糖尿病合并角膜炎患者围手术期的临床管理及防治策略

Clinical management and preventive strategy of infectious keratitis in diabetic patients during perioperative period

摘要:

目的 探讨糖尿病合并感染性角膜炎患者的临床特点及感染菌构成特点。方法 对2006 年6 月-2015 年6 月河北省眼科医院按照同一诊断标准收治的320 例糖尿病合并感染性角膜炎患者，以及320 例非糖尿病感染性角膜炎患者进行回顾性分析，采集两组患者术前临床资料，观察并分析感染性角膜炎特点，探讨防治措施。结果 角膜炎伴有糖尿病患者合并高血压、三酰甘油、总胆固醇、眼部用药史高于单纯角膜炎患者。角膜炎感染患者中，伴有糖尿病患者的真菌感染率为40.31%，高于对照组的20.00%（P <0.05）。本地角膜炎伴 有糖尿病患者真菌感染以镰刀霉属、菌丝体较多见，占真菌感染的59.69% ；细菌感染中，以肺炎链球菌、表皮葡萄球菌较多见，占细菌感染的47.54%。结论 糖尿病感染性角膜炎是致盲的常见原因，应早期进行病原学检查和积极做好感染性角膜炎的预防，一旦发生角膜炎，要根据感染菌特点采取不同治疗措施，有助于视功能的恢复。

Abstract:

Objective To investigate the clinical characteristics of diabetic patients with infectious keratitis. Methods A retrospective study was carried out on 320 diabetic patients with infectious keratitis in accordance with the same diagnostic criteria and 320 non-diabetic patients with infectious keratitis in our hospital from June 2006 to June 2015. The clinical data of the patients in the two groups before and after operation were compared and analyzed, and the characteristics of infectious keratitis were studied. Results The rates of hypertension, high triglyceride, high total cholesterol and eye medication history in the keratitis patients with diabetes mellitus were much higher than those in the keratitis patients without diabetes. The rate of fungal infection in the patients with diabetes mellitus was 40.31%, while that of the patients without diabetes was 20.00%, the difference was statistically significant (P < 0.05). Further analysis showed that in the patients with diabetes the main pathogenic fungi for keratitis were Fusarium and mycelium accounting for 59.69% of the fungal infection, the common infectious bacteria were Streptococcus pneumoniae and Staphylococcus epidermidis accounting for 47.54% of the bacterial infection. Conclusions Infectious keratitis is a common cause of blindness in diabetic patients. Etiological examination and active prevention should be done as early as possible. When infectious keratitis occurs, different measures should be taken according to the characteristics of different pathogens to restore visual function.