非感染性葡萄膜炎的临床治疗指南及当前实际治疗模式的研究启示

The practice guideline of non-infectious uveitis and the revelation of current studies on actual treatment modalities

葡萄膜炎的发病原因和机制相当复杂,涉及自身免疫、外伤、感染等多种因素。主要分为感染性和非感染性两大类,非感染性葡萄膜炎又分为外源性和内源性。糖皮质激素是唯一获得美国食品和药物管理局批准用于非感染性葡萄膜炎治疗的药物。由于葡萄膜炎患者长期大量应用糖皮质激素会产生严重的副作用,为此,2000年美国一个专家小组制定了一项有关葡萄膜炎的治疗指南,并于2005年进行了修订。美国Quan Dong Nguyen和他的团队开展了一项覆盖全美的多中心横断面研究,在27个州按照国际疾病分类第9版代码(360.12,360.11,363.20,374.3,364.3)招募的60名眼科医生和风湿病学家中展开。其目标是了解目前非感染性前葡萄膜炎、中间葡萄膜炎、后葡萄膜炎和全葡萄膜炎的治疗模式,从而获得葡萄膜炎患者的人口统计信息、治疗种类及其描述、记录相关的计量特征。研究还试图评估目前葡萄膜炎治疗指南在临床的普及程度。笔者结合美国专科医生治疗非感染性葡萄膜炎的横断面研究结果,仅就当前专业范围内对葡萄膜炎治疗指南的认知程度、临床执行范围及个人实践体会进行汇总分析,以期引起同行思考。

The causes and pathophysiology fo uveitis are quite complex, involving autoimmunity, trauma, infection and other factors. It is mainly divided into infectious and non-infectious uveitis. non-infectious uveitis is divided into exogenous and endogenous. Glucocorticoids is the only drug which approved by U. S. Food and Drug Administration for the treatment of non-infectious uveitis. Since long-teru~ glucocorticoid experience will cause serious side effects for uveitis patients, in 2000, an American experts group developed a practice guideline on uveitis, and revised it in 2005. Quan Dong Nguyen and his team conducted a multi-center cross-sectional study across the United States. This study recruited 60 ophthalmologists and rheumatologists in accordance with the International Classification of Diseases, Ninth Revision code （360.12,360. 11,363.20,374.3,364. 3 ） from 27 states. The goal is to understand the current treatment information of non-infectious anterior uveitis, intermediate uveitis, posterior uveitis and panuveitis, moreover to obtain demographic information, treatment types of uveitis patients and the measurement characteristics relevant to descriptions, record. The study also tried to assess universal degree of the practice guideline in current uveitis treatment. According to the results of the American cross-sectional study about non-infectious uveitis treatment,the author presented a pooled analysis of the current awareness degree of uveitis practice guideline within the professional scope, the range of clinical implementation and personal practice experience in order to arouse counterparts＇ thinking.