沙眼患者临床与实验室诊断研究

Study on the clinic and laboratory diagnosis of patients with trachoma

目的探讨沙眼临床特征,选择适用于临床病因学诊断的实验室检查方法。设计回顾性病例系列。研究对象2003年1月至2006年8月间在北京同仁医院眼科中心临床诊断为沙眼的患者61例。方法沙眼诊断标准参照国内1979年制定的沙眼分期标准,对患者的一般情况、临床表现和实验室检查结果进行了回顾性分析。实验室检查包括结膜刮片查找包涵体、沙眼衣原体抗原检查和PCR检查。主要指标角结膜临床体征,结膜刮片、沙眼衣原体抗原及PCR检查结果。结果临床诊断沙眼患者61例中,男性28例,女性33例,平均年龄(29.05±19.99)岁;Ⅰ、Ⅱ和Ⅲ期患者分别占88.5%、8.2%和3.3%。刮片检查包涵体阳性检出率11.5%;沙眼衣原体抗原检查阳性检出率为68.9%;PCR检查阳性检出率为78.7%,抗原及PCR检查的检出率高于刮片检出率(P=0.00)。结论门诊沙眼患者主要为Ⅰ期表现,病变较轻,临床需选择敏感的抗原或PCR检查辅助沙眼病因学诊断。

Objective To investigate the clinical manifestation of trachoma, and to select the appropriate laboratory test for clinical diagnosis. Design Retrospective case series. Participants Retrospective analysis of medical records from 61 patients with trachoma from Jan 2003 to Aug 2006 in Bejing Tongren Eye Center. Methods Grades of trachoma diagnosis were according to the criteria designed by Chinese Ophthalmological Society （1979）. The general state of health, case history, and the laboratory investigations of patients were recorded. Laboratory tests included the conjunctiva scraping for inclusions, C. trachomatis immune antigen test and PCR test. Main Outcome Measures Manifestation of corneal and conjunctiva, the results of laboratory tests of C. trachomatis. Results Out of sixty-one patients including 28 males and 33 females, the average old was （29.05±19.99） years. 88.5% cases were in Ⅰ stage of trachoma, 8.2% were in Ⅱ stage, and 3.3% were in Ⅲ stage. The C. trachomatis inclusions were found in 7 （11.5%） scraping smears. 42 （68.9%） cases were positive in C. trachomatis antigen test. 46 （75.4%） cases were positive in PCR tests. The positive rates of antigen and PCR test were significantly higher than that of scraping （P=0.00）. Conclusions A majority of clinical patients were in Ⅰ stage of trachoma. The degree of their distress was minimal. It is necessary to apply C. trachomatis, antigen test or PCR test to improve the clinical diagnosis.