强直性脊椎炎伴发葡萄膜炎的临床特征和治疗

Clinical diagnosis and treatment of uveitis associated with ankylosing spondylitis

目的探讨强直性脊椎炎(AS)伴发葡萄膜炎的临床特征、诊断、治疗及预后。方法对1996年1月至2001年6月就诊的葡萄膜炎患者进行详细询问,对有腰骶部疼痛病史患者行骶髂关节X线影像学检查,并根据1984年修订的纽约AS诊断标准进行诊断,同时就其伴发的葡萄膜炎进行临床观察和分析。结果AS伴发葡萄膜炎患者44例,男性41例,女性3例。葡萄膜炎的发病年龄为(33±15)岁。葡萄膜炎病史>40d者34例,均有葡萄膜炎复发史;其中18例(52.9%)患者复发间隔时间≥1年,双眼受累者23例(67.6%),均为单眼交替发病。所有患眼均表现为急性非肉芽肿性前葡萄膜炎;葡萄膜炎持续时间为(27±12)d;其中41例(93.2%)患者有腰痛史,X线影像学检查显示均为骶髂关节炎;经糖皮质激素和睫状肌麻痹剂眼液治疗后,40只眼中33只眼(82.5%)最佳矫正视力≥1.0。结论AS伴发葡萄膜炎多发生于男性,呈急性、复发性、非肉芽肿性前葡萄膜炎表现,根据典型的临床特征和X线影像学改变可确诊;主要治疗方法为滴用睫状肌麻痹剂和糖皮质激素眼液,绝大多数患者预后良好。

Objective To investigate the clinical features, diagnosis, treatment and prognosis of uveitis associated with ankylosing spondylitis (AS). Methods A history about low back pain was carefully reviewed in patients with uveitis and X-ray examination was performed if necessary. Forty-four patients were diagnosed as AS from January 1996 to June 2001 in Zhongshan Ophthalmic Center according to the modified New York criteria for AS. Data concerning these patients, especially with respect to the clinical features, diagnosis and treatment, were retrospectively analyzed. Results Of 44 patients, 41 were male. The age of the patients at onset of uveitis was (33±15) years old. All of the 34 patients who had a uveitis history over 40 days showed a recurrent inflammation. In 18 patients (52.9%), the interval between the relapse of uveitis was more than one year. Bilateral ocular involvement was found in 23 out of 34 patients with recurrent uveitis. However, none of them showed a bilateral inflammation at the onset of uveitis. All patients showed acute anterior uveitis with a duration of (27±12) days. All patients had definitely radiological evidences of bilateral sacroiliitis, although not all of them had typical history of lower back pain. Treatment with corticosteroids eyedrops and cycloplegic agent was used in all patients. Vision equal to or better than 1.0 was achieved in 82.5% of these patients. Conclusions Uveitis associated with AS is characterized by acute nongranulamatous anterior uveitis with recurrent episodes in male. Diagnosis is made according to typical clinical features and radiological evidences of bilateral sacroiliitis. Treatment with corticosteroid eyedrops and cycloplegic is able to resolve the inflammation rapidly and leads to a good prognosis in most patients.