CAJ | 학술논문

目的探讨角膜异物外伤后非结核分枝杆菌性角膜炎的临床特点、诊断及治疗.方法回顾性系列病例研究.分析2007年3月至2008年1月期间南通大学附属医院诊治的12例(12只眼)非结核分枝杆萧性角膜炎患者的临床和实验室资料,包括病史、临床表现、实验室检查、诊断和治疗经过以及预后情况.主要的实验诊断方法包括角膜病灶刮取物的微生物培养、抗酸染色、聚合酶链式反应、病变角膜的组织病理及电镜检查.治疗方法包括局部和全身应用抗生素、5%碘酊病灶烧灼清创以及角膜移植.患者的平均年龄、病程采用算术平均数法计算.结果本组11例为同一基层医院角膜金属异物摘除术后群发感染,另1例发生于芦苇刺伤角膜后.较特征性的体征包括角膜基质灰蓝色或灰白色结晶样、多灶性浸润,可伴有溃疡形成、后弹力层放射状改变等.12例微生物培养均为快速生长型非结核分枝杆菌(5例鉴定为龟分枝杆菌脓肿亚型),8例聚合酶链式反应检查7例细菌阳性,3例电镜检查均见吞噬了细长杆状或短粗型的分枝杆菌的门细胞和坏死组织.10例经局部和全身应用多种抗生素(阿米卡星、利福平、氧氟沙星、加替沙星、环丙沙星、阿奇霉素等)以及5%碘酊病灶烧灼清创2～5个月治愈,2例药物治疗6个月无明显疗效经板层或穿透性角膜移植治愈.结论非结核分枝杆菌性角膜炎是一种少见的机会性感染,可在角膜异物摘除术后群发流行,诊断困难,易被误诊为真菌性角膜炎,可经细菌培养、抗酸染色明确诊断.该病病程长,药物治疗反应慢,大多数患者可经抗生素控制,顽固性病例需角膜移植治愈.
목적 탐토각막이물외상후비결핵분지간균성각막염적림상특점、진단급치료.방법 회고성계렬병례연구.분석2007년3월지2008년1월기간남통대학부속의원진치적12례(12지안)비결핵분지간소성각막염환자적림상화실험실자료,포괄병사、림상표현、실험실검사、진단화치료경과이급예후정황.주요적실험진단방법포괄각막병조괄취물적미생물배양、항산염색、취합매련식반응、병변각막적조직병리급전경검사.치료방법포괄국부화전신응용항생소、5%전정병조소작청창이급각막이식.환자적평균년령、병정채용산술평균수법계산.결과 본조11례위동일기층의원각막금속이물적제술후군발감염,령1례발생우호위자상각막후.교특정성적체정포괄각막기질회람색혹회백색결정양、다조성침윤,가반유궤양형성、후탄력층방사상개변등.12례미생물배양균위쾌속생장형비결핵분지간균(5례감정위구분지간균농종아형),8례취합매련식반응검사7례세균양성,3례전경검사균견탄서료세장간상혹단조형적분지간균적문세포화배사조직.10례경국부화전신응용다충항생소(아미잡성、리복평、양불사성、가체사성、배병사성、아기매소등)이급5%전정병조소작청창2～5개월치유,2례약물치료6개월무명현료효경판층혹천투성각막이식치유.결론 비결핵분지간균성각막염시일충소견적궤회성감염,가재각막이물적제술후군발류행,진단곤난,역피오진위진균성각막염,가경세균배양、항산염색명학진단.해병병정장,약물치료반응만,대다수환자가경항생소공제,완고성병례수각막이식치유.
Objective To study the clinical features, diagnosis and treatment of non-tuberculous mycobacterial keratitis (NTMK). Methods It was retrospective case series study. Twelve eyes in 12 patients with NTMK following corneal foreign body trauma in 2007 were studied retrospectively including the case histories, clinical findings, laboratory examinations, diagnosis, treatment and prognosis. The main laboratory examination included corneal scrapings by culturing, polymerase chain reaction (PCR) and transmission electron microscopy (TEM), corneal lesions by histopathologic examinations and TEM. The patients received local and systemic antibiotics therapy, lesion cleaning followed by cauterization with tincture of iodine (5%) and (or) keratoplasty. Results All cases had a history of corneal trauma, there was corneal metallic foreign body removal at one hospital in 11 cases, corneal reed trauma in 1 case. The characteristic signs involved grayish-blue crystalloid keratopathy, multifocal infiltrates, satellites,radiatiform changes in the Descement's membrane. The results of laboratory examinations of the scrapings of the cornea infection were as follows: all cultures (12/12) were positive for rapidly growing mycobacteria, and isolates from 5 patients were all diagnosed as mycobacterium chelonae subspecies abscess; acid-fast staining revealed positive bacilli in all the 4 patients ; seven of 8 patients were positive for bacterium by PCR. Transmission electron microscopy in all the 3 specimens showed many slender red-shaped or short coarse-shaped bacteria which were phagocytized by monocytes, and some necrotic tissue. Infections in 10 eyes were resolved by combined treatment regimen including a combination of antimicrobial agents (amikacin, rifampin, gatifloxation, ciprofloxacin, azithromycin and/or ofloxacin, etc. ) and local lesion cleaning followed by cauterization with 5% tincture of iodine within 2-5 months; two cases resolved by keratoplasty which poorly responded to antibiotic therapy for 6 months. Conclusions NTMK is a rare, recalcitrant opportunistic infection which can occur in an epidemic fashion following corneal foreign body trauma. The diagnosis of NTMK is difficult, and may easily be misdiagnosed as fungal keratitis. Acid-fast staining, TEM, especially bacterial culture can help to obtain definitive diagnosis. NTMK has a long response period to medical management. The majority of patients can be cured by local and systemic antibiotics therapy, and the recalcitrant infections could be resolved by keratoplasty.