眼内液检测对急性视网膜坏死综合征继发视网膜脱离的预测作用

Predictive effect of intraocular fluid testing in retinal detachment secondary to acute retinal necrosis syndrome

目的探讨眼内液检测对急性视网膜坏死综合征(ARN)继发视网膜脱离(RD)的预测作用。方法回顾性临床研究。2019年1月至2023年10月于南京医科大学附属眼科医院检查确诊的ARN患者40例40只眼纳入研究。根据随访期间是否发生RD,将患者分为发生RD组(A组)、未发生RD组(B组),分别为18例18只眼、22例22只眼。患者均在确诊后行玻璃体腔注射20 mg/ml更昔洛韦0.1 ml(含更昔洛韦2 mg)治疗,2~3次/周。首次玻璃体腔注射更昔洛韦前抽取前房水,检测其中血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(BFGF)、血管细胞黏附因子(VCAM)、白细胞介素(IL)-6、IL-8、IL-10浓度;荧光定量聚合酶链反应检测其中单纯疱疹病毒(HSV)、水痘带状疱疹病毒(VZV)载量。受试者工作特征曲线(ROC曲线)计算并分析房水中炎性细胞因子以及HSV-DNA、VZV-DNA载量预测ARN患者发生RD的ROC曲线下面积(AUC),评判其预测价值。结果A组18只眼、B组22只眼中,感染VZV、HSV分别为16、2只眼和21、1只眼。两组患眼房水VZV-DNA、HSV-DNA载量比较,差异有统计学意义(Z=-3.762,P<0.001)。与B组比较,A组患眼房水中VEGF(Z=-3.996)、BFGF(Z=-2.430)、IL-6(Z=-3.303)、IL-8(Z=-3.480)、IL-10(Z=-3.409)浓度显著升高,差异有统计学意义(P<0.05);而VCAM浓度差异无统计学意义(Z=-0.054,P=0.957)。ROC曲线分析结果显示,VEGF、病毒载量、IL-10、IL-8、IL-6、BFGF预测ARN发生RD的AUC分别为0.871、0.848、0.828、0.823、0.806、0.737;VEGF、IL-10、IL-8、IL-6、BFGF联合预测ARN发生RD的AUC为0.924。最佳截断值:病毒载量为0.40×106拷贝/ml,IL-10、IL-8、IL-6分别为50.65、1695.50、6634.00 pg/ml。结论房水病毒载量以及细胞因子单独或联合对ARN发生RD具有较高的预测价值。

Objective To explore the predictive effect of intraocular fluid testing in the assessment of retinal detachment(RD)occurring in acute retinal necrosis syndrome(ARN).Methods A retrospective study.From January 2019 to October 2023,40 patients with 40 eyes diagnosed as ARN in Nanjing Medical University Eye Hospital were collected for this study.According to whether RD occurred during the follow-up period,the patients were divided into RD group(group A)and no RD group(group B),with 18 patients 18 eyes and 22 patients 22 eyes,respectively.All patients were given intravitreal 20 mg/ml ganciclovir 0.1 ml(ganciclovir 2 mg),2 to 3 times per week after diagnosis.The concentrations of vascular endothelial growth factor(VEGF),basic fibroblast growth factor(BFGF),vascular cell adhesion factor(VCAM),interleukin(IL)-6,IL-8,and IL-10 in the preaqueous solution were measured before the first injection of ganciclovir.The loads of herpes simplex virus(HSV)and varicella-herpes zoster virus(VZV)were detected by fluorescence quantitative polymerase chain reaction.Receiver operating characteristic curve(ROC curve)calculated and analyzed the area under ROC curve(AUC)of inflammatory cytokines in aqueous humor and HSV-DNA and VZV-DNA loads in predicting RD in ARN patients to evaluate their predictive value.Results In 18 eyes in group A and 22 eyes in group B,VZV and HSV was infected in 16 and 2 eyes and 21 and 1 eyes,respectively.The VZV-DNA and HSV-DNA load were compared between the two groups,the difference was statistically significant(Z=-3.762,P<0.001);compared with group B,the concentrations of VEGF in humor(Z=-3.996),BFGF(Z=-2.430),IL-6(Z=-3.303),IL-8(Z=-3.480),and IL-10(Z=-3.409)increased significantly in group A,the difference was statistically significant(P<0.05);there was no statistically significant difference in VCAM between the two groups(Z=-0.054,P=0.957).The ROC curve analysis showed that the AUC of VEGF,nucleic acid copies,IL-10,IL-8,IL-6,and bFGF for predicting RD in ARN was 0.871,0.848,0.828,0.823,0.806,0.737,respectively.The AUC of combination of VEGF,IL-10,IL-8,IL-6,and BFGF predicted the RD in ARN was 0.924.The optimal cut-off value of nucleic acid copies was 0.40×106,and IL-10,IL-8 and IL-6 were 50.65,1695.50 and 6634.0 pg/ml,respectively.Conclusion Aqueous humor viral load as well as cytokines alone or in combination have a reference value for predicting RD secondary to ARN.