CAJ | 학술논문

目的研究丝状真菌性角膜炎致病菌株的基因分型及临床意义.方法收集北京同仁医院眼科中心2006年1-12月经病原学检查诊断为丝状真菌性角膜炎的患者52例,对分离的致病菌株进行rDNA ITS基因分型和形态学鉴定与分析,并对患者进行治疗和随访,分析基因分型与临床多因素的关系.结果基因分型与形态学鉴定种的一致率达90.3％.根据rDNA ITS基因的亲缘关系,将52株丝状真菌分为4组:第1组22株(20株茄病镰刀菌和2株尖孢镰刀菌);第2组12株(8株串珠镰刀菌、3株层生镰刀菌和1株雪腐镰刀菌);第3组5株(4株少见眼部真菌和1株串珠镰刀菌);第4组13株(10株曲霉菌属和3株链隔孢属).第1组、第2组与第3组、第4组相比,患者发病时间、诱发因素、溃疡严重程度、抗真菌治疗的疗效比较,差异均有统计学意义(P=0.000,P=0.03,P=0.01,P=0.035).结论 rDNA ITS基因分型能够准确地鉴定角膜丝状真菌,对于少见或鉴定困难的菌株具有明显的优势.由于菌株的基因型不同,丝状真菌性角膜炎的临床特点具有一定的差异.
목적 연구사상진균성각막염치병균주적기인분형급림상의의.방법 수집북경동인의원안과중심2006년1-12월경병원학검사진단위사상진균성각막염적환자52례,대분리적치병균주진행rDNA ITS기인분형화형태학감정여분석,병대환자진행치료화수방,분석기인분형여림상다인소적관계.결과 기인분형여형태학감정충적일치솔체90.3％.근거rDNA ITS기인적친연관계,장52주사상진균분위4조:제1조22주(20주가병렴도균화2주첨포렴도균);제2조12주(8주천주렴도균、3주층생렴도균화1주설부렴도균);제3조5주(4주소견안부진균화1주천주렴도균);제4조13주(10주곡매균속화3주련격포속).제1조、제2조여제3조、제4조상비,환자발병시간、유발인소、궤양엄중정도、항진균치료적료효비교,차이균유통계학의의(P=0.000,P=0.03,P=0.01,P=0.035).결론 rDNA ITS기인분형능구준학지감정각막사상진균,대우소견혹감정곤난적균주구유명현적우세.유우균주적기인형불동,사상진균성각막염적림상특점구유일정적차이.
Background The study on the classification of fungi is very important for the diagnosis and treatment of fungal keratitis.Identifying the different species of filamentous fungi is a critical factor for the application of anti-fungal drug in treating keratitis.ObjectiveThis report studies the relationship between the genotype of filamentous fungi and the clinical factors.MethodsFifty-two patients with filamentous fungal keratitis determined by clinical and laboratory examination were recruited in Tongren Hospital from January 2006-December 2006.The lesions were graded on the severity of the corneal ulcer and the presence of hypopyon.The filamentous fungal keratitis was treated with topical and systemic administration of anti-fungal drugs or corneal transplantation.The isolates were cultured in potato culture and identified by morphological characteristics based on the Nelson criterion and genotyped by the rDNA ITS method.The clinical data was retrospectively analyzed.ResultsForty-eight species (eubacteria are bacteria,not fungi)of fungus were identified by morphological characteristics,and the filamentous fungi were divided into 4 types based on the phylogenetic relationships within the rDNA ITS of the 52 filamentous fungi.The morphological characteristics and genotype were confirmed in 48 strains of eubacteria and 31 strains of 52 filamentous fungi (90.3%).The 4 groups of fungi were classified by genotype as follows:group 1 represents 22 strains including 20 strains of Fusarium solani and 2 strains of Fusarium oxysporum;group 2 represents 12 strains including 8 strains of Fusarium moniliformis,3 strains of Fusarium proliferatum and 1 strain of Fusarium incarnatum;group 3 represents 5 strains including 1 strain of Fusarium moniliformis and 4 unknown strains;group 4 represents 13 strains including 10 strains of Aspergillus spp.and 3 strains of Alternaria spp.Significant differences were found in the disease duration (P=0.00),inducing cause (P=0.03),ulcer grade (P=0.01)and outcome of the anti-fungal treatment (P=0.035)when compared between group 1 and 2 with group 3 and 4.Conclusion Filamentous fungi that cause keratitis could be correctly identified by sequencing the internal tanscribed spacer of rDNA.There are significant clinical differences among the groups classified by genotype.