18例结核性后葡萄膜炎患者临床特征分析  

Clinical characteristics of 18 cases of tuberculous posterior uveitis

作　　者：张彦坤[1] 关艳 韩朝[1] 章志华[2] ZHANG Yan-kun;GUAN Yan;HAN Zhao;ZHANG Zhi-hua(Department of Ophthalmology,Hebei Chest Hospital,Shijiazhuang 050041,China;Department of Science and Education,Hebei Chest Hospital,Shijiazhuang 050041,China)

机构地区：[1]河北省胸科医院眼科,石家庄050041 [2]河北省胸科医院科教处,石家庄050041

出　　处：《结核与肺部疾病杂志》2022年第3期216-221,共6页Journal of Tuberculosis and Lung Disease

基　　金：河北省2019年度医学科学研究课题计划项目(20191029)。

摘　　要：目的:探讨结核性后葡萄膜炎的临床特征。方法:采用回顾性分析的方法,收集2018年5月至2020年6月河北省胸科医院眼科诊断为结核性后葡萄膜炎并接受规范化治疗的18例患者临床资料,对其临床特征进行描述性分析。结果:18例均为初治结核病患者,16例有就诊延迟,时间为14~90 d,仅1例有结核病密切接触史。根据眼部光学相干断层扫描(OCT)、眼底血管造影(FFA)、眼底照相等多模式检查,可分型为脉络膜结节8例(44.4%)、脉络膜结核瘤5例(27.8%)、视网膜下脓肿伴发脉络膜新生血管3例(16.7%)和匍行性脉络膜炎2例(11.1%)。16例(88.9%)血红细胞沉降率增快;18例T-SPOT.TB检测阳性;PPD试验一般阳性(硬结平均直径10~19 mm)和强阳性(硬结平均直径≥20 mm)患者各9例;5例行前房水眼内液宏基因mNGS检测者,1例妊娠期患者检出结核分枝杆菌而确诊。合并血行播散性肺结核者12例(66.7%),这些患者同时又合并结核性脑膜炎7例、脊柱结核和脾结核各2例、脑部结核瘤1例,其中抗酸杆菌痰涂片镜检阳性者7例、病变组织GeneXpert MTB/RIF阳性者6例,脊柱和脾组织病理均阳性。单纯眼部病变者6例(33.3%),均无全身不适症状,以视力下降为主,3例病变累及黄斑区者视力严重下降;均结合结核和眼科相关检查、试验性抗结核治疗有效后确诊。16例患者经抗结核药物联合皮质类固醇、2例合并脉络膜新生血管的患者在以上治疗基础上联合抗新生血管内皮生长因子治疗后视力均得以提高并趋于平稳。结论:结核性后葡萄膜炎多无结核病相关接触史和治疗史,易就诊延迟和漏诊。眼科多模式成像检查有助于结核性后葡萄膜炎临床分型,结核相关检查对其结核性诊断有重要意义,分子生物学及病理检查能帮助查找病原学依据,全身影像学检查能早期发现结核播散情况。抗结核药物联合皮质类固醇治疗效果良好,必要时还可玻璃Objective:To investigate the clinical characteristics of tuberculous posterior uveitis.Methods:A retrospective study was conducted in 18 patients diagnosed of tuberculous posterior uveitis in Hebei Chest Hospital from May 2018 to June 2020.All the patients accepted standardized treatment and the clinical data were collected,the clinical characteristics were descriptively analyzed.Results:The 18 patients were all newly treated,and 16 cases had delayed visit of 14-90 days.Only 1 patient had a history of close contact to tuberculosis.According to the multimodal examination of OCT,FFA and fundus photography,they were diagnosed as choroidal nodules(n=8,44.4%),choroidal tuberculoma(n=5,27.8%),subretinal abscess(n=3,16.7%)and creeping choroiditis(n=2,11.1%).The erythrocyte sedimentation rate increased in 16 cases(88.9%);T-SPOT TB test was found positive in 18 cases;as to PPD test,9 cases were generally positive(mean diameter of induration 10-19 mm)and 9 cases were strongly positive(mean diameter of induration≥20 mm);of the 5 cases tested with mNGS in the aqueous humor,the diagnosis was confirmed in one pregnancy case by detecting Mycobacterium tuberculosis.Of the 12 cases(66.7%)who complicated with hematogenous disseminated pulmonary tuberculosis,7 were also complicated with tuberculous meningitis,2 were complicated with spinal tuberculosis,2 were complicated with splenic tuberculosis,and 1 was complicated with brain tuberculoma;of them,7 were positive for acid fast bacilli sputum smear,6 cases were positive for GeneXpert MTB/RIF in diseased tissue,and the pathology of spine and spleen were positive.There were 6 cases(33.3%)were with simple eye lesions,without any general symptoms,and the main symptom was decreased vision;the visual acuity of 3 patients with macular lesions decreased seriously,and the diagnosis was made after tuberculosis,ophthalmic related examination and experimental anti-tuberculosis treatment were effective.For 16 patients treated with anti-tuberculous drugs combined with corticosteroids,and 2 pat

关 键 词：结核 眼 葡萄膜炎 后 疾病特征 

分 类 号：R529.8[医药卫生—内科学] R773.9[医药卫生—临床医学]