29例病毒性葡萄膜炎患者临床特征分析

目的探讨29例临床诊断为病毒性葡萄膜炎患者的临床特点。方法收集病毒性葡萄膜炎患者完整的临床资料,分析患者葡萄膜炎的类型,检测房水中病毒核酸,运用Logistic回归分析评价房水病毒核酸阳性与病毒性葡萄膜炎临床表现之间的相关性。结果29例患者中12例为后葡萄膜炎(视网膜坏死,41.3%),17例为前葡萄膜炎(虹膜炎、虹膜睫状体炎,58.6%)。29例中有15例(51.7%)PCR技术检测房水病毒为阳性,病毒性前葡萄膜炎中PCR检出房水病毒核酸阳性有6例,阳性率为35.3%;病毒性后葡萄膜炎PCR检出房水病毒核酸阳性有9例,阳性率为75%。15例中水痘-带状疱疹病毒14例(93.3%),EB病毒和水痘-带状疱疹病毒合并感染1例(6.7%)。另外RT-PCR法检测房水中不同病毒阳性的患者临床表现也可能有所差异。RT-PCR法检出病毒核酸阳性的患者更容易出现前房闪辉(13例,92.8%)(OR=0.055,P=0.038)、羊脂状KP(10例,71.4%)(OR=0.026,P=0.028)、角膜水肿(11例,37.9%)(OR=0.029,P=0.003)、眼压升高(17例,58.6%)(OR=0.029,P=0.003)。结论RT-PCR法检测29例病毒性葡萄膜炎患者房水病毒核酸阳性诊断率为51.7%,主要临床表现为前房闪辉、KP形态改变、角膜水肿和眼压升高,可能对临床诊断病毒性葡萄膜炎的病因,并对协助诊断与监测治疗有一定的指导意义。

Objective To investigate the clinical characteristics of 29 patients with clinically diagnosed as viral uveitis.Methods Collected the clinical data of patients,analyzed the type of uveitis,detected viral nucleic acid in aqueous humor,and evaluated the correlation between positive viral nucleic acid in aqueous humor and clinical manifestations of viral uveitis by Logistic regression analysis.Results Of the 29 patients,12 cases were posterior uveitis(retinal necrosis,41.3%)and 17 cases were anterior uveitis(iritis,iridocyclositis,58.6%).Among 29 patients,15 cases(51.7%)were positive of viral nucleic acid by PCR.6 cases(35.3%)were positive by PCR in viral anterior uveitis,9 cases(75%)were positive in posterior uveitis.Among the 15 cases,14 cases(93.3%)were infected by varicella zoster virus,and 1 case(6.7%)was infected both by EB virus and varicella zoster virus.In addition,the clinical manifestations of different virus in aqueous humor detected by RT-PCR might also be different.Patients with positive viral nucleic acid detected by RTPCR were more likely to have anterior chamber flicker(13 cases,92.8%)(OR=0.055,P=0.038),sheep fat KP(10 cases,71.4%)(OR=0.026,P=0.028),corneal edema(11 cases,37.9%)(OR=0.029,P=0.003).The intraocular pressure increased(17 cases,58.6%)(OR=0.029,P=0.003).Conclusion The positive diagnostic rate of viral nucleic acid in aqueous humor of 29 patients with viral Uveitis detected by RT-PCR is 51.7%.The main clinical manifestations are anterior chamber flicker,KP morphological changes,corneal edema and elevated intraocular pressure,which may have certain guiding significance for clinical diagnosis of the etiology of viral Uveitis and assistance in diagnosis,monitoring and treatment.