急性视网膜坏死综合征视力预后相关因素分析

Factors associated with visual prognosis of acute retinal necrosis syndrome

目的探讨影响急性视网膜坏死综合征（ARN）患者视力预后的相关因素。方法系列病例研究。回顾性分析1999年1月至2010年6月北京协和医院眼科收治的41例（53只眼）ARN患者的临床资料。男性23例（56．1％），女性18例（43．9％）；年龄18-73岁，平均（444-12）岁；单眼发病者29例（70．7％），双眼先后发病者12例（29．3％）。根据末次随诊矫正视力将患者分为≥0．1组（A组，28只眼）和〈0．1组（B组，25只眼）。结果采用X^2检验、Fisher精确检验、Mann-Whitney检验、双变量相关分析和多项logistic回归分析处理。结果所有患者均予全身抗病毒药物和糖皮质激素治疗，其中10只眼接受视网膜激光光凝治疗，26只眼接受玻璃体腔注射更昔洛韦治疗，31只眼接受玻璃体切除术治疗。29例单眼发病患者接受全身抗病毒治疗后对侧眼均未发病。A组初诊矫正视力≥0．1者（85．7％，24／28）明显多于B组（16．0％，4／25）（X^2=23．037，P=0．000）。A组患者接受全身抗病毒治疗距离患眼发病时间[（15±13）d]明显短于B组[（30±34）d]（Z=-2．414，P=0．016）。B组发生视网膜脱离（80．0％，20／25）、闭塞性视网膜中央血管病变（56．0％，14／25）、视神经萎缩（36．0％，9／25）和增生性玻璃体视网膜病变（92．0％，23／25）者明显多于A组（25．0％，7／28；10．7％，3／28；7．1％，2／28；39．3％，11／28）（X^2=13．862、10．440、5．048、13．749，P=0．000、0．001、0．025、0．000）。双变量相关分析结果表明，患眼视力预后与眼压升高、预防性视网膜激光光凝治疗、玻璃体腔注射更昔洛韦无明显相关性（P〉0．05）。logistics回归分析结果表明，患眼视力预后与初诊矫正视力（OR=27．225，P=0．003）、闭塞性视网膜中央血管病变（OR=0．065，P=0．053）等因素有关。结论ARN患眼的视力预后与初诊矫正视力和闭塞性视网膜中央血管病变相关。

Objective To investigate relevant factors affecting the prognosis of acute retinal necrosis syndrome （ARN）. Methods Case-series study. The clinical data of 41 patients （53 eyes） with ARN were retrospectively analyzed. Eyes were divided into two groups according to best corrected visual acuity at final visit. The groups were best corrected visual acuity better than 0. 1 （group A,28 eyes） and worse than 0. 1 （group B,25 eyes）. Data were analyzed using the Xz test, Fisher exact test, Mann-Whitney test, bivariate correlation statistics, and multinomial logistic regression analysis. Results All patients were treated with systemic antivirus drugs and glucocorticoid. Ten eyes were treated with prophylactic laser retinopexy ,26 eyes underwent intravitreal ganciclovir, and 31 eyes underwent vitreetomy. All contralateral eyes of unilateral ARN patients were not involved after systemic antivirus treatment. Compared to group B （16. 0% ,4/25 ）, more eyes with best corrected visual acuity better than 0. 1 at first visit were observed in group A （ 85.7% , 24/28 ） （ X^2 = 23. 037, P = 0. 000）. Duration from onset of symptoms until first administration of antivirus drugs was shorter in group A [ （ 15± 13 ） days ] than in group B [ （ 30±34 ） days, Z = - 2. 414, P = 0.016 ]. Compared to group A（25.0% ,7/28;10.7% ,3/28;7.1% ,2/28;39. 3% ,11/28） ,more eyes in group B suffered fromretinal detachment （80. 0% ,20/25 ）, occlusive central retinal vasculopathy （56. 0%, 14/25 ）, optic atrophy （36.0% ,9/25 ） and proliferative vitroretinopathy（92. 0% ,23/25 ） （X^2 = 13. 862,10. 440,5. 048,13. 749; P = 0. 000,0. 001,0. 025,0. 000）. Logistics regression analysis showed that visual prognosis were related to factors including best corrected visual acuity better at first visit （ OR = 27. 225 , P = 0. 003 ） and occlusive central retinal vaseulopathy （ OR = 0. 065, P = 0. 053 ）. No difference in the number of eyes with increased intraocular pressure was observed between group A and group B （ P 〉 0. 05 ）. Prophylactic laser retinopexy before retinal detachment and intravitreal ganciclovir were not associated with visual prognosis （ P 〉 0.05 ）. Conclusion Worse visual acuity at first visit and occlusive central retinal vasculopathy are major relevant factors threatening visual prognosis.