青光眼睫状体炎综合征患者房水病毒情况分析

Analysis of cytomegalovirus in aqueous of Posner-Schlossman syndrome

目的研究巨细胞病毒(CMV)在青光眼睫状体炎综合征(PSS)患者房水中的感染情况,并比较分析CMV阳性和阴性PSS患者临床特点的差异。方法抽取26例(26眼)PSS患者的房水及血清,采用酶联免疫吸附试验(ELISA)检测房水及血清中CMV Ig G抗体,并采用聚合酶链反应(PCR)验证检测结果。用Fisher精确检验对CMV阳性组和阴性组间性别、眼别、是否合并视野损害、虹膜损害、白内障、角膜后沉着物(KP)等特点进行比较,使用独立样本t检验对2组间年龄、视力、眼压、杯盘比大小、病程、发作时间及角膜内皮计数进行比较分析。结果26例患者中15例(57.7%)CMV检测阳性。CMV阳性组的平均眼压为(39.5±12.6)mm Hg,高于CMV阴性组的(23.9±12.7)mm Hg,差异有统计学意义(P=0.005)。另外,发作眼的角膜内皮细胞计数大多比对侧眼少,两眼间的角膜内皮细胞计数差在CMV阳性组为(784±301)个/mm^2,明显高于CMV阴性组的(353±433)个/mm^2,差异有统计学意义(P=0.006)。其他临床特点在2组间的差异无统计学意义。结论超过一半的PSS患者存在前房CMV感染,其眼压明显高于CMV阴性组患者,且反复发作时可诱发CMV性角膜内皮炎,引起更严重的角膜内皮细胞损害,成为与CMV阴性PSS患者相鉴别的重要临床特点,并可指导临床上对此类PSS患者的抗病毒治疗。

Objective To analyze the cytomegalovirus （CMV） in aqueous of Posner-Schlossman syndrome （PSS） patients and compare the clinical characteristics in CMV-positive and negative eyes. Methods Twenty-six eyes of 26 PSS patients were enrolled in this cross-sectional study. All patients underwent aqueous and serum analysis for CMV by enzyme linked immunosorbent assay （ELISA） and polymerase chain reaction （PCR）. The main clinical features were compared between CMV-positive and negative groups, including age, sex, affected eye, visual acuity, intraocular pressure （IOP）, cup to disc ratio （C/D）, the eyes with visual field defect, iris atrophy, keratic precipitates （KP） and cataract, total disease course, the number of endothelial cells in affected eyes and its relative endothelial cell loss to the fellow eyes. Results Twenty-six PSS eyes were tapped, of which 15 eyes （57.7%） were CMV-positive. The average IOP of CMV-positive group was 39.5 ± 12.6 mmHg, which was significantly higher than that of CMV-negative group （23.9 ±12.7 mmHg, P = 0. 005 ）. And in the CMV-positive eyes, the relative endothelial cell loss to the fellow eyes was 784 ± 301 cells/ram2 , which was significantly more than that in the CMV-negative eyes （353± 433 cells/mm2, P = 0. 006）. No significant differences were found in other clinical features. Conclusions More than a half of the PSS patients were CMV-positive. CMV-positive PSS patients more likely presented higher IOP peak and severe endothelial cell loss than CMV-negative eyes. Therefore, the clinical signs would be helpful for clinicians to distinguish the CMV-positive and negative PSS patients and to guide clinical antivirus treatment.