摘要目的 分析总结肺炎克雷伯杆菌肺炎并发内源性眼内炎的临床特点及诊治要点.方法 回顾分析北京朝阳医院收治的肺炎克雷伯杆菌肺炎并发内源性眼内炎病例3例,并结合相关文献进行复习.以“肺炎”“内源性眼内炎”和“肺炎克雷伯杆菌”为关键词检索中国知网数据库和万方数据库;以“pneumonia”“endogenous endophthalmitis”和“Klebsiella pneumoniae”为关键词检索PubMed数据库和Web of Science数据库,检索时间为2008年1月至2018年6月.结果 3例肺炎克雷伯杆菌肺炎并发内源性眼内炎患者均为男性,年龄分别为54、82及48岁,均为单眼发病,既往均有2型糖尿病病史.临床表现除全身症状以及呼吸系统症状外,均存在患眼疼痛、视力进行性下降、眼眶周围软组织炎、结膜炎、瞳孔对光反射减弱或消失、角膜水肿及前房内渗出.3例胸部影像学表现为肺内多发团片影,眼部超声可见患眼玻璃体内高回声信号填充、视网膜脱离,血培养证实为肺炎克雷伯杆菌;2例合并肺脓肿和肝脓肿,其中1例合并脑脓肿.共检索到有关肺炎克雷伯杆菌肺炎并发内源性眼内炎的文献28篇,共81例,加上本研究3例共84例,年龄为0～86岁,男53例,女31例.双眼发病16例,单眼发病68例.结论 肺炎克雷伯杆菌肺炎并发内源性眼内炎好发于中老年男性,糖尿病是最常见的易感因素,多单眼受累,呼吸系统症状和眼科症状同时或先后出现.表现为眼痛与视力下降,眼科检查、胸部影像学检查及血液和房水病原学检查对本病的诊断具有重要价值;患眼视力预后不良,早期进行局部抗感染治疗和玻璃体切割术有助于挽救患眼视力.

abstractsObjective To study the clinical features and the diagnosis and treatment of endogenous Klebsiella pneumoniae endophthalmitis associated with Klebsiella pneumoniae pneumonia.Methods Three cases of endogenous Klebsiella pneumoniae endophthalmitis associated with Klebsiella pneumoniae with microbiological evidence were studied.The related literatures published from January 2008 to June 2018 were reviewed with "pneumonia","endogenous endophthalmitis"and "Klebsiella pneumoniae"as the keywords in CNKI,Wanfang,PubMed and Web of Science databases.Results The 3 patients,all males,aged 54 years,82 years and 48 years respectively.They all had a history of type 2 diabetes mellitus.Endophthalmitis occurred in one eye in all of them,and the patients had eye symptoms including eye pain,progressive loss of vision,periorbital area inflammation,conjunctivitis,weakening or disappearance of pupil light reflex,corneal edema and anterior chamber effusion.All of 3 cases had multiple patchy pulmonary lesions,and Klebsiella pneumoniae was proven to be the pathogen by blood culture.Two cases had pulmonary abscess and liver abscess,and one of them had brain abscess.A total of 28 literatures with 81 cases of endogenous Klebsiella pneumoniae endophthalmitis associated with Klebsiella pneumoniae pneumonia were retrieved from CNKI,WanFang,PubMed and Web of Science database.Conclusions Klebsiella pneumoniae was one of the most common pathogens of pneumonia and endogenous endophthalmitis,which would seriously damage the lung and the eye.The early clinical features were not specific.Misdiagnosis or missed diagnosis might cause serious consequences.Eye pain and visual disturbance symptoms,ophthalmic examination,chest imaging,blood and aqueous humor etiology were of great value in the diagnosis of this disease.