强直性脊柱炎伴发葡萄膜炎16例临床分析  

Uveitis associated with ankylosing spondylitis:a clinical analysis of 16 case

作　　者：陈洁[1] 何跃[2] 陈梅[1] 杨祖成[1] 

机构地区：[1]泸州医学院附属医院风湿免疫科,646000 [2]泸州医学院附属医院眼科,646000

出　　处：《实用医学杂志》2010年第7期1187-1189,共3页The Journal of Practical Medicine

摘　　要：目的:探讨强直性脊柱炎(AS)伴发葡萄膜炎的临床特征、诊断、治疗及预后,提高对该病的认识。方法:回顾性分析从2006年1月至2008年10月在本院就诊的AS伴发葡萄膜炎患者的临床特点、诊断、治疗和预后。结果:AS伴发葡萄膜炎患者16例(17只眼),男14例,女2例;AS发病年龄14～47岁,平均(32±12)岁;葡萄膜炎发病年龄15～52岁,平均(33±14)岁,病史7d～4年,持续时间为10～42d,平均(28±8)d,有反复发作;15例为单眼受累,双眼受累者1例(6.25%),为单眼交替发病;所有患眼均表现为急性非肉芽肿性前葡萄膜炎;16例(100%)患者均有腰痛史,X线影像学检查显示均为骶髂关节炎,15例(93.75%)HLA-B27检查为阳性;经糖皮质激素和睫状肌麻痹剂眼液治疗后,15例好转,1例效果不佳,使用肿瘤坏死因子-α抑制剂治疗后好转。结论:AS伴发葡萄膜炎多发生于男性,多呈急性、非肉芽肿性前葡萄膜炎表现;与HLA-B27和病情活动有关;根据典型的临床特征和影像学改变可确诊;主要治疗方法为滴用睫状肌麻痹剂和糖皮质激素眼液,并要积极控制AS,对治疗效果不佳者可使用肿瘤坏死因子-α抑制剂;绝大多数患者预后良好。Objective To investigate the clinical characteristics of uveitis associated with ankylosing spondylitis （AS）. Methods Analyzing the clinical, laboratory and treatment data of uveitis associated with AS patients hospitalized from 2006.1.1 to 2008.10.31 retrospectively. Results Of 16 （17 eyes） patients, 14 were male. The median age of AS was （32 ± 12） （14 - 47） years old and uveitis was （33 ± 14）（ 15 - 52） years old; the history of uveitis was 7 days to 4 years and the median duration was （28 ± 8） （10 - 42） days. All cases were acute nongranulomatous anterior uveitis and could break out repeately; 15 （93.75%） cases were monocular involvement, while 1 （6.25%） case was binocular involvement （monocular inflamation alternately）. All cases had typical history of lower back pain and definitely radiologieal evidences of sacroiliitis. HLA-B27 of 15 （93.75%） cases was positive. All cases were treated with corticosteroids and cycloplegic agent eyedrops, 15 （93.75%） cases were improved, while 1 （6.25%） cases was improved by using tumor necrosis factor-a （TNF-a） inhibitor simultaneously. Conclusion Uveitis associated with AS, mostly occurs in male, is characterized by acute nongranulamatous anterior uveitis. It is related with HLA-B27 and the activity of AS. Diagnosis is made according to typical clinical features and radiological evidences of sacroiliitis. Tightly contol the activity of AS and the treatment with corticosteroids and cycloplegic agent eyedrops are able to resolve the inflammation rapidly. The patients who can not contol by the traditional treatment also can be improved by using TNF-a inhibitor simultaneously. The prognosis is good in most patients.

关 键 词：脊柱炎 强直性 葡萄膜炎 诊断 治疗 

分 类 号：R593.23[医药卫生—内科学] R773[医药卫生—临床医学]