成人和儿童眼犬弓蛔虫病临床表现差异及眼内液检测特点

Difference of clinical characteristics in ocular toxocariasis between adults and children and characteristics of anti-toxocaria antibody in intraocular fluids

目的对比观察成人和儿童眼犬弓蛔虫病(OT)的临床表现特点,初步探讨眼内液检测在OT早期诊断中的作用。方法回顾性研究。2018年1月至2019年10月于首都医科大学附属北京朝阳医院眼科临床及实验室检查确诊的OT患者60例60只眼纳入研究。采集患者病史信息并行裂隙灯显微镜、间接检眼镜检查以及房水或玻璃体液犬弓蛔虫抗体检测。行视力检查58例;未行视力检查2例,均为儿童患者。视力检查采用新版标准对数视力表进行,统计时换算为最小分辨角对数(logMAR)视力。根据年龄将患者分为成人组、儿童组,分别为12例12只眼、48例48只眼。对比观察两组患者临床特点及诊疗要点。符合正态分布的计量资料组间比较行独立样本t检验;偏态分布的计量资料组间比较行Mann-Whitney秩和检验。定性资料比较行χ^(2)检验。结果成人组、儿童组患者中,有明确犬猫接触史者分别为7(58.3%,7/12)、34(70.8%,34/48)例,成人组明显低于儿童组,但差异无统计学意义(χ^(2)=0.236,P=0.627)。首诊时,成人组、儿童组患者自述视物模糊分别为10(83.3%,10/12)、22例(45.8%,22/48)。成人组、儿童组患眼logMAR视力≥1.85者分别为3(25.0%,3/12)、20(43.5%,20/46)只眼;小于0.3者分别为8(66.7%,8/12)、22(45.8%,22/46)只眼。成人组患眼视力优于儿童组,差异有统计学意义(Z=2.162,P=0.031)。两组患眼不同临床分型构成比比较,差异无统计学意义(χ^(2)=1.908,P=0.385)。成人组、儿童组患眼眼前节炎症发生率分别为25.0%(3/12)、56.3%(27/48);两者比较,差异无统计学意义(χ^(2)=3.750,P=0.053)。成人组、儿童组患眼玻璃体液抗体浓度均大于房水。玻璃体液、房水抗体浓度,儿童组分别为36.51(22.58)、19.94(21.78)U/ml;成人组分别为45.95(56.44)、32.20(38.64)U/ml。儿童组患眼玻璃体液、房水抗体浓度比较,差异有统计学意义(Z=-1.984,P=0.047)。结论与儿童OT患者比较,成人OT患者初诊时视力更好,玻璃体腔炎症或增生轻微;眼内液弓蛔虫相关的抗体检测有助于早期明确诊断。

Objective To compare the clinical manifestations of ocular toxoplasmosis(OT)in adult and children,and to preliminarily explore the role of intraocular fluid detection in the early diagnosis of OT.Methods A retrospective study.From January 2018 to October 2019,60 cases of OT patients with 60 eyes diagnosed in the Department of Ophthalmology of Beijing Chaoyang Hospital Affiliated of Capital Medical University were included in the study.The medical history information of patients was collected in parallel with slit-lamp microscopy,indirect ophthalmoscope examination,and canine toxoplasma antibody detection in aqueous or vitreous fluid.Fifty-eight cases underwent visual inspection;2 cases did not underwent visual inspection,who were children.The visual acuity examination was carried out using the new version of the standard logarithmic visual acuity chart,which was converted into the logarithmic minimum angle of resolution(logMAR)visual acuity during statistics.According to age,the patients were divided into adult group and child group,with 12 eyes in 12 cases and 48 eyes in 48 cases,respectively.The clinical characteristics and main points of diagnosis and treatment of the two groups of patients were compared and observed.The comparison among the measurement data groups conforming and the normal distribution was performed by the independent t test.The comparison between the measurement data groups of the skewed distribution was performed by the Kruskal-Wallis test.The qualitative data were compared withχ^(2) test.Results Among the adult group and the child group,7(58.3%,7/12)and 34(70.8%,34/48)patients with a clear history of contact with dogs and cats were in the adult group and the child group,respectively.The adult group was significantly lower than the child group,however,there was no different statistical significance(χ^(2)=0.236,P=0.627).At the first visit,the self-reported blurred vision of the adult group and the child group was 10(83.3%,10/12)and 22(45.8%,22/48)cases,respectively.In the adult group and the child group,3(25.0%,3/12)and 20(43.5%,20/46)eyes with logMAR visual acuity greater than 1.85,8(66.7%,8/12)and 22(45.8%,22/46)eyes with logMAR visual acuity less than 0.3.The visual acuity of the adult group was better than that of the child group,and the difference was statistically significant(Z=2.162,P=0.031).There was no statistically significant difference in the composition ratio of different clinical types of the two groups of eyes(χ^(2)=1.908,P=0.385).The incidence of inflammation in the anterior segment of the eye in the adult group and the child group were 25.0%(3/12)and 56.3%(27/48),respectively;there was no statistically significant difference between the two groups(χ^(2)=3.750,P=0.053).The concentration of antibodies in the vitreous humor of the affected eye in the adult group and the child group was greater than that of aqueous humor.The antibody concentrations of vitreous humor and aqueous humor were 36.51(22.58)and 19.94(21.78)U/ml in the children group;45.95(56.44)and 32.20(38.64)U/ml in the adult group.Comparison of antibody concentrations in the vitreous humor and aqueous humor of the affected eyes in the child group showed statistically significant differences(Z=-1.984,P=0.047).Conclusions Compared with children with OT,adult patients with OT have better vision and mild inflammation or hyperplasia of the vitreous cavity.The detection of antibodies related to toxoplasma in the intraocular fluid is helpful for early diagnosis.