上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

重症细菌性角膜炎危险因素和致病菌分析

孙静芬，周正申   

  1. 上海交通大学 医学院附属瑞金医院眼科， 上海 200025
  • 出版日期:2016-06-28 发布日期:2016-07-25
  • 通讯作者: 周正申, 电子信箱: zzs10595@rjh.com.cn。
  • 作者简介:孙静芬（1967—）， 女， 副主任医师， 博士; 电子信箱: sunjingfen@sohu.com。

Analysis of risk factors and pathogenic bacteria for severe bacterial keratitis

SUN Jing-fen， ZHOU Zheng-shen   

  1. Department of Ophthalmology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2016-06-28 Published:2016-07-25

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摘要：

目的 通过对重症细菌性角膜炎的流行病学、微生物学、临床表现和进展的研究，找出其危险因素和致病菌。方法 回顾性分析2009年1月—2015年6月在上海交通大学医学院附属瑞金医院眼科治疗的221例（228眼）重症细菌性角膜炎患者资料，其中大部分患者经角膜组织和眼表分泌物细菌培养证实为细菌性角膜炎，小部分未培养出细菌，但高度怀疑细菌性，并抗生素治疗有效。患者平均随访期为（8.55±6.92）月。结果 微生物学细菌检出率为75.57%，主要致病菌是革兰阳性球菌（42.54%）和革兰阴性杆菌（26.32%）。两类细菌所致的角膜炎预后差别无统计学意义（P=0.152）。205眼（89.91%）有明确的全身或眼部的危险因素，9眼（3.94%）有2种或以上危险因素，23眼（10.09%）未找到明显的危险因素。患者佩戴角膜接触镜是最常见的危险因素，占46.92%（107眼，P=0.001）。结论 细菌性角膜炎最常见的危险因素是佩戴角膜接触镜，主要的致病菌为革兰阳性球菌和革兰阴性杆菌。佩戴角膜接触镜所致的细菌性角膜炎预后最好。

关键词: 重症细菌性角膜炎, 危险因素, 致病菌

Abstract:

Objective To investigate epidemiology, microbiology, and clinical manifestations and progression for severe bacterial keratitis and identify its risk factors and pathogenic bacteria. Methods Data of 221 cases (228 eyes) of severe bacterial keratitis treated at the Department of Ophthalmology in Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine between January 2009 and June 2015 were analyzed retrospectively. The bacterial keratitis was confirmed in most patients by bacterial culture for corneal tissues and the secretion from ocular surface. No bacterium was found through bacterial culture in the remainder cases that were highly suspected of bacterial keratitis and responsive to antibiotic treatment. The average follow-up period was (8.55±6.92) months. Results The bacteria detection rate was 75.57% and the major pathogenic bacteria were gram positive cocci (42.54%) and gram negative bacilli (26.32%). The difference in the prognosis of bacterial keratitis caused by these two types of bacteria was not statistically significant (P=0.152). The systemic or ocular risk factors were found in 205 eyes (89.91%), two or more risk factors were identified in 9 eyes (3.94%), and no obvious risk factors were found in 23 eyes (10.09%). Wearing corneal contact lens was the most common risk factor and was accounted for 46.92% (107 eyes, P=0.001). Conclusion The most common risk factor for bacterial keratitis is wearing corneal contact lens. The most common pathogenic bacteria are gram positive cocci and gram negative bacilli. Bacterial keratitis caused by wearing contact lens has the best prognosis.

Key words: severe bacterial keratitis, risk factors, pathogenic bacteria