10%碘酊联合三唑类多烯类药物治疗真菌性角膜溃疡的临床研究
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摘要
目的:探讨非手术方法综合治疗真菌性角膜溃疡的临床疗效。
方法:选择07年1月至08年2月间哈尔滨二四二医院病房确诊真菌性角膜溃疡患者57例57眼,患者年龄18～75岁,平均年龄45.76岁;男性43例(75.44%),女性14例(24.56%);职业:农民及农民工53例(92.98%),学生1例,退休工人2例,干部1例;诱因:稻壳划伤者5例,玉米屑进入者5例,植物杆划伤者2例,铁锈进入者2例,不明异物进入者14例,患病前有感冒症状者2例,无明显诱因者27例(47.37%);视力:光感4眼(7.02%),手动/20cm 13眼(22.81%),指数/30cm 7眼(12.28%),0.02～0.1者5眼(8.77%),0.12～0.2者7眼(12.28%),0.25～0.5者16眼(28.07%),＞0.5者5眼(8.77%)。随机分为对照组和治疗组,前者27眼采用氟康唑联合两性霉素B治疗,后者30眼采用角膜清创10%碘酊烧灼术联合伊曲康唑、氟康唑和纳他霉素治疗,对两组患者治疗2月后的病程、疗效进行比较。
结果:(1)疗程方面:治疗组2月内20例药物治愈者,疗程18d～56d,平均32.10±10.84d,对照组2月内治愈12例,疗程24d～53d,平均39.58±9.35d。二者对比差异具有统计学意义(p＜0.05),治疗组优于对照组。(2)疗效方面:治疗组轻型9眼治愈9眼;中型14眼治愈10眼,显效2眼,有效2眼;重型7眼治愈1眼,显效2眼,有效2眼,无效2眼;对照组:轻型9眼治愈9眼;中型13眼治愈3眼,显效3眼,有效4眼,无效3眼;重型5眼有效2眼,无效3眼。二者对比差异具有统计学意义(p＜0.05),治疗组优于对照组。
结论:非手术疗法治疗真菌性角膜溃疡是一种有效的手段;三唑类和多烯类药物联合角膜病灶清创碘酊烧灼术治疗真菌性角膜溃疡疗效优于氟康唑联合两性霉素B治疗组;非手术疗法对早期治疗,溃疡病灶直径≤6mm,浸润深度浅者疗效好。
Purpose:To approach the clinical effectiveness of Non-surgical therapy of fungal keratitis.
Methods:Clinically collected the 57 patients(57 eyes)diagnosed as the fungal keratitis desease come from haerbin 242 hospital,the age of patients between 18 and 75,average 45.76 years old;Male 43(75.44%),woman 14 (24.56%)example;Occupation:the peasants and farmer labors 53 example (92.98%),pupil 1 example,Retired workers 2 example,leader 1 example; Motivation:rice testa striking 5 example,corn chipping 5 example,plant stalk 2 example,rust 2 example,in nubibus corpus alienum 14 example,to have a cold before with disease 2 example,non obviouslymotivation 27(47.37%) example;Vision:light perception have 4 eyes(7.02%),hand movement/20cm have 13 eyes(22.81%),Fingerzahl/30era have 7 eyes(12.2 %),the sifht of 5 eyes(8.77%)from 0.02 to 0.1,0.12～0.2have 7 eyes (12.28%),0.25～0.5have 16eyes(28.07%),＞0.5 have 5 eyes(8.77 %).Patients are divided into contrasted group and treating group at random. The observed group have 27 patiens(27 eyes)treated by fluconazol and lushanmycin.The treating group have 30 patiens(30eyes)treated by triazole group drug,polyene group drug and 10%iodine occupation conbined debriding cornea.To compare the course of disease and curative effect after 2 monthes treatmeat.
Results:(1)The course of disease aspect:The 20 healing well patients within 2 monthes of the treating group take 18～56 date,average 32.10±10.84 date,the 12 healing well patients within 2 monthes of the observed group take 24～53 date,average 39.58±9.35 date.To contrast difference of the two has statistical significance(p＜0.05),the treating group is superior to the contrasted group.(2)The curative effect aspect:The 9 eyes Var.mitis patients of the treating group curing 9 eyes;The 14 medium-sized eyes curing 10 eyes,excellence 2 eyes,utility 2 eyes;The 7 gravis type eyes curing 1 eye,excellence 2 eyes,utility 2 eyes,ineffective 2 eyes;The contrasted group:The 9 Var.mitis eyes cruing 9 eyes.The 13 medium-sized eyes curing 3 eyes,excellence 3 eyes,utility 4 eyes,ineffective 3 eyes;The 5 gravis type eyes utility 2 eyes,ineffective 3 eyes.To contrast difference of the two hasstatistical significance(p＜0.05),the treating group is superior to the contrasted group.
