Vogt-小柳原田综合征患者血-房水屏障功能的动态观察

Dynamic observation of function of blood-aqueous barrier in Vogt-Koyanagi-Harada syndrome

目的检测Vogt-小柳原田(VKH)综合征患者不同病期血-房水屏障功能变化,为临床治疗提供依据。方法VKH综合征患者77例(144只眼)根据临床特点将其分为后葡萄膜炎期组10例(20只眼)、前葡萄膜受累期组27例(50只眼)、前葡萄膜炎反复发作期组23例(41只眼)和消退期组17例(33只眼)。对照组50例(100只眼)。应用激光前房蛋白细胞测定仪(LFCM)和裂隙灯显微镜检测各期患者前房闪辉和前房细胞数。结果后葡萄膜炎期患者裂隙灯检查前房细胞和前房闪辉均为0级(20只眼),LFCM检测前房细胞数为(0.9±0.6)/0.5mm3,与正常对照组(0.8±0.6)/0.5mm3的差异无统计学意义(P=0.899),前房闪辉值为(9.7±3.4)pc/ms,高于对照组(5.3±2.3)pc/ms,具有统计学意义(P<0.001)。前葡萄膜受累期患者裂隙灯前房细胞为25只眼(1+)、19只眼(2+)和6只眼(3+),前房闪辉为27只眼(1+)和23只眼(2+),LFCM前房细胞数分别为(13.7±6.5)/0.5mm3、(40.8±17.6)/0.5mm3、(75.7±25.5)/0.5mm3、前房闪辉值分别为(31.4±12.8)pc/ms、(133.4±59.5)pc/ms。前葡萄膜炎反复发作期患者裂隙灯前房细胞为19只眼(1+)、15只眼(2+)、7只眼(3+),前房闪辉为24只眼(1+)、17只眼(2+),LFCM前房细胞数分别为(11.2±5.4)/0.5mm3,(29.6±14.4)/0.5mm3、(69.3±22.2)/0.5mm3,前房闪辉值分别为(34.9±14.3)pc/ms、(150.9±83.3)pc/ms,前葡萄膜受累期和前葡萄膜炎反复发作期患者前房闪辉值和前房细胞数均高于对照组,具有统计学意义(P<0.001)。消退期患者裂隙灯前房细胞为0级(33只眼),前房闪辉为0(15只眼)和18只眼(1+),LFCM前房细胞数为(1.0±0.7)/0.5mm3,与对照组的差异无统计学意义(P=0.310),前房闪辉值分别为(9.5±4.8)pc/ms、(30.0±12.3)pc/ms,均高于对照组,具有统计学意义(P<0.001)。结论VKH综合征各期均有不同程度血-房水屏障的破坏,但并非各期均有炎症细胞存在,此结果对VKH综合征临床治疗有重要指导意义。

Objective To detect the changes of function of blood-aqueous barrier in different Syndrome stages of patients with Vogt-Koyanagi-Harada （VKH） syndrome in order to provide the appropriate therapy. Methods According to clinical manifestation, 77 patients （144 eyes） with VKH syndrome were divided into 4 groups： 10 cases in posterior uvietis stage group （20 eyes）, 27 in anterior uveal involvement stage group （50 eyes）, 23 in recurrent anterior uvitis stage group （41 eyes）, and 17 in convalescent stage group （33 eyes）. The other 50 cases （100 eyes） were in the control group. Flare and cells of anterior chamber in patient with VKH Syndrome at different stages were graded and measured by laser flare and cell meter （LFCM） and slitlamp microscope. Results According to the results of slitlamp biomicroscopy, anterior chamber flare and cells were at the 0 grade in the patients at posterior uvietis stage （20 eyes）. The results of LFCM examination revealed that the flare value and cells were （9.7±3.4） pc/ms and （0.94±0.6）/0.5 mm^3 in posterior uvietis stage group, and （5.3±2.3） pc/ms and （0.8± 0.6）/0.5 mm^3 in the control group. The differences between the two groups were significant （P〈0.001） andinsignifieant （P=0.899）, respectively. In anterior uvealinvolvement stage group, the cells in anterior chamber was at grade 1＋ in 25 eyes, 2＋ in 19, and 3＋ in 6, respectively, while the flare was at grade 1＋ in 27 eyes and 2＋ in 23; the number of cells in anterior chamber was （13.7±6.5）/0.5 mm^3,（40. 8± 17. 6）/0.5 mm^3. and （75.7±25. 5）/ 0.5 mm^3 respectively, and the value of flare was （31. 4±12.8） pc/ms and （133.4±59.5） pc/ms. In recurrent anterior uvitis stage group, the cells in anterior chamber was at grade 1＋ in 19 eyes, 2＋ in 15, and 3＋ in 7, respectively, while the flare was at grade 1＋ in 24 eyes and 2＋ in 17; the number of cells in anterior chamber was （11. 2± 5. 4）/0.5 mm^3, （29. 6± 14.4 ）/0.5 mm^3, and （69.3±22.2）/0.5 mm^3, respectively, and the value of flare was （34. 94±14.3） pc/ms and （150. 9±83. 3） pc/ms. The flare and cells in anterior chamber both in anterior uveal involvement stage and recurrent anterior uvitis stage group were higher than that in the control group （P〈0.001）, In convalescent stage group, the cells was at grade 0 in 33 eyes and the flare was at grade 0 in 15 eyes and 1＋ in 18; while the number of cells was （1.0±0.7）/0.5 mm^3 which was insignificantly differed from that in the control group （1）=0.310）, and the value of flare was （9. 5±4.8） pc/ms and （30. 0±12.3） pc/ms which were both higher than that in the control group （P〈0. 001）. Conclusions The breakdown of blood aqueous barrier with different degrees occurs at each stage in VKH syndrome, whereas inflammatory cells appearing in anterior chamber are only noted at some certain stages. This is very significant to offer directional and effective treatment to the patients with VKH syndrome.