中西医结合治疗梅毒性葡萄膜炎临床观察

Clinical manifestations of syphilitic uveitis with integrated treatment of traditional Chinese and western medicine

目的观察梅毒性葡萄膜炎患者的临床表现和中西医治疗效果。方法中西医结合治疗梅毒性葡萄膜炎患者9例17只眼,对其临床特征和治疗效果进行回顾性分析。结果 9例患者中男性5例,女性4例,年龄38~60岁,平均年龄47.4岁。病程7 d^6个月,病程中位数45 d。6例患者确诊前曾应用激素治疗导致病情加重。双眼发病8例,全葡萄膜炎9只眼,后部葡萄膜炎8只眼,1例2只眼同时诊断Vogt-小柳原田综合征。荧光素眼底血管造影(FFA)检查表现为视盘着染或强荧光、视网膜斑片状弱荧光,视网膜血管管壁荧光渗漏及着染。吲哚菁绿血管造影(ICGA)检查表现为早期鳞状、斑点状弱荧光,后期融合成类圆形改变。驱梅治疗3个月或半年,12只眼视力恢复至0.6以上(70.6%),眼部及全身症状无复发。结论认识梅毒性葡萄膜炎的临床特征,进行梅毒血清学筛查是减少该病误诊的重要措施,及时驱梅并配合中药治疗预后较好。

OBJECTIVE To observe clinical manifestations and treatment efficacy of combination of traditional Chinese and western medicine on syphilitic uveitis. METHODS Analyzed and summarized retrospectively the clinical manifestations and integrated treatment efficacy of traditional Chinese and western medicine of 9 patients （17eyes） diagnosed as syphilitic uveitis. RESULTS There were 5 males and 4 females; the ages were from 38 to 60 years old, with a mean age of 47.4 years old. Six patients were diagnosed before the application of hormone therapy. Eight patients were bilateral. Nine eyes were panuveitis, 8 eyes were posterior uveitis, 1 patient （2 eyes） at the same time with Vogt-Koyanagi-Harada syndrome. FFA showed staining or hyperfluorescence of optic disc, cystoid macular edema, retinal patchy fluorescence, venous leakage, early squamous, punctate fluorescence, later merged into circular change. A11 patients were treated with penicillin and traditional Chinese medicine treatment, 12 eyes （70.6%） had improved vision above 0.6. CONCLUSIONS Syphilitic uveitis has typical symptoms and signs. Syphilis serological screening is an important measure to reduce the misdiagnosis of the disease. The prognosis is good with early diagnosis and timely treatment of penicillin and traditional Chinese medicine treatment.