病程等对比,差异无统计学意义(P＞0.05),糖尿病组糖尿病病史平均为(8.14±2.11)a.糖尿病组的年龄和角膜感染程度评分与非糖尿病组相比,差异有统计学意义(P＜0.05).在糖尿病组中,镰刀菌属10例(16.7％),曲霉菌属40例(66.7％),念珠菌属10例(16.7％);在非糖尿病组中,镰刀菌属25例(41.7％),曲霉菌属30例(50.0％),念珠菌属5例(8.3％),两两比较差异都有统计学意义(P＜0.05).糖尿病组与非糖尿病组的治疗总有效率分别为86.7％和98.3％,糖尿病组的治疗总有效率明显差于非糖尿病组(P＜0.05).多分变量Logistic回归显示浸润病灶、前房积脓、曲霉菌为影响糖尿病真菌性角膜炎预后的主要危险因素(P＜0.05).结论 糖尿病真菌性角膜炎患者相对于非糖尿病患者而言主要表现为发病年龄偏大、角膜感染较重、预后差的特点,曲霉属为其主要病原菌.浸润病灶、前房积脓和曲霉菌为影响糖尿病真菌性角膜炎预后的主要危险因素.%Objective To investigate the clinical features and etiology of diabetic fungal keratitis in diabetic patients,to find out the main risk factors for the prognosis.Methods A retrospective study was used.From February 2013 to May 2016,120 patients in our hospital diagnosed as fungal keratitis with complete clinical data were enrolled,including 60 cases of diabetic fungal keratitis (diabetic group) and 60 cases of non-diabetic fungal keratitis (non-diabetes group).All the demographic characteristics,clinical symptoms,etiological examination results were recorded,and the patient's prognosis and risk factors were also recorded.Results There were no significant differences in gender,BMI,duration of disease (P ＞ 0.05) between two groups.The average history of diabetes in the diabetic group was 8.14± 2.11 years.The age and corneal infection severity scores compared between the diabetic group and the non diabetes group were significantly different (P＜0.05).In the diabetic group,there were 10 cases of Fusarium sp (16.7％),40 cases of Aspergillus sp (66.7％),10 cases of Candida (16.7％).In the non diabetes group,there were 25 cases of Fusarium sp (41.7 ％),30 cases of Aspergillus sp (50 ％),5 cases of Candida (8.3 ％).The distribution of fungal infections in two groups showed statistical significantly difference (P ＜0.05).The total effective cure rate of diabetic group and non-diabetic group were 86.7 ％ and 98.3 ％,respectively.Multi-variable Logistic regression analysis showed that the main risks for prognosis were infiltration lesions,hypopyon and Aspergillus in the diabetic fungal keratitis patients (P＜0.05).Conclusion Compared with those in non-diabetic group,fungal keratitis patients in diabetic group was more older.Aspergillus was the main pathogen.The infiltration lesions,hypopyon and Aspergillus were the main prognosis risk factors in the diabetes fungal keratitis patients.