糖皮质激素对真菌性角膜炎预后的影响
王敬亭;边江;王欣;史伟云;李素霞
【期刊名称】《中华眼视光学与视觉科学杂志》 【年(卷),期】2019(021)006
【摘要】Objective: To assess the impact of the pre-diagnostic use of corticosteroid on the prognosis of visual outcomes and treatment methods of fungal keratitis. Methods: This was a retrospective consecutive case cohort study. Two hundred and eleven eyes of 211 patients diagnosed with fungal keratitis from December 2014 to December 2015 in Shandong Eye Hospital were analyzed. Thirty-six eyes of 36 patients with a history of corticosteroid use before the diagnosis was the corticosteroid group. The remaining 175 eyes of 175 patients with no use of corticosteroid before or during the treatment was the control group. Patients' demographics, clinical findings, management details, changes after the antifungal therapy, and corrected distance visual acuity 2 months after the cure were recorded. Independent samples t test and chi-square test were used for statistical analysis. Results: The demographic data were matched between the two groups. The fungal onset time of the corticosteroid group was 14.5±10.1 days, which was significantly shorter than that of the control group, 20.6±22.5 days (t=2.657, P=0.008). The mean diameter of corneal lesions was 6.3±2.4 mm in the corticosteroid group, which was
significantly larger than that of the control group 4.8±2.1 mm (t=3.683, P＜0.001). The positive rate of a corneal scrape was 97.2% in the corticosteroid group and 90.6% in the control group, with no significant difference between the groups (χ2=1.633, P=0.201). Only 1 case (2.8%) in the corticosteroid group was cured by antifungal drugs, which was significantly lower than that of the control group, with 34 cases (19.4%) (χ2=5.983, P=0.014). Penetrating keratoplasty was performed in 22 cases (61.1%) in the corticosteroid group, a proportion that was significantly higher than that in the control group, with 55 cases (31.4%) (χ2=11.351, P=0.001). A corrected distance visual acuity of less than 0.3 after antifungal therapy was recorded in 32 cases (88.9%) in the corticosteroid group, a proportion which was significantly higher than in the control group, 110 cases (62.8%) (χ2=9.194, P=0.002). Conclusions: Corticosteroid use before a diagnosis of fungal keratitis can increase the range of lesions, while antifungal drugs seem to be less effective, which increases the probability of penetrating keratoplasty and a poorer outcome.%目的:探讨在确诊为真菌性角膜炎之前使用糖皮质激素对真菌性角膜炎患者的视力预后及治疗方式的影响.方法:回顾性病例对照研究.收集2014年12月至2015年12月于山东省眼科医院确诊的真菌性角膜炎患者211例(211眼),其中36例(36眼)在确诊为真菌性角膜炎之前的治疗中有明确使用过糖皮质激素的患者作为激素组,175例(175眼)在治疗过程中从未使用过激素者作为对照组.采集患者的人口学信息、临床检查结果、抗真菌药物治疗
后的病情变化、治疗方案和治愈后2个月的最佳矫正视力(BCVA).采用独立样本t检验与卡方检验对数据进行统计分析.结果:2组患者人口学特征对比差异无统计学意义.激素组发病时间为(14.5±10.1)d,明显短于对照组[(20.6±22.5)d],差异有统计学意义(t=2.657,P=0.008).激素组病灶大小为(6.3±2.4)mm,明显大于对照组[(4.8±2.1)mm],差异有统计学意义(t=3.683,P＜0.001).激素组角膜刮片阳性率为97.2%,对照组阳性率为90.6%,差异无统计学意义(χ2=1.633,P=0.201).激素组有1例(2.8%)为药物治愈,明显低于对照组[34例(19.4%)],差异有统计学意义(χ2=5.983,P=0.014);激素组中行穿透性角膜移植术的患者22例(61.1%),明显高于对照组[55例(31.4%)],差异有统计学意义(χ2=11.351,P=0.001).激素组中(BCVA)低于0.3的患者32例(88.9%),明显高于对照组[110例(62.8%)],差异有统计学意义(χ2=9.194,P=0.002).结论:真菌性角膜炎使用糖皮质激素后病损范围增大,抗真菌药物治愈率低,穿透性角膜移植手术率高,预后不佳.
【总页数】7页(426-432)
【关键词】糖皮质激素;真菌性角膜炎;预后 【作者】王敬亭;边江;王欣;史伟云;李素霞
【作者单位】山东省眼科研究所,青岛 266071;山东省眼科医院,济南 250021;山东省眼科研究所,青岛 266071;山东省眼科医院,济南 250021;山东省眼科研究所,青岛 266071;山东省眼科医院,济南 250021;山东省眼科研究所,青岛 266071;山东省眼科医院,济南 250021;山东省眼科研究所,青岛 266071;山东省眼科医院,济南 250021 【正文语种】中文
糖皮质激素对真菌性角膜炎预后的影响
