系统性红斑狼疮并发视网膜静脉阻塞的临床分析

Clinical analysis of retinal vein occlusion caused by systemic lupus erythematosus

目的 探讨系统性红斑狼疮 (systemic lupus erythematosus,SL E)并发视网膜静脉阻塞的临床特点。 方法 对 9例 12只眼 SL E并发视网膜静脉阻塞的患者进行视力、眼底检查及检测血抗核抗体(antinuclear antibody,ANA)、抗双链 DNA (抗 ds DNA)、补体 3(C3)、补体 4 (C4 )和血红细胞沉降率 (ery-throcyte sedimentation rate,ESR)。 3例行荧光素眼底血管造影 (fundus fluorescein angiography,FFA)检查 ,并对伴有眼部其他表现或全身病变的患者进行分析。 结果 视网膜中央静脉阻塞 (central retinalvein occlusion,CRVO) 6例 8只眼 ,视网膜分支静脉阻塞 (branch retinal vein occlusion,BRVO) 3例 4只眼 ;3例 5只眼 FFA显示早期出现视网膜静脉及毛细血管广泛荧光渗漏 ;6例单眼视网膜静脉阻塞的对侧眼有 4只眼有棉绒斑、视网膜出血等 SL E眼底改变 ;4例合并有眼部干燥性角结膜炎或溃疡性睑缘炎 ,8例患者伴随有全身症状 ;所有病例 ANA、抗 ds DNA阳性、血 ESR大于 5 0 mm/h,6例 C3下降 ,5例 C4 下降。 结论 SL E是导致视网膜静脉阻塞的全身病变之一。 SL E并发视网膜静脉阻塞的患者其视力及视网膜静脉和毛细血管屏障功能损害严重 ,病变与 SL E活动程度相关 ,并可合并其他眼部或全身性病变.

Objective To investigate the clinical characteristics of retinal vein occlusion caused by systemic lupus erythematosus (SLE). Methods Visual acuities, fundus examination, antinuclear antibody (ANA), anti-double-stranded DNA(anti-dsDNA), complement 3 (C 3), complement 4 (C 4) and erythrocyte sedimentation rate (ESR) were detected in 9 patients (12 eyes) with retinal vein occlusions caused by SLE. Fundus fluorescein angiography (FFA) was performed on 3 patients. Patients with other ocular or general lesions were analyzed. Results Central retinal vein occlusion (CRVO) in 6 patients (8 eyes) and branch retinal vein occlusion (BRVO) in 3 (4 eyes) were found. The results of FFA showed that 5 eyes of 3 patients had extensive leakage of retinal vein and capillary. Four contralateral eyes of 6 patients with unilateral retinal vein occlusion had SLE fundus alterations such as cotton-wool spot and retinal hemorrhage. Four patients had xerotic keratitis or ulcerative blepharitis and 8 had general lesions. Positive ANA and anti-dsDNA, and ESR >50 mm/h were detected in all the patients. Decreasing C 3 in 6 patients and C 4 in 5 were found. Conclusions SLE is one of the general conditions causing retinal vein occlusion. Visual acuity and barrier of retinal vein and capillary are damaged seriously in patients with retinal vein occlusion caused by SLE, which may be accompanied with other ocular or general lesions. It is suggested that retinal vein occlusion is relative with SLE activity.