摘要
目的:应用眼内液检测技术明确葡萄膜炎的病因。方法:收集2019年5月至2022年5月就诊于新疆维吾尔自治区人民医院眼科诊断为葡萄膜炎患者35例(35只眼)的病例资料。其中，男性15例(15只眼)，女性20例(20只眼)；年龄9~77岁，平均年龄(45.6±16.2)岁。病原体检出阳性者归属感染性葡萄膜炎组；反之，归属非感染性葡萄膜炎组。采集所有患者的眼内液，检测其病原体核酸、病原体抗体及细胞因子浓度。检测的病原体项目包括巨细胞病毒、单纯疱疹病毒－1、带状疱疹病毒及EB病毒；细胞因子包括白细胞介素(IL)－6、IL－8、IL－10、血管内皮生长因子、血管细胞黏附分子及碱性成纤维细胞生长因子。年龄和细胞因子的数据符合正态分布，以±s表示；眼内液病原体核酸和抗体阳性数采用频数和百分比描述。结果:35例(35只眼)患者病原体检出阳性者16例(16只眼)，占45.71%。其中，病毒检测阳性者11例(11只眼)，占68.75%(11/16)；弓形虫、梅毒及结核杆菌阳性者分别为3例(3只眼)、1例(1只眼)及1例(1只眼)，分别占18.75%(3/16)、6.25%(1/16)及6.25%(1/16)。感染性葡萄膜炎组患者血管内皮生长因子、碱性成纤维细胞生长因子、IL－6、IL－8、1L－10及血管细胞黏附分子的含量分别为(253.48±873.32)pg/ml、(4.98±4.43)pg/ml、(1025.83±2788.75)pg/ml、(0.98±1.61)pg/ml、(3603.84±4423.55)pg/ml及(96.34±168.14)pg/ml；而非感染性葡萄膜炎组患者细胞因子的含量分别为(112.05±213.78)pg/ml、(3.41±3.17)pg/ml、(4136.17±9985.88)pg/ml、(30.02±84.08)pg/ml、(4935.31±6105.64)pg/ml及(1247.63±2777.05 ) pg/ml，后者均高于前者。经眼内液检测，患者最终诊断为特发性葡萄膜炎、感染性葡萄膜炎及自身免疫性疾病相关葡萄膜炎者分别有11例(11只眼)、16例(16只眼)及8例(8只眼)，分别占31.43%、45.71%及22.86%。所有患者中全葡萄膜炎、前葡萄膜炎及后葡萄膜炎者分别为14例(14只眼)、13例(13只眼)及8例(8只眼)，分别占40.00%、37.14%及22.86%，未见中间葡萄膜炎。其中，前葡萄膜炎平均年龄最大、单眼及非感染性较多，全葡萄膜炎多为双眼患者。感染性与非感染性葡萄膜炎者男女占比分别为45.45%和11.11%；感染性与非感染性葡萄膜炎者血液巨细胞病毒抗体阳性率分别为56.25%和73.68%，单纯疱疹病毒－1抗体阳性率分别为93.75%和94.74%。结论:眼内液检测对感染性葡萄膜炎病原学诊断有一定价值，也可对非感染性葡萄膜炎的病因学诊断提供参考。
Abstract
Objective:The aim of this study is to clarify the etiology of uveitis using intraocular fluid testing techniques.Methods:35 cases (35 eyes) with uveitis who underwent intraocular fluid testing in Xinjiang Uygur Autonomous Region People′s Hospital from May 2019 to May 2022 were collected. Among them, there were 15 males (15 eyes) and 20 females (20 eyes) with the average age of (45.6±16.2) years, ranging from 9 to 77 years. Patients with positive pathogens defined as infectious uveitis; conversely, those with negative pathogens were defined as non-infectious uveitis. The intraocular fluid was collected from all patients to detect the pathogen nucleic acid, antibody and cytokine concentrations. Pathogens included the cytomegalovirus, herpes simplex virus, herpes zoster virus, Epstein-Barr virus; cytokines included interleukin (IL)-6, IL-8, IL-10, vascular endothelial growth factor, vascular cell adhesion molecule, and basic fibroblast growth factor. Age and cytokine concentration conforming to the normal distribution were expressed in ±s. The positive cases of the pathogen load and pathogen antibody were expressed as cases and percentages.Results:There were 16 cases (16 eyes) with positive pathogens in 35 patients, accounting for 45.71%. Of these, 11 (11 eyes) were positive for viruses, accounting for 68.75% (11/16); there were 3 cases (3 eyes) for Toxoplasma gondii, 1 case (1 eye) for syphilis and 1 case (1 eye) for Mycobacterium tuberculosis, accounting for 18.75% (3/16), 6.25% (1/16) and 6.25% (1/16). The mean expression of vascular endothelial growth factor, basic fibroblast growth factor, IL-6, IL-8, 1L-10, vascular cell adhesion molecule in the intraocular fluid of patients with infectious uveitis was (253.48±873.32) pg/ml, (4.98±4.43) pg/ml, (1025.83±2788.75) pg/ml, (0.98±1.61) pg/ml, (3603.84±4423.55) pg/ml, (96.34±168.14) pg/ml, respectively; the average expression of cytokines in the intraocular fluid of patients with non-infectious uveitis was (112.05±213.78) pg/ml, (3.41±3.17) pg/ml, (4136.17±9985.88) pg/ml, (30.02±84.08) pg/ml, (4935.31±6105.64) pg/ml, and (1247.63±2777.05 ) pg/ml, and the latter was all higher than the former. After the intraocular fluid detection, the final diagnosis was idiopathic uveitis in 11 cases (11 eyes), infectious uveitis in 16 cases (16 eyes) and autoimmune disease related uveitis in 8 cases (8 eyes), accounting for 31.43%, 45.71%, and 22.86%, respectively. There were 14 cases (14 eyes) with total uveitis, 13 cases (13 eyes) with anterior uveitis, 8 cases (8 eyes) with posterior uveitis, accouting for 40.00%, 37.14% and 22.86%. The patients with intermediate uveitis were not observed. The anterior uveitis was the oldest on average age, monocular and non-infectious, as well as total uveitis in both eyes. The percentages of male and female with infectious and non-infectious uveitis were 45.45% and 11.11%, respectively; for infectious and non-infectious uveitis, the positive rates of blood cytomegalovirus antibodies were 56.25% and 73.68%, respectively, and the positive rates of herpes simplex virus-1 antibodies were 93.75% and 94.74%, respectively.Conclusions:Intraocular fluid detection has a certain value in the etiological diagnosis of infectious uveitis, and also provides a reference for the etiological diagnosis of non-infectious uveitis.
基金项目
首都卫生发展科研专项项目(首发2022-2-2035)
万方数据