目的：探究真菌性角膜炎致病菌菌属分布情况，分析影响其临床转归的主要因素。

方法：前瞻性研究。选取2018-03/2021-03于我院就诊的真菌性角膜炎患者102例，均先予联合抗真菌药物治疗，药物治疗无效则行手术治疗。治疗前通过真菌培养分析致病菌菌属分布情况及不同致病菌患者手术率，并根据临床转归情况将纳入患者分为临床转归良好组(76例)和临床转归不良组(26例)，探究真菌性角膜炎临床转归的影响因素。

结果：纳入患者102例中真菌检查结果呈阳性74例(72.5%)，药物治疗无效转手术治疗的患者13例(12.7%)，不同致病菌属感染患者手术率比较有显著差异(P<0.05)，镰刀菌属致病患者手术率显著高于其他菌属。与临床转归不良组比较，临床转归良好组患者病程更短，溃疡面积、浸润深度、前房积脓更小，居住地多为城镇，致病菌多为除镰刀菌以外者(P<0.05)。Logistic回归分析显示，病程、溃疡面积、浸润深度、前房积脓、致病菌属、居住地是影响临床转归的危险因素(均P<0.05)。

结论：真菌性角膜炎主要致病菌有镰刀菌、曲霉菌等，镰刀菌属致病后药物治疗效果更差，病程、溃疡面积、浸润深度、前房积脓、致病菌属、居住地情况均可影响该病临床转归。

METHODS: A prospective study was conducted. A total of 102 patients with fungal keratitis treated in our hospital from March 2018 to March 2021 were included in the study. They were treated with combined antifungal drugs therapy first, and surgery was performed if the drug treatment was ineffective. The distribution of the pathogenic bacteria genera and the surgical rate of patients with different pathogenic bacteria were analyzed through fungus culture before treatment, and patients were divided into cured(76 cases)and not cured(26 cases)groups according to their clinical outcome. The main factors affecting the clinical outcome of fungal keratitis were explored.

RESULTS: Among the 102 patients included, 74 patients(72.5%)had positive fungal test results, and 13 patients(12.7%)were treated by surgery due to the ineffective drug therapy. There were significant differences in the surgical conversion rate of patients affected by different pathogenic bacteria genera(P<0.05). The conversion rate of patients with Fusarium was significantly higher than that of other pathogenic bacteria. Compared with not cured group, cured group had shorter course of disease, less ulcer area, infiltration depth and hypopyon. Most of them lived in cities and towns, and most of the pathogenic bacteria were fungi other than Fusarium(P<0.05). Logistic regression analysis showed that the course of disease, ulcer area, infiltration depth, hypopyon, pathogenic bacteria and residence were the risk factors affecting clinical outcome(P<0.05).

CONCLUSION: The main pathogenic bacteria of fungal keratitis are Fusarium, Aspergillus, etc. The drug treatment effect of Fusarium is worse. The course of disease, ulcer area, infiltration depth, hypopyon, pathogenic bacteria and residence can affect the clinical outcome of fungal keratitis.