表层巩膜炎及巩膜炎90例临床分析

Study on the clinical manifestation of 90 cases with scleritis and episcleritis

目的 探讨表层巩膜炎及巩膜炎患者的临床特征.方法 回顾性病例系列研究.对2010年1月至2013年1月间在北京同仁眼科中心门诊临床诊断为表层巩膜炎及巩膜炎的90例患者进行回顾性分析,总结其临床特征.分析指标包括一般情况、病史、症状、体征、并发症（视力下降、前葡萄膜炎、角膜炎、眼压升高、白内障以及眼底病变等）和相关性疾病.对数据进行x2检验.结果 90例表层巩膜炎和巩膜炎患者中,67例（74.4％）为双眼发病,23例（25.6％）为单眼发病.患者年龄4～83岁,平均（48±15）岁.男性患者30例（33.3％）,女性60例（66.7％）.不同性别的患者在表层巩膜炎与巩膜炎中所占比例的差异有统计学意义（x2=10.000,P＜0.01）.90例患者中表层巩膜炎36例（40.0％）,巩膜炎54例（60.0％）.儿童组（0～16岁）2例（2.2％）,均为表层巩膜炎患者;青壮年组（17 ～44岁）39例（43.4％）,其中13例为表层巩膜炎患者,26例为巩膜炎患者;中年组（45 ～59岁）30例（33.3％）,9例为表层巩膜炎患者,21例为巩膜炎;老年组（≥60岁）19（21.1％）,12例为表层巩膜炎患者,7例为巩膜炎患者.经统计学检验分析,4个年龄组患者患病差异有统计学意义（x2=33.822 P＜0.01）.青壮年组、中年组和老年组明显多于儿童组（x2值分别为33.390、24.500和13.762,P＜0.01）;青壮年组明显多于老年组（x2 =6.889,P＜0.01）.巩膜炎患者发生眼部并发症显著多于表层巩膜炎患者（x2=30.044,P＜0.01）.发生巩膜炎时较表层巩膜炎更易发生视力下降、角膜炎和引起眼压升高,其差异有统计学意义（x2值分别为130.200、67.200、54.444,P＜0.01）.19例（21.1％）患者患有不同程度的关节炎,10例（11.1％）患者局部存在感染性因素,巩膜炎患者伴发相关性疾病显著多于表层巩膜炎患者（x2=145.644,P＜0.01）.结论 巩膜炎在各个年龄段都可能发生,主要见于青中年人,是一类少见的、可引起严重眼部炎症的疾病,临床医师应重视其相关性疾病及眼部并发症的诊治.

Objective To evaluate the demographic characteristics,clinical features,ocular complications,and disease associations of patients who were diagnosed as scleritis and episcleritis in clinic.Methods A retrospective case series study.Ninety patients were diagnosed clinically as scleritis and episcleritis in Beijing Tongren Hospital from Jan 2010 to Jan 2013.Analyzed the general states of health,case history,the clinical manifestation,clinical features,ocular complications （decrease in vision,anterior uveitis,keratitis,ocular hypertension,cataract,and diseases of retina）,and disease associations,to summarize the clinical characteristics of scleritis and episcleritis.Results Ninety patients were recorded,from 4 to 83 years old,and the average was （48 ± 15） years old.30 cases （33.3％） were male,and 60 （66.7％） were female.There were no significant difference between male and female （x2 =10.000,P ＜0.01）.In the 90 cases,36 （40.0％） were episleritis and 54 cases （60.0％） were scleritis.Children group （0-16 years old） had 2 cases （2.2％）,which all were episleritis.Young adult group （17-44 years old） had 39 cases （43.4％）,including 13 were episleritis and 26 cases were scleritis.Middle adult group （45-59 years old） had 30 cases,including 9 cases episleritis and 21 cases scleritis.There were 19 cases （21.2％） in aged group （≥60 years）,including 12 cases episleritis and 7 scleritis.Young adult group,Middle adult group and Aged group were significantly more than Children and aged group （x2 =33.390,24.500 and 13.762,P ＜0.01）.Young group was significantly more than Aged group Children group （x2 =6.889,P ＜ 0.01）.Ocular complications were more frequent overall in patients with scleritis versus in those with episcleritis（x2 =30.044,P ＜ 0.01）,including decrease in vision,keratitis,and ocular hypertension （x2 =130.200,67.200,54.444,P ＜0.01）.Nineteen cases （21.1％） had different types of arthritis,and 10 cases （11.1％） had infection diseases in local.There were difference between episcleritis and scleritis （x2 =145.644,P ＜ 0.01）.Conclusions Scleritis occurs in all ages,but mainly in adults.It is uncommon,and potentially life-threatening diseases.It is needed pay attention to diagnosis and treatment of the patients with systemic disease and ocular complications by Ophthalmologist.