前葡萄膜炎的临床诊治分析

The diagnosis and treatment analysis of anterior uveitis

目的探讨前葡萄膜炎的临床特点、治疗效果、视力预后及诊治中存在的问题。方法回顾性系列病例研究。收集2001年1月至2007年6月期间在天津市眼科医院诊治的各类前葡萄膜炎患者478例，男性281例，女性197例；平均发病年龄（36±15）岁。通过详细临床检查、实验室检查和治疗观察，对其临床类型、疗效、并发症及视力预后进行分析。结果急性前葡萄膜炎242例（50．6％），复发性前葡萄膜炎197例（41．2％），慢性前葡萄膜炎39例（8．2％）。依据病因分为特发性前葡萄膜炎231例（48．3％），不伴有全身疾病的人类白细胞抗原．B27阳性葡萄膜炎76例（15．9％），病毒性葡萄膜炎52例（10．9％），合并强直性脊柱炎34例（7．1％），Fuehs综合征29例（6．1％），青光眼睫状体炎综合征24例（5．0％）及幼年性关节炎合并葡萄膜炎17例（3．6％）。各种并发症发生率为31．6％（151例），轻度视力损害（低于0．5）发生率为11．1％（53例），中度和重度视力损害（低于0．3）为7．5％（36例），致盲率（低于0．05）为2．5％（12例）。结论前葡萄膜炎临床类型多样，特发性前葡萄膜炎、人类白细胞抗原-B27相关性前葡萄膜炎及病毒性前葡萄膜炎是常见类型，完善特异性实验室检查项目有助于病因诊断和给予适当治疗。

Objective To explore the clinical characters, effects of treatment, the prognosis of visual acuity and the problems in the treatment of the anterior uveitis. Methods The retrospective case series study was used to observe the clinical characters and treatment effects of 478 cases of anterior uveitis from January 2001 to June 2007 in Tianjin Eye Hospital. Among the 478 cases of patients, the male was 281 cases and the female was 197 cases. The mean age was （36 ± 15） years old. Both the clinical examinations and immunologic investigations were performed. The clinical characters, effects of treatment, complications and prognosis of the anterior uveitis were analyzed. Results There were 242 cases （50. 6% ） with acute anterior uveitis, 197 cases （41.2%） with recurrent anterior uveitis and 39 cases （8.2%） with chronic anterior uveitis. There were 231 cases（48. 3% ） with idiopathic uveitis, 76 cases （15.9%） with human leukocyte antigen-B27 associated uveifis without systemic diseases, 52 cases （10. 9% ） with herpetic uveitis, 34 cases （7.1%） with ankylosing spondylitis, 29 cases （6. 1% ） with Fuchs syndrome, 24 eases （5. 0% ） with glaneomatocyclitic crisis and 17 cases （3.6%） with juvenile idiopathic arthritis-associated uveitis. The rate of complications was 31.6% （151 cases）, the rate of mild visual impairment （less than 0.5） was 11.1% （53 cases）, the moderate and severe visual impairment （less than 0.3） was 7.5% （ 36 cases）, and the rates of blindness （ less than 0. 05 ） was 2. 5% （ 12 cases）. Conclusions The types of anterior uveitis are varied. Idiopathic anterior uveitis, human leukocyte antigen-B27 associated uveitis and herpetic uveitis are the most common entities. The careful clinical and immunologic examinations could be benefit for the etiological diagnosis and prompt treatment.