抗中性粒细胞胞浆抗体相关性血管炎并发巩膜炎及白内障1例并文献复习

Anti-neutrophil cytoplasmic antibody associated vasculitis complicated with scleritis and cataract:a case study and literature review

目的探讨抗中性粒细胞胞浆抗体(antineutrophil cytoplasmic antibody,ANCA)相关性血管炎(associated vasculitis,AAV)并发巩膜炎及白内障的临床特点及诊疗方法。方法复习1例73岁女性患者的病历资料。其于外院诊断为AAV 1年后并发左眼巩膜炎,近半年左眼视物模糊逐渐加重,在本院诊断为左眼并发性白内障,行左眼白内障超声乳化吸出+人工晶体植入术。结果术后第1天矫正视力0.3,随访4个月眼前后节情况稳定。结论AAV相关性血管炎临床表现复杂多样,是一组具有潜在视力威胁并发症的罕见疾病。处于早期或缓解期的血管炎患者ANCA指标可呈阴性,当病情缓解时其滴度会降低,可作为监测病情进展和判断治疗效果的评估指标。全身用药和眼科早期干预可以减轻眼部病损程度,眼部症状的成功治疗通常基于有效的全身治疗,但有时手术干预也是必需的,且手术的选择及药物治疗对于疾病的预后非常重要。

Objective To investigate the clinical characteristics,diagnosis and treatment of antineutrophil cytoplasmic antibody(ANCA)associated vasculitis(AAV)complicated with scleritis and cataract.Methods Review the medical records of a 73-yearold female patient.One year after she was diagnosed as AAV in a foreign hospital,she was complicated with left eye scleritis,and the blurred vision in the left eye gradually worsened in the past six months.In our hospital,she was diagnosed as complicated cataract in the left eye,and she underwent phacoemulsification and intraocular lens implantation for cataract in the left eye.Results The corrected visual acuity was 0.3 on the first day after operation,and the anterior posterior segment was stable after 4 months of follow-up.Conclusion The clinical manifestations of AAV are complex and diverse,which is a group of rare diseases with potential vision threatening complications.The ANCA index of patients with vasculitis in the early or remission stage can be negative,and its titer will decrease when the disease is in remission,which can be used as an evaluation index to monitor the progress of the disease and judge the treatment effect.In terms of treatment,the combination of systemic drugs and early intervention of ophthalmology can reduce the degree of eye damage.The successful treatment of eye symptoms is usually based on effective systemic treatment,but sometimes the intervention of surgery is also necessary,and the selection of surgery and drug treatment are very important for the prognosis of the disease.