HLA-B27相关的前葡萄膜炎眼后节并发症的临床特点

Clinical features of posterior segment complications in patients with HLA-B27-associated anterior uveitis

目的探讨HLA—B27阳性的前葡萄膜炎眼后节并发症的临床特点及治疗。方法2002年1月至2005年10月就诊的前葡萄膜炎患者采用流式细胞术进行外周HLA-B27的检测，筛选出71-例82眼HLA-B27阳性前葡萄膜炎患者，分为两组：实验组为眼后节受累的患者24例31眼，对照组为眼后节未受累的患者47例51眼。另有HLA—B27阴性前葡萄膜炎患者74例116眼作参考。所有患者均进行裂隙灯、眼底镜等常规眼科查体，部分行眼底荧光血管造影。分析了HLA—B27相关的前葡萄膜炎眼后节并发症的临床特点。采用x^2检验及t检验进行统计学分析。结果71例82眼HLA—B27阳性前葡萄膜炎中有24例31眼占37．8％出现眼后节并发症者，包括：黄斑囊样水肿12例15眼占48．4％，视乳头水肿7例8眼占25．8％，而玻璃体炎最多见为21例27眼占87．1％，8例10眼占32．3％患者存在两种或两种以上的眼后节表现。74例116眼HLA—B27阴性者有8例12眼占10．3％有眼后节表现。实验组中发生前房成型纤维素渗出31眼中18眼占58．06％和积脓31眼中9眼占29．03％明显高于对照组（前房纤维素渗出51眼中3眼，5．88％，X^2=27．56，P〈0．01；前房积脓51眼中1眼，1．96％，X^2=13．20，P〈0．01）；实验组中伴发相关全身性疾病24例中有16例占66．67％的几率高于对照组（47例中有17例，31．66％，X^2=5．94，P〈0．05）。出现眼后节并发症的患者经全身及局部应用糖皮质激素治疗，31眼中有11眼最佳矫正视力≥1．0。结论HLA-B27阳性前葡萄膜炎易出现眼后节并发症，HLA—B27相关的前葡萄膜炎眼后节受累的患者发生相关全身性疾病和前房纤维素渗出与积脓的几率较高。

Objective To explore the clinical features and treatment of posterior segment complications in patients with HLA-B27-associated anterior uveitis（AU）. Methods A hopital-based study of patients with anterior uveitis was performed. All patients were assayed HLA-B27 haplotypw by flow cytometry. There were 71 patients（82 eyes） with HLA-B27 positive who were divided into two group： the test group：HLA-B27-positive AU with posterior segment complications （24 patients, 31 eyes）, the control group：HLA-B27-positive AU without posterior segment complications （47 patients, 51 eyes）. All patients were undergone a complete ophthalmologic examination （fundus fluorescein angiography were performed in the part of patients）, X^ 2 test and t test were used as statistics to analyse the results. In addition there were 74 patients （116 eyes） with HLA-B27-negative. Results Posterior segment manifestations were found in 24 cases （31 eyes, 37.8%） of 71 cases （82 eyes） with HLA-B27- positive anterior uveitis and they included cystoid macular edema（15 eyes,48.4%）, optic edema （8 eyes,25.8%） and vitritis （27 eyes,87.1%） which was the most commonest one.Eight patients（10 eyes,32.3%） had more than one finding. Only 8 cases （12 eyes,10.3%） with posterior segment manifestations were found in 74 patients（116 eyes） with HLA-B27-negative AU. The fibrin exudate （18 of 31 eyes,58.06%） and hypopyon （9 of 31 eyes,29.03%） in patients in test group was significantly higher than that in the control group of patients （fibrin exudate, 3 of 51 eyes, 5.88%, p〈0.01; hypopyon, 1 of 51 eyes, 1.96%, p〈0.01）. The frequency of correlative systemic diseases in test group （16 of 24 patients, 66.67%） was higher than one in control group（17 of 47 patients,31.66%, X^ 2=5.94, P 〈0.05）. correlative systemic diseases wasn＇t found in patients of HLAB27-negative AU with posterior segment complications. Afer treatment with systemic or local corticosteroids being used in all patients in test group, vision of 11 of 31 eyes equal to or better than 1.0. Conclusion Posterior segment manifestations are associated with HLA-B27-positive AU. Patients with posterior segment ocular complications in HLA-B27＋ anterior uveitis have a higher incidence of associated systemic diseases and fibrin exudate ~ hypopyon in anterior chamber.