转甲状腺素蛋白基因Gly83Arg突变致玻璃体淀粉样变性一家系玻璃体切割手术后继发性青光眼观察分析  

Long-term follow-up observation after vitrectomy in a family with vitreous amyloidosis due to transthyretin gene Gly83Arg mutation

作　　者：李红 陈兴旺 宿罡 任荟璇 芶越 蒋模 聂小梅 谢兵 蔡善君 Li Hong;Chen Xingwang;Su Gang;Ren Huixuan;Gou Yue;Jiang Mo;Nie Xiaomei;Xie Bin;Cai Shanjun(Department of Ophthalmology,Guizhou Eye Hospital,The Affiliated Hospital of Zunyi Medical University,Guizhou Branch of National Clinical Research Center for Ophthalmopathy,Special Key Laboratory of Ocular Diseases of Guizhou Province,Zunyi 563003,China)

机构地区：[1]遵义医科大学附属医院眼科,贵州省眼科医院,国家眼病临床研究中心贵州省分中心,贵州省眼疾病特色重点实验室,563003

出　　处：《中华眼底病杂志》2021年第6期418-422,共5页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金(31871261,81760174);贵州省创新人才团队项目(黔科合平台人才[2018]5601);贵州省科技计划项目(黔科合基础-ZK[2021]一般423);遵义医学院附属医院硕士科研启动基金(院字(2016)43号)。

摘　　要：目的长期观察转甲状腺素蛋白(TTR)基因Gly83Arg突变致一家系玻璃体淀粉样变性玻璃体切割手术继发性青光眼的发生情况,探索其可能原因。方法回顾性病例研究。2008年1月至2020年1月于遵义医科大学附属医院眼科确诊为TTR基因Gly83Arg突变致家族性玻璃体淀粉样变性的一家系13例23只眼纳入研究。其中,男性7例12只眼,女性6例11只眼;平均年龄(43.0±4.8)岁。患眼均行经睫状体平坦部标准三通道玻璃体切割手术。根据手术中是否形成完全玻璃体后脱离(PVD)分为完全PVD组和非完全PVD组;根据手术后继发性青光眼发生及玻璃体淀粉样变性复发时间分为1~12个月组、13~36个月组,>37个月组。手术后平均随访时间(36.7±6.0)个月。组间继发性青光眼发生率及玻璃体淀粉样变性复发率比较采用χ^(2)检验;手术后玻璃体淀粉样变性复发和继发性青光眼相关性采用Spearman秩相关分析。结果23只眼中,完全PVD组、非完全PVD组分别为8、15只眼。手术后玻璃体淀粉样变性复发15只眼(65.22%,15/23)。非完全PVD组、完全PVD组分别为14(93.30%,14/15)、1(6.70%,1/15)只眼;两组玻璃体淀粉样变性复发率比较,差异有统计学意义(χ^(2)=11.676,P<0.01)。1~12个月组、13~36个月组、>37个月组分别为1(4.35%,1/23)、12(52.17%,12/23)、2(8.70%,2/23)只眼。13~36个月组复发率显著高于1~12个月组、>37个月组。手术后发生继发性青光眼11只眼(47.80%,11/23)。1~12个月组、13~36个月组、>37个月组分别为1(4.35%,1/23)、8(34.78%,8/23)、2(8.70%,2/23)只眼。13~36个月组继发性青光眼发生率高于1~12个月组、>37个月组。继发性青光眼11只眼中,手术后玻璃体淀粉样变性复发眼10只,非复发眼1只。Spearman秩相关分析结果显示,玻璃体淀粉样变性复发与继发性青光眼发生之间呈正相关(rs=0.516,P=0.012)。结论TTR基因Gly83Arg突变所致的玻璃体淀粉样变性一家系玻璃体切割手术后�Objective To investigate the causes of secondary glaucoma after vitrectomy for familial vitreous amyloidosis associated with transthyretin(TTR)gene Gly83Arg mutation.Methods A retrospective case study.From January 2008 to January 2020,13 cases(23 eyes)with hereditary vitreous amyloidosis and treated by vitrectomy in the Affiliated Hospital of Zunyi Medical University were collected.Among them,there were 7 males with 12 eyes and 6 females with 11 eyes.The average age was 43.0±4.8 years.All the affected eyes underwent standard three-channel vitrectomy through the flat part of the ciliary body.According to whether complete vitreous detachment(PVD)was formed during the operation,it was divided into complete PVD group and incomplete PVD group;according to the occurrence time of secondary glaucoma and vitreous amyloidosis after surgery,it was divided into 1-12 months group and 13-36 months group,>37 months group.The average follow-up time after surgery was 36.7±6.0 months.The incidence of secondary glaucoma and the recurrence rate of vitreous amyloidosis between groups were compared byχ^(2) test;the correlation between recurrence of vitreous amyloidosis and secondary glaucoma after surgery was analyzed by Spearman rank correlation analysis.Results Among the 23 eyes,there were 8 eyes in the complete PVD group and 15 eyes in the incomplete PVD group,respectively.Vitreous amyloidosis recurred in 15 eyes(65.22%,15/23)after surgery.There were 14(93.30%,14/15)and 1(6.70%,1/15)eyes in the incomplete PVD group and the complete PVD group,respectively;the comparison of the recurrence rate of vitreous amyloidosis between the two groups was statistically significant(χ^(2)=11.676,P<0.01).1-12 months group,13-36 months group,>37 months group included 1(4.35%,1/23),12(52.17%,12/23),2(8.70%,2/23)Only eye.The recurrence rate in the 13-36 months group was significantly higher than that in the 1-12 months group and>37 month group.Secondary glaucoma occurred in 11 eyes(47.80%,11/23)after surgery.1-12 months group,13-36 months group,ab

关 键 词：淀粉样变 家族性 玻璃体切除术 青光眼 

分 类 号：R779.6[医药卫生—眼科]