眼弓形虫病临床特征及治疗预后分析  

Clinical characteristics and treatments of patients with ocular toxoplasmosis

作　　者：成拾明 张茂菊 阮坤炜 张勇 陶勇[4] Cheng Shiming;Zhang Maoju;Ruan Kunwei;Zhang Yong;Tao Yong(Department of Ophthalmology,Taihe Hospital,Affiliated Hospital of Hubei University of Medicine,Shiyan 442000,China;Department of Ophthalmology,Central Hospital of Enshi Autonomous Prefecture,Enshi 445000,China;Graduate School of Jinzhou Medical University,Jinzhou 121001,China;Department of Ophthalmology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]湖北省十堰市太和医院眼科湖北医药学院附属医院,442000 [2]湖北省恩施州中心医院眼科,445000 [3]锦州医科大学研究生院,121001 [4]首都医科大学附属北京朝阳医院眼科,100020

出　　处：《中华眼底病杂志》2020年第9期680-684,共5页Chinese Journal of Ocular Fundus Diseases

基　　金：湖北省卫生厅面上项目(WJ2019M056)。

摘　　要：目的观察眼弓形虫病(OT)患者的临床特征和治疗预后。方法回顾性临床研究。2011年7月至2019年6月于十堰市太和医院眼科及北京朝阳医院眼科临床及实验室检查确诊的OT患者12例14只眼纳入研究。患者中,男、女性各为6例7只眼;平均年龄(33.4±12.8)岁;病程7 d^30年。首诊误诊为真菌性眼内炎、病毒性葡萄膜炎及非感染性葡萄膜炎各2例。患者均行BCVA、眼压、裂隙灯显微镜、眼底彩色照相检查及血清学弓形虫特异性抗体检查。行眼内液检测7例。其中,仅行弓形虫抗体检测1例;Goldmann-witmer系数(GWC)检测6例,同时行PCR检测4例。行FFA检查5例6只眼;OCT检查6例6只眼。行抗弓形虫药物治疗11例。治疗后随访时间1周~39个月。回顾分析患者的临床表现特征和治疗预后。结果所有患者血清弓形虫特异性抗体检测结果均为阳性。行眼内液检测7例中,弓形虫IgG抗体阳性1例;GWC>4者5例,2<GWC<4者1例。同时行PCR检测的4例中,阳性1例(25.0%,1/4),为2<GWC<4者。14只眼中,BCVA<0.1、0.1~0.3、>0.3者分别为4、6、4只眼。病灶活动期、晚期分别为12、2只眼。角膜后沉着物伴或不伴前房闪辉或前房细胞6只眼;先天性黄斑缺损1只眼;玻璃体炎3只眼,其中伴多个视网膜色素沉着灶、牵拉性视网膜脱离分别为2、1只眼;新旧病灶并存合并Kyrieleis动脉炎2只眼。活动期12只眼中,伴不同程度玻璃体炎9只眼(75.0%,9/12)。单一病灶4只眼;多个病灶10只眼。治疗前后患眼BCVA比较,差异无统计学意义(P=0.83)。患者视力预后差的主要原因包括原发病灶累及或靠近黄斑区、误诊及误治。结论OT眼底可呈单病灶或多病灶改变,活动期常伴有玻璃体炎症;原发病灶累及或靠近黄斑区、误诊及误治是患者视力预后差的主要原因。Objective To investigate the clinical characteristics,treatments and prognosis of ocular toxoplasmosis(OT).Methods A retrospective clinical trial.Twelve cases(14 eyes)with OT which was confirmed by clinical and laboratory tests were included in the Department of Ophthalmology,Taihe Hospital in Shiyan and the Department of Ophthalmology,Beijing Chaoyang Hospital in Beijing from July 2011 to June 2019.Among the 12 cases,6 cases were female(7 eyes)and 6 cases were male(7 eyes).The mean age of the participants was 33.4±12.8 years and the duration of illness ranged from 7 days to 30 years.Fungal endophthalmitis,viral uveitis and non-infectious uveitis were misdiagnosed in 2 cases respectively at the first visit.All the patients underwent BCVA,intraocular pressure,slit-lamp microscope,fundus color photography examinations and toxoplasma-specific serological antibodies tests.Intraocular influid were detected for 7 cases,among which 1 case for antibody only,and 6 cases for Goldmann-witmer coefficient(GWC).Of the 6 cases tested for GWC,4 cases were tested with PCR assay in the ocular fluid addtionally.FFA was performed in 5 cases(6 eyes)and OCT in 6 cases(6 eyes).Eleven cases were treated with antitoxoplasma therapy.The follow-up duration after treatment varied from 1 week to 39 months.BCVA,clinical features and prognosis were retrospectively analyzed.Results Specific antibody seropositivity of Toxoplasma gondii was detected in all 12 patients.Of the 7 cases tested with intraocular fluid,1 case was IgG positive and the other 6 cases with 5 cases with GWC>4 and 1 case with 2<GWC<4.Only 1 case(25%)was positive among 4 cases with PCR assays meanwhile.BCVA was:<0.1 in 4 eyes,0.1~0.3 in 6 eyes and>0.3 in 4 eyes.KPs with or without anterior chamber flash or cells could be detected in 6 eyes,congenital macular defect 1 eye,vitreitis 3 eyes(2 eyes with multiple retinal pigmentation foci and 1 eye with tractive retinal detachment),and coexistence of new and old lesions with Kyrieleis arteritis 2 eyes.Nine eyes showed different de

关 键 词：弓形虫病 眼/诊断 弓形虫病 眼/治疗 预后 

分 类 号：R771.3[医药卫生—眼科] R531.8[医药卫生—临床医学]