真菌性角膜炎致病与预后关系的分析
摘要
目的
了解真菌性角膜炎中菌属差异对疾病预后的影响,分析两者之间的相关性。
方法
选取镰孢菌属、曲霉菌属、互隔交链孢霉和无孢菌群作为研究对象,对2005.1.～2008.12.于河南省眼科研究所诊断为真菌性角膜炎并行真菌培养及菌种鉴定者尽可能完整的搜集其病历资料,重点包括所感染菌种、自发病到来院就诊时间、就诊时病变严重程度,并对其预后进行电话随访。分别就菌属差异、就诊时间不同与预后之间的关系进行描述性及统计学分析(SPSS13.0统计学软件χ2检验)。结果
随访共获结果527例,其中镰孢菌属感染356例,曲霉菌属感染85例,互隔交链孢霉感染49例,无孢菌群感染37例；菌属差异与预后之间存在关联χ2=46.998 P<0.005, Pearson列联系数rP=0.2882,认为菌属差异与预后在统计学上明显相关,但关联强度不大,其中镰孢菌属与曲霉菌属感染,预后之间差别没有统计学意义,互隔交链孢霉与无孢菌群感染,预后之间差别没有统计学意义；镰孢菌属感染,就诊时间与预后明显相关,χ2=9.662 P=0.047<0.05,其中又以就诊时间小于7天,和就诊时间7～15天之间差异显著,χ2=7.476P=0.024<0.05,而15天以后至更长则没有统计学差异,χ2=0.485 P=0.785>0.05；互隔交链孢霉和无孢菌群感染,就诊时间与预后之间没有统计学关联,χ2=2.484 P=0.478>0.05。
结论
真菌性角膜炎致病菌不同会导致预后的差异,对于致病力较强的镰孢菌属和曲霉菌属,治疗手段可以倾向于更积极,而对于毒力较弱的菌群则以保守治疗为主。在临床上,病变严重程度直接决定治疗方案的选择,但它只是影响结局的一部分因素,若能加入对致病菌的考虑,必然能优化治疗方案,一定程度上避免二次手术、手术失败等结果出现。
Objective
The prevalence of fungal keratitis(FK) have increased gradually in recent years.Many kinds of fungi may lead to different endings which make FK become difficulty to manege for ophthalmologist.This study was to analyze the relationship between pathogens and prognosis in FK.
Methods
FK cases were collected from Henan Eye Institute during Jan 2005 to Dec 2008.The diagnosis of FK were based on the multiple spots inoculation of fungi.four strains were included:Fusarium,Eurotium,Alternaria alternata,Mycelia sterilia.The data were retrospectively analysed with the SPSS13.0 statistical software package,and chisquare was used.
Results
527 cases were collected, including Fusarium 356 cases, Eurotium 85 cases, Alternaria alternata 49 cases and Mycelia sterilia 37 cases. There were statistical correlations between pathogens and prognosis,but it was not closeχ2=46.998 P<0.005, Pearson's correlation coefficient r=0.2882. With respect to Fusarium,visit before 7 days or between 7 to 15 days lead to different prognosis,and the distinction was statistically significantχ2=7.476 P=0.024<0.05;to Alternaria alternata and Mycelia sterilia,there were no statistical correlation between the prognosis and the visit timeχ2=2.484 P=0.478>0.05.
Conclusions
Different pathogens can bring about different prognosis.Active treatment is necessary for the virulent pathogens,like Fusarium and Eurotium,but to the patients suffered from Alternaria alternata or Mycelia sterilia,drug treatment should be preferred.In clinic,treatment were determined by diseased degree immediately,if we get much more mind in pathogens,the prognosis must be better,then we can also avoid some secondary operation or failing of operation.
了解真菌性角膜炎中菌属差异对疾病预后的影响,分析两者之间的相关性。
方法
选取镰孢菌属、曲霉菌属、互隔交链孢霉和无孢菌群作为研究对象,对2005.1.～2008.12.于河南省眼科研究所诊断为真菌性角膜炎并行真菌培养及菌种鉴定者尽可能完整的搜集其病历资料,重点包括所感染菌种、自发病到来院就诊时间、就诊时病变严重程度,并对其预后进行电话随访。分别就菌属差异、就诊时间不同与预后之间的关系进行描述性及统计学分析(SPSS13.0统计学软件χ2检验)。结果
随访共获结果527例,其中镰孢菌属感染356例,曲霉菌属感染85例,互隔交链孢霉感染49例,无孢菌群感染37例；菌属差异与预后之间存在关联χ2=46.998 P<0.005, Pearson列联系数rP=0.2882,认为菌属差异与预后在统计学上明显相关,但关联强度不大,其中镰孢菌属与曲霉菌属感染,预后之间差别没有统计学意义,互隔交链孢霉与无孢菌群感染,预后之间差别没有统计学意义；镰孢菌属感染,就诊时间与预后明显相关,χ2=9.662 P=0.047<0.05,其中又以就诊时间小于7天,和就诊时间7～15天之间差异显著,χ2=7.476P=0.024<0.05,而15天以后至更长则没有统计学差异,χ2=0.485 P=0.785>0.05；互隔交链孢霉和无孢菌群感染,就诊时间与预后之间没有统计学关联,χ2=2.484 P=0.478>0.05。
结论
真菌性角膜炎致病菌不同会导致预后的差异,对于致病力较强的镰孢菌属和曲霉菌属,治疗手段可以倾向于更积极,而对于毒力较弱的菌群则以保守治疗为主。在临床上,病变严重程度直接决定治疗方案的选择,但它只是影响结局的一部分因素,若能加入对致病菌的考虑,必然能优化治疗方案,一定程度上避免二次手术、手术失败等结果出现。
Objective
The prevalence of fungal keratitis(FK) have increased gradually in recent years.Many kinds of fungi may lead to different endings which make FK become difficulty to manege for ophthalmologist.This study was to analyze the relationship between pathogens and prognosis in FK.
Methods
FK cases were collected from Henan Eye Institute during Jan 2005 to Dec 2008.The diagnosis of FK were based on the multiple spots inoculation of fungi.four strains were included:Fusarium,Eurotium,Alternaria alternata,Mycelia sterilia.The data were retrospectively analysed with the SPSS13.0 statistical software package,and chisquare was used.
Results
527 cases were collected, including Fusarium 356 cases, Eurotium 85 cases, Alternaria alternata 49 cases and Mycelia sterilia 37 cases. There were statistical correlations between pathogens and prognosis,but it was not closeχ2=46.998 P<0.005, Pearson's correlation coefficient r=0.2882. With respect to Fusarium,visit before 7 days or between 7 to 15 days lead to different prognosis,and the distinction was statistically significantχ2=7.476 P=0.024<0.05;to Alternaria alternata and Mycelia sterilia,there were no statistical correlation between the prognosis and the visit timeχ2=2.484 P=0.478>0.05.
Conclusions
Different pathogens can bring about different prognosis.Active treatment is necessary for the virulent pathogens,like Fusarium and Eurotium,but to the patients suffered from Alternaria alternata or Mycelia sterilia,drug treatment should be preferred.In clinic,treatment were determined by diseased degree immediately,if we get much more mind in pathogens,the prognosis must be better,then we can also avoid some secondary operation or failing of operation.
引文
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