利福布汀在获得性免疫缺陷综合征患者中引起的前房积脓型葡萄膜炎  

Rifabutin-associated hypopyon uveitis in AIDS patients

作　　者：何太雯[1] 卢洪洲[1] 杨娅玲[1] 陈利荣 张仁芳[1] 江睿 HE Taiwen;LU Hongzhou;YANG Yaling;CHEN Lirong;ZHANG Renfang;JIANG Rui(Department of Ophthalmology,Shanghai Public Health Clinical Center,Shanghai 201508,China;Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]上海市公共卫生临床中心眼科,上海201508 [2]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2023年第1期64-68,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：上海市2020年度“科技创新行动计划”医学创新研究专项-上海市感染性疾病(艾滋病)临床医学研究中心(20MC1920100)。

摘　　要：目的 提高对利福布汀相关性前房积脓型葡萄膜炎的认识、诊断及治疗能力。方法 回顾性系列病例研究。回顾分析14例(24眼)获得性免疫缺陷综合征(AIDS)合并结核分枝杆菌复合群(MTC)或非结核分枝杆菌(NTM)感染患者应用利福布汀后发生前房积脓型葡萄膜炎的眼部临床表现及其治疗随访结果。结果本组病例中,男性13例、女性1例;年龄24~78岁,平均(42.50±14.29)岁;体重44~73 kg,平均(54.21±9.07)kg。CD_(4)^(+)T淋巴细胞(19~260)个/μL,平均(91.07±59.36)个/μL。临床表现:单眼或双眼(同时或先后)急性发作眼红、眼痛、畏光、视力明显下降。大量角膜后沉积物,前房纤维素性渗出,前房积脓,虹膜后粘连。眼底无法窥及。B超示玻璃体大量团状强回声影。治疗:14例均给予局部糖皮质激素类药物、扩瞳剂治疗。1例除局部治疗外给予全身应用甲泼尼龙40 mg, 3 d。14例(24眼)患者眼部病变均迅速完全缓解,8眼葡萄膜炎复发。结论 随着利福布汀的广泛应用,利福布汀相关性葡萄膜炎日益增多,医师应重视这种潜在的并发症。认识此病,可以避免前房穿刺、玻璃体注药、玻璃体切除术等有创操作。及时治疗可大大提高患者视力,减少并发症的发生。Objective To improve the knowledge, diagnostic and therapeutic ability of rifabutin-associated hypopyon uveitis.Methods Retrospective case series. The ocular clinical features, therapy and follow-up results of 14 AIDS patients(24 eyes) with rifabutin-associated hypopyon uveitis were analyzed.Results Thirteen males and 1 female aged from 24 to 78 years and weighting from 44 to 73 kilograms were included. The means of CD_(4)^(+)T-lymphocyte counts of the 14 patients were( 91.07±59.36) cells/μL. Unilateral or bilateral hypopyon uveitis developed in all patients. All cases presented with acute onset of redness, pain,photophobia and blurred vision of the affected eyes. Keratic precipitates, hypopyon and iris posterior synechiae were seen in all patients. The fundus cannot be seen. B-scan ultrasonography showed extensive strong flake echoes in the vitreous. All patients were treated with topical steroids and mydriatic drops. In one case, systemic and topical treatment with steroids was applied. All 14 patients(24 eyes) showed rapid and complete remission of ocular lesions. The relapse occurred in 8 patients. Conclusions With the widespread use of rifabutin, the incidence of rifabutin-associated uveitis is increasing. Ophthalmologists should pay attention to this potential complication. Recognition of rifabutin-associated hypopyon uveitis may prevent unnecessary invasive diagnostic and therapeutic procedures. Timely treatment can greatly improve the vision and reduce the incidence of complications.

关 键 词：利福布汀 前房积脓 葡萄膜炎 获得性免疫缺陷综合征 

分 类 号：R773[医药卫生—眼科]