病毒性前葡萄膜炎患者房水病毒类型检测分析

Analysis of aqueous humor virus type in patients with viral anterior uveitis

目的分析临床诊断为病毒感染性前葡萄膜炎患者的房水病毒检测结果。设计回顾性病例系列。研究对象临床诊断为病毒感染性前葡萄膜炎患者25例(25眼)。方法记录患者全身病毒感染病史,对患者进行血清免疫学检查(HLA-B27、RF等)、常规眼科检查(包括视力、眼压、裂隙灯、间接检眼镜检查等),通过前房穿刺获取房水,应用RT-PCR技术检测房水病毒。通过Logistic回归分析评估临床表现与PCR检测病毒阳性的关系。主要指标房水RT-PCR病毒检测结果。结果12例(48%)患者有病毒感染病史。25例(25眼)患者中14例(56%)房水RT-PCR病毒检测阳性。其中水痘-带状疱疹病毒9例(36%),患者既往均有水痘或带状疱疹病史;单纯疱疹病毒4例(16%);巨细胞病毒1例(4%)。PCR检测病毒阳性的患者更易出现角膜水肿(19眼,76%)(OR=2.006,P=0.043)、眼压升高(19眼,76%,平均(32.3±19.7)mmHg)(OR=1.905,P=0.013)、色素性KP(9眼,36%)(OR=1.31,P=0.014)或细小灰白KP(8眼,32%)(OR=1.41,P=0.014)。结论RT-PCR房水病毒检测对临床辅助诊断病毒前葡萄膜炎有一定价值。病毒性前葡萄膜炎最常见的致病病毒是水痘-带状疱疹病毒。主要临床表现为角膜水肿、眼压高、色素性KP或细小灰白KP。

Objective To retrospectively analyze the aqueous humor virus of 25 patients with viral infectious anterior uveitis(AU).Design Retrospective case series.Participants 25 cases(25 eyes)of AU who were clinically suspected of viral infection.Methods All patients were record the history of viral infection,and performed serum immunological examinations,routine eye examinations(including visual acuity,intraocular pressure(IOP),slit lamp,indirect ophthalmoscope examination,etc.),and detected aqueous virus by real-time(RT-PCR)technology.Logistic regression analysis was used to evaluate the relationship between clinical manifestations and positive virus detection by PCR.Main Outcome Measures RT-PCR virus detection.Results 12 patients(48%)had a history of viral infection,and 7 patients(28%)had a history of overwork.RT-PCR was positive in 14/25(56%),and the positive of VZV,HSV1/2 and CMV was 9/25(36%),4/25(16%)and 1/25(4%),redpectively.19 eyes(76%)were sensitive with anti-virus therapy.Corneal edema(OR=2.006,P=0.043),high IOP(OR=1.905,P=0.013)and pigmented KP(OR=1.31,P=0.014)or fine KP(OR=1.41,P=0.014)were significantly related with PCR positivity.Conclusion The detection of aqueous humor virus by RT-PCR has a good application value in the diagnosis of viral infectious anterior uveitis.Corneal edema,high IOP,pigmented KP or tiny gray white KP are associated with viral infection of anterior uveitis.