Conclusion:Non-surgical therapy of fungal keratitis is a effective method; the curative effect of treating fungal keratitis with triazole group drug,polyene group drug and 10%iodine tincture conbined debriding cornea superior to that treated by fluconazol and lushanmycin;The curative effect of Non-surgical therapy of fungal keratitis that early treatment,corneal ulcer diameter≤6mm,superficial infiltrating depth is well.
方法:选择07年1月至08年2月间哈尔滨二四二医院病房确诊真菌性角膜溃疡患者57例57眼,患者年龄18～75岁,平均年龄45.76岁;男性43例(75.44%),女性14例(24.56%);职业:农民及农民工53例(92.98%),学生1例,退休工人2例,干部1例;诱因:稻壳划伤者5例,玉米屑进入者5例,植物杆划伤者2例,铁锈进入者2例,不明异物进入者14例,患病前有感冒症状者2例,无明显诱因者27例(47.37%);视力:光感4眼(7.02%),手动/20cm 13眼(22.81%),指数/30cm 7眼(12.28%),0.02～0.1者5眼(8.77%),0.12～0.2者7眼(12.28%),0.25～0.5者16眼(28.07%),＞0.5者5眼(8.77%)。随机分为对照组和治疗组,前者27眼采用氟康唑联合两性霉素B治疗,后者30眼采用角膜清创10%碘酊烧灼术联合伊曲康唑、氟康唑和纳他霉素治疗,对两组患者治疗2月后的病程、疗效进行比较。
结果:(1)疗程方面:治疗组2月内20例药物治愈者,疗程18d～56d,平均32.10±10.84d,对照组2月内治愈12例,疗程24d～53d,平均39.58±9.35d。二者对比差异具有统计学意义(p＜0.05),治疗组优于对照组。(2)疗效方面:治疗组轻型9眼治愈9眼;中型14眼治愈10眼,显效2眼,有效2眼;重型7眼治愈1眼,显效2眼,有效2眼,无效2眼;对照组:轻型9眼治愈9眼;中型13眼治愈3眼,显效3眼,有效4眼,无效3眼;重型5眼有效2眼,无效3眼。二者对比差异具有统计学意义(p＜0.05),治疗组优于对照组。
结论:非手术疗法治疗真菌性角膜溃疡是一种有效的手段;三唑类和多烯类药物联合角膜病灶清创碘酊烧灼术治疗真菌性角膜溃疡疗效优于氟康唑联合两性霉素B治疗组;非手术疗法对早期治疗,溃疡病灶直径≤6mm,浸润深度浅者疗效好。
Purpose:To approach the clinical effectiveness of Non-surgical therapy of fungal keratitis.
Methods:Clinically collected the 57 patients(57 eyes)diagnosed as the fungal keratitis desease come from haerbin 242 hospital,the age of patients between 18 and 75,average 45.76 years old;Male 43(75.44%),woman 14 (24.56%)example;Occupation:the peasants and farmer labors 53 example (92.98%),pupil 1 example,Retired workers 2 example,leader 1 example; Motivation:rice testa striking 5 example,corn chipping 5 example,plant stalk 2 example,rust 2 example,in nubibus corpus alienum 14 example,to have a cold before with disease 2 example,non obviouslymotivation 27(47.37%) example;Vision:light perception have 4 eyes(7.02%),hand movement/20cm have 13 eyes(22.81%),Fingerzahl/30era have 7 eyes(12.2 %),the sifht of 5 eyes(8.77%)from 0.02 to 0.1,0.12～0.2have 7 eyes (12.28%),0.25～0.5have 16eyes(28.07%),＞0.5 have 5 eyes(8.77 %).Patients are divided into contrasted group and treating group at random. The observed group have 27 patiens(27 eyes)treated by fluconazol and lushanmycin.The treating group have 30 patiens(30eyes)treated by triazole group drug,polyene group drug and 10%iodine occupation conbined debriding cornea.To compare the course of disease and curative effect after 2 monthes treatmeat.
Results:(1)The course of disease aspect:The 20 healing well patients within 2 monthes of the treating group take 18～56 date,average 32.10±10.84 date,the 12 healing well patients within 2 monthes of the observed group take 24～53 date,average 39.58±9.35 date.To contrast difference of the two has statistical significance(p＜0.05),the treating group is superior to the contrasted group.(2)The curative effect aspect:The 9 eyes Var.mitis patients of the treating group curing 9 eyes;The 14 medium-sized eyes curing 10 eyes,excellence 2 eyes,utility 2 eyes;The 7 gravis type eyes curing 1 eye,excellence 2 eyes,utility 2 eyes,ineffective 2 eyes;The contrasted group:The 9 Var.mitis eyes cruing 9 eyes.The 13 medium-sized eyes curing 3 eyes,excellence 3 eyes,utility 4 eyes,ineffective 3 eyes;The 5 gravis type eyes utility 2 eyes,ineffective 3 eyes.To contrast difference of the two hasstatistical significance(p＜0.05),the treating group is superior to the contrasted group.
