急性视网膜坏死的病原学研究  

Etiological study of acute retinal necrosis

作　　者：徐海燕[1] 叶俊杰[1] 耿爽[1] 

机构地区：[1]中国医学科学院 北京协和医学院 北京协和医院眼科,100730

出　　处：《中华眼视光学与视觉科学杂志》2015年第5期265-269,共5页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的 探讨急性视网膜坏死（ARN）病原学研究在临床治疗中的价值.方法 回顾性系列病例研究.总结分析1996年1月至2012年12月在北京协和医院眼科诊断为ARN的39例（45眼）患者（ARN组）的临床资料.所有患者均行常规眼部检查.39例患者均抽取静脉血行血清TORCH检测,其中22例患者行血清总IgG检测.15眼于玻璃体切除术中抽取玻璃体液,行玻璃体液总TORCH及IgG检测.对照组为2006年6月至2008年11月因非感染性视网膜疾病而行玻璃体切除手术的患者15例（15眼）.15例患者术前均行血清总IgG检测,术中抽取玻璃体液,行玻璃体液总TORCH及IgG检测.数据采用独立样本t检验进行分析.结果 对照组患者血清总IgG含量为（10.02±2.69） g/L,ARN组为（10.10±2.38）g/L,2组差异无统计学意义.对照组玻璃体液总IgG为（135.3±178.0）mg/L;ARN患眼玻璃体液中检测出HSV-IgG、CMV-IgG,玻璃体液总IgG含量为（2 949.2±1 845.1）mg/L,2组患者的玻璃体液总IgG的差异有统计学意义（t=6.024,P＜0.01）.对照组血清HSV-IgG的几何平均滴度为86.10-62.02,ARN组为86.30-±-65.31,2组差异无统计学意义.ARN组患者7眼HSV的Goldmann-Witmer系数C值（CWC）＞6,提示为HSV感染;1眼CMV的CWC值＞6,提示CMV感染.结论 ARN患者玻璃体液的特异性病毒抗体检测可提示感染病原体,对因治疗可提高ARN的治疗效果.Objective To investigate the importance of etiological research in clinical therapy of acute retinal necrosis （ARN）.Methods Retrospective cases-series study.Analyzed the clinical data of 45 eyes （39 cases） of ARN patients who were diagnosised in the Department of Ophthalmology of PUMCH during January 1996 to December 2012.All patients underwent routine eye examination.Blood samples were taken from 39 patients for serum TORCH test,22 patients underwent total serum IgG detection.15 eyes underwent the TORCH and total IgG detection of vitreous humor.The control group：15 patients （15 eyes） underwent vitrectomy surgery for non-infectious retinal disease during June 2006 to November 2008 in PUMCH.During the process of operation,venous blood and vitreous humor was drawn for the total IgG and the TORCH test respectively.Data were analyzed using independent t test.Results The total IgG results of control group patients＆#39; was 10.02±2.69 g/L,and was 10.10±2.38 g/L in ARN group.The difference was not statistically significant.The Vitreous humor total IgG of control group was 135.3±178.0 mg/L.HSV-IgG and CMV-IgG was detected in the vitreous humor of 15 eyes,the average value of the total IgG of vitreous humor was 2 949.2±1 845.1 mg/L.The difference between vitreous humor total IgG was statistically significant （t=6.024,P〈0.01）.The Geometric mean titer （GMT） of blood serum HSV in control group was：86.10±62.02,and the GMT in ARN group was：86.30-265.31.The difference between two antibodies＆#39; GMT was not statistically significant.Among GWC values of ARN group,the GWC values of 7 eyes in HSV〉6,the value suggested the pathogens was HSV.Conclusion The pathogens were suggested by the detection of specific antibodies to the virus in vitreous humor.The treatment for the cause can improve the therapy of ARN.

关 键 词：视网膜坏死综合征 急性 实验室技术和方法 抗体滴度 Goldmann-Witmer系数C 

分 类 号：R774.1[医药卫生—眼科]