65例诊断不明的葡萄膜炎患者玻璃体切割标本检查诊断结果分析

Use of diagnostic vitrectomy in eyes with uveitis of unknown etiology

目的 观察分析诊断不明的葡萄膜炎患者玻璃体切割标本的诊断阳性率。 方法 回顾性系列病例研究。诊断不明的葡萄膜炎患者65例67只眼纳入研究。其中，男性31例32只眼，女性34例35只眼。年龄6～84岁，平均年龄（55.00±18.56）岁。所有患眼均行常规三通道睫状体平坦部入路玻璃体切割手术，在无灌注的情况下切除并收集核心玻璃体标本及时送检，予微生物涂片及培养、抗原抗体、细胞因子、细胞学、流式细胞术免疫表型分析、基因重排等方式进行检测。分析患眼玻璃体切割标本检查的诊断结果。 结果 67只眼中，通过玻璃体标本查出病因者40只眼，诊断阳性率为59.7%。其中，细菌涂片或培养阳性者20只眼，占总诊断阳性率的50.0%；细胞学、细胞因子、流式细胞术免疫表型分析、基因重排检测高度提示或确诊为淋巴瘤11只眼，占总诊断阳性率的27.5%；病毒IgM、IgG显著增高、Goldmann-Witmer系数C值＞3者3只眼，占总诊断阳性率的7.5%；真菌涂片或培养阳性者3只眼，占总诊断阳性率的7.5%；弓蛔虫IgG显著增高2只眼，占总诊断阳性率的5.0%；弓形虫IgG显著增高1只眼，占总诊断阳性率的2.5%。 结论 诊断不明葡萄膜炎患者玻璃体切割标本的诊断阳性率为59.7%。

Objective To analyze the results of diagnostic pars plana vitrectomy （PPV） in patients with uveitis of unknown cause. Methods This is a retrospective case series study. Sixty-five patients （67 eyes） with uveitis of unknown cause were enrolled in this study. There were 31 males （32 eyes） and 34 females （35 eyes）. The ages were from 6 to 84 years, with the mean age of （55.00±18.56） years. All eyes were received PPV. Examination of vitreous samples consisted of microbial stains and culture, microbial DNA and antibody detection, cytokine measurement, cytology, flow cytometry and gene rearrangement detection. Results Vitreous analysis was positive in 40 of 67 eyes （59.7%）. Positive results indicated bacterial endophthalmitis in 20 of 40 eyes （50.0%）, lymphoma in 11 eyes （27.5%）, viral IgM and IgG increased significantly in 3 eyes （7.5%）, fungal endophthalmitis in 3 eyes （7.5%）, IgG of toxocara increased significantly in 2 eyes （5.0%）, IgG of toxoplasma Gondii increased significantly in 1 eye （2.5%）. Conclusion The diagnostic yield of vitreous samples in uveitis eyes of unknown cause is 59.7%.