白塞综合征葡萄膜炎临床特点分析  

Clinical features of patients with Behcet′s uveitis

作　　者：刘新书[1,2] 高斐 赵潺[1] 张美芬[1] Liu Xinshu;Gao Fei;Zhao Chan;Zhang Meifen(Department of Ophthalmology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Ophthalmology,the Fourth People′s Hospital of Shenyang,Shenyang 110031,China)

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 [2]沈阳市第四人民医院眼科,110031

出　　处：《中华眼科杂志》2020年第3期217-223,共7页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金(81770917);北京市科技计划(Z171100001017217)。

摘　　要：目的总结白塞综合征葡萄膜炎(BU)的临床特点。方法回顾性系列病例研究。收集1998年1月至2015年11月就诊于北京协和医院眼科葡萄膜炎专业组的BU患者,整理临床资料。总结BU的临床表现、并发症、最佳矫正视力(最小分辨角对数视力)及药物治疗方案。分析不同病程视力变化情况及生物制剂治疗前后BU复发次数。应用χ2检验及Wilcoxon符号秩检验进行统计学分析。结果共纳入132例(233只眼)BU患者,其中男性104例(78.8%),女性28例(21.2%),性别分布差异有统计学意义(χ2=43.76,P<0.01)。BU发病年龄为(28.9±8.7)岁,主要集中在21~40岁(102例,77.3%)。口腔溃疡(132例,100.0%)、皮肤病变(103例,78.0%)、外阴溃疡(90例,68.2%)、关节受累(44例,33.3%)及针刺反应阳性(39例,29.5%)为BU前5位眼外表现。患者常双眼受累(101例,76.5%),全葡萄膜炎(110例,83.3%)为最主要的葡萄膜炎类型。共188只眼(80.7%)出现并发症,最常见的眼前、后节并发症分别为并发性白内障(58.8%,137/233)及黄斑水肿(59.1%,114/193)。病程前8年,患者视力呈下降趋势;在病程第8年,20.9%(9/43)的患眼最佳矫正视力<0.3,39.5%(17/43)的患眼最佳矫正视力>1.0。97.0%(128/132)的患者接受糖皮质激素联合免疫抑制剂治疗。16例顽固性BU加用生物制剂(肿瘤坏死因子拮抗剂或干扰素α)后BU复发频次显著减少,由4.0(1.0,5.5)次/年降至0.5(0.0,1.5)次/年,差异有统计学意义(Z=-2.81,P=0.005)。结论BU在青壮年男性中多见,常累及双眼,主要表现为全葡萄膜炎。患者眼部并发症极为常见,视力严重受损。糖皮质激素联合免疫抑制剂在多数情况下可控制眼内炎性反应,但对于顽固性葡萄膜炎,生物制剂的应用取得较好疗效。Objective To characterize the clinical features of patients with Behcet′s uveitis.Methods Retrospective case series study.Medical records of patients who were diagnosed as Behcet′s uveitis in Peking Union Medical College Hospital between January 1998 and November 2015 were retrospectively reviewed.Information about the clinical manifestation,complication,best corrected visual acuity(logarithm of the minimum angle of resolution)and medication was collected.The correlation of visual acuity and the disease course,as well as inflammation relapse times before and after biological agents applied was analyzed.Chi square test and Wilcoxon signed-rank test were applied for statistical analysis.Results A total of 132 patients(233 eyes)with Behcet′s uveitis were included,among which 104(78.8%)were male and 28(21.2%)were female,with statistically significant difference(χ2=43.76,P<0.01).The average age at the onset of uveitis was(28.9±8.7)years,with most patients at 21-40 years(102 cases,77.3%).Oral aphthae(132 cases,100.0%)were the most frequent extraocular manifestations,followed by dermatologic lesions(103 cases,78.0%),genital ulcers(90 cases,68.2%),arthritis(44 cases,33.3%)and positive pathergy test(39 cases,29.5%).Ocular involvement was bilateral in 76.5%(101 cases)of the patients,and panuveitis was the most common type(110 cases,83.3%).Complications were seen in 80.7%(188/233)of the eyes,with cataract(58.8%,137/233)and macular edema(59.1%,114/193)being the most common anterior and posterior segment complications,respectively.At the eighth year of uveitis,best corrected visual acuity decreased to less than 0.3 in 20.9%(9/43)of the eyes,and more than 1.0 in 39.5%(17/43)of the eyes.A combination of glucocorticoids and immune modulators remained the first line therapy(97.0%,128/132)for Behcet′s uveitis.For 16 refractory cases,an addition of biological agents significantly reduced the inflammation relapse[0.5(0.0,1.5)times per year vs.4.0(1.0,5.5)times per year,Z=-2.81,P=0.005].Conclusions Behcet′s uveitis mainly

关 键 词：贝赫切特综合征 葡萄膜炎 视敏度 干扰素Α 

分 类 号：R77[医药卫生—眼科]