Conclusion:Non-surgical therapy of fungal keratitis is a effective method; the curative effect of treating fungal keratitis with triazole group drug,polyene group drug and 10%iodine tincture conbined debriding cornea superior to that treated by fluconazol and lushanmycin;The curative effect of Non-surgical therapy of fungal keratitis that early treatment,corneal ulcer diameter≤6mm,superficial infiltrating depth is well.
引文
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7 王丽娅,杨子建,张月琴等.河南地区真菌性角膜炎病因学及流行病学分析.中国实用眼科杂志.2006,24(3):331-333
8 刘祖国主编,眼表疾病学.2003北京.人民卫生出版社.382-386
9 Hasany SM,Basu PK,Kazdan JJ.Production of corneal ulcer by opportunistic and saprophytic fungi I.The effect of pretreatment of fungi with steriod.Can J Ophthalmol.1973,8:119-131
10 Brooks DE,Andrew SE,Denis H,et al.Rose bengal positive epithelial microerosions as a manifestation of equine keratomycosis.Vet Ophthalmol.,2000,3(2-3):83-86.
11 Yan SZ,Rodrigues RG,Cahn2Hidalgo D,et al.Hemoglobin induces binding of several extracellular matrix proteins to Candida albicans.J Biol Chem.1998,273:5638-5644.
12 Naiker S,Odhav B.Mycotic keratitis.profile of Fusarium species and their mycotoxins.Mycoses.2004 Feb;47(1-2):50-6.
13 Stern,G.A.,and M.Buttross.1991.Use of corticosteroids in combination with antimicrobial drugs in the treatment of infectious corneal disease.Ophthalmology 98:847-853.
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2 李凤鸣主编,眼科全书.1996年,北京,人民卫生出版社,1376
3 王丽娅,张月琴,王印其,等.中国三地区真菌性角膜病致病菌种的调查.中华眼科杂志,2000,36:138-140.
4 Tanure MAG,Cohen EJ,Sudesh S,et al.Spectrumof fungal keratitis at Wills Eye Hospital,Philadelphia,Pennsylvania.Cornea.2000,19:3072312.
5 陈玮,钟兴武,陈晓莲,等.真菌性角膜溃疡致病菌种类及药物敏感性分析.中国医师杂志.2006,8(4):565-5666
6 杜兆东,梁涛,赵桂秋等.真菌性交膜炎病原菌的流行病学调查.青岛大学医学院学报.2007,43(2):174-175
7 王丽娅,杨子建,张月琴等.河南地区真菌性角膜炎病因学及流行病学分析.中国实用眼科杂志.2006,24(3):331-333
8 刘祖国主编,眼表疾病学.2003北京.人民卫生出版社.382-386
9 Hasany SM,Basu PK,Kazdan JJ.Production of corneal ulcer by opportunistic and saprophytic fungi I.The effect of pretreatment of fungi with steriod.Can J Ophthalmol.1973,8:119-131
10 Brooks DE,Andrew SE,Denis H,et al.Rose bengal positive epithelial microerosions as a manifestation of equine keratomycosis.Vet Ophthalmol.,2000,3(2-3):83-86.
11 Yan SZ,Rodrigues RG,Cahn2Hidalgo D,et al.Hemoglobin induces binding of several extracellular matrix proteins to Candida albicans.J Biol Chem.1998,273:5638-5644.
12 Naiker S,Odhav B.Mycotic keratitis.profile of Fusarium species and their mycotoxins.Mycoses.2004 Feb;47(1-2):50-6.
13 Stern,G.A.,and M.Buttross.1991.Use of corticosteroids in combination with antimicrobial drugs in the treatment of infectious corneal disease.Ophthalmology 98:847-853.
14 张康兰,杨艳峰.真菌性角膜炎手术治疗的实验与临床研究.2002,第二军医大学学位论文
15 谢立信,史伟云,董晓光等.108例真菌性角膜炎的临床和病理组织学研究.眼科研究.1999,17(4):283-285
16 Larone DH.Medically important fungi A Guide to identification,2nd ed.London:Elsevier Scientific Publishing Co,1987.
17 Robin JB,Chan R,Rao NA,ct al.Fluorescein-conjugated lectin visualization of fungi and acanthamoebac in infectious keratitis Ophthalmology 1989,96(8):198-202
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