【作者】 常晓可；

【导师】 王丽娅；

【作者基本信息】 郑州大学 ， 眼科学， 2010， 硕士

【摘要】 目的分析边缘年龄人群(老年人和未成年人)真菌性角膜炎的流行病学及病原学特征,并与国内外相关文献以及本地区中间年龄人群真菌性角膜炎的流行病学及病原学特征进行比较,增强临床医师对这一特殊年龄人群真菌性角膜炎的发病情况及疾病特点的认识。方法选取2005年1月-2008年12月就诊于河南省眼科研究所经培养确诊为真菌性角膜炎患者578例共578眼,按照年龄界限分为三组：(1)老年组101例(年龄≥60岁)；(2)未成年组62例(年龄≤18岁)。(3)对照组415例(19岁≤年龄≤59岁)。对其不同年龄段人群的真菌性角膜炎的流行病学特征(如发病年份、季节、职业、年龄分布、危险因素、疾病结局等)及病原学特征进行回顾性分析。结果1.边缘年龄人群真菌性角膜炎发病呈上升趋势,年发病高峰集中在9月和10月,存在明显的季节性。边缘年龄人群真菌性角膜炎男性的发病率均明显高于女性。老年组真菌性角膜炎患者多集中在60-64岁年龄段(39.6%),随着年龄的增大,发病人数逐渐减少。未成年组真菌性角膜炎患者以15-18岁年龄段患者最多(38.71%),且随着年龄的增大,发病人数逐渐增加。老年组中,36.63%的患者有明确外伤史,最终行手术治疗的患者人数为50人(49.50%),其中行穿透性角膜移植(PK)手术者17例(16.83%),眼内容物剜除(E0)手术者16例(15.84%)。未成年组有明确外伤史者20例(32.26%),最终行手术干预者16例(25.81%),,其中行穿透性角膜移植(PK)手术者5例,板层角膜移植(LK)手术者10例,病灶切除手术(FE+CK)者1例。老年组平均病程为22天,60—64岁年龄段的平均病程最长(28.13天),80岁以上年龄段平均病程最短(10.50天),其病程随年龄的增加逐渐缩短。未成年组平均病程为9.69天,15—18岁年龄段平均病程最长(12.25天),1-4岁年龄段病程最短(6.00天),其病程随年龄的增加逐渐增长。2.老年组分离出致病菌属共5种,依次为镰孢菌属46例(45.54%)、曲霉菌属27例(26.73%)、互隔交链孢属15例(14.85%)、无孢菌属11例(10.89%)和青霉菌属2例(1.98%)。其中镰孢菌属感染患者最终手术干预率最高(63.03%)。未成年组亦以镰孢菌属为首要致病菌属,占50.00%,其次为曲霉菌属10例(16.13%)、无孢菌8例(12.90%)、互隔交链孢属7例(11.30%)及青霉菌属6例(9.68%)。各属种最终治疗结局亦不相同,其中镰孢菌属手术率达35.48%。结论1边缘年龄人群真菌性角膜炎患者与无年龄界限真菌性角膜炎一样,其发病均呈明显上升趋势。2.边缘年龄人群真菌性角膜炎的发病季节较无年龄界限真菌性角膜炎及对照组稍有提前,可能与未成年人和老年人这一特殊年龄人群的体质以及耐受性有关。3.随着边缘年龄人群真菌性角膜炎患者在年龄上更接近于中间年龄人群,其疾病特点亦愈接近无年龄界限真菌性角膜炎。4.老年人真菌性角膜炎的手术率较高,且致残率高,而未成年人往往对抗真菌药物的反应较好。5.镰孢菌属以毒性强、手术率高在边缘年龄人群真菌性角膜炎病原学中依然占据重要地位。6.边缘年龄人群真菌性角膜炎流行病学及病原学均有其自身特点,应加强对该年龄段真菌性角膜炎的认识和研究,提高疾病预后。更多还原

【Abstract】 ObjectiveTo investigate the epidemiological and etiological characteristics of fungal keratitis at extremes of age and compare them with fungal keratitis affecting the general adult population to heighten the understanding of clinical doctor on the fungal keratitis at extremes of age.Methods578 culture-proven cases of fungal keratitis diagnosed at Henan Eye Institute between January 2005 to December 2008 were retrospectively reviewed. Patients were divided into 3 groups based on age:(1) elderly group if the age was 60 years or older, (2) juvenile group if the age was 18 years or younger and (3) control group if the age was between 19 and 59 years. Features studied included epidemiological characteristics (included the patient’s age, sex, duration of symptoms at presentation, month of onset of infection, known predisposing risk factor, results of microbiology examinations and details of surgical intervention, if any.) and etiological characteristics.Results:A total of 578 cases of confirmed fungal keratitis were identified. The incidence of fungal keratitis at extremes of age was increased year by year. And the highest monthly prevalence was during September and October. The incidence of fungal keratitis at extremes of age had a male preponderance.39.6% of cases were 60-64 years old in the elderly, while the incidence of fungal keratitis in juvenile group was higher in 15-18 years old. The incidence of fungal keratitis was higher and higher with the age being younger and younger, while it was contrary in juvenile.37 patients (36.63%) had a definite history of trauma and surgical intervention was performed on 50 patients (49.50%), with acute penetrating keratoplasty in 16.83%(17 cases) and 15.84% required evisceration (16 cases) in elderly. In juvenile, the most important risk prevalence is also trauma (32.26%), and 16 cases needed surgical intervention (25.81%), including acute penetrating keratoplasty in 8.06%(5cases) and lamellar keratoplasty in 16.13%(10 cases) in juvenile. The mean duration from the onset of symptoms to presentation to our institution was 22 days, the 60-64 years stage had the longest mean duration(28 days), and the patients aged older than 80 had the shortest one(11days) in elderly. while in juvenile, The mean duration from the onset of symptoms to presentation to our institution was shorter than the old(9.69days), the 15-18 years stage had the longest mean duration(12.25 days), and the patients aged 1-4 years had the shortest one(6days). Most of the isolated fungi were Fusarium species(46 cases,45.54%) in elderly, followed by Aspergillus species (27 cases, 26.73%), Alternaria species (15 cases,14.85%), Mycelia species(11 cases,10.89%), Penicillium species(2 cases,1.98%). The Fusarium species has the highest surgical intervention rate (63.03%). And Fusarium species was also the most commonly isolated pathogens in juvenile(50%), followed by Aspergillus species (10 cases, 16.13%), Curvularia species(8 cases,12.9%), Alternaria species (7 cases,11.30%), Penicillium species(6 cases,9.68%). The Fusarium species has the highest surgical intervention rate in both elderly and juvenile.Conclusions1. The incidence of fungal keratitis at extremes of age was increased year by year.2. The highest monthly prevalence of fungal keratitis at extremes of age was earlier than that affecting the general adult population. We attributed this to the special physical capacity and toleration at extremes of age.3. With the age getting close to the general adult population, the characteristics of epidemiological is approaching these of the general adult population.4. Fungal keratitis in the elderly had a high surgical intervention rate, and also a high mutilation rate. While, the juvenile affecting fungal keratitis usually had a good reaction to anti-fungal medicine.5. Fusarium species play an important role in the fungal keratitis at extremes of age with their powerful toxicity and high surgical intervention rate.6. Fungal keratitis at extremes of age has its own feature and should be known and studied more to improve its prognosis.更多还原