新型冠状病毒感染后急性神经视网膜病变临床特征的初步研究  

Clinical characteristics of acute macular neuroretinopathy in China associated with COVID-19 infection

作　　者：陆遥[1] 洪晶[1] 窦宏亮[1] 马佰凯 王常观[1] Lu Yao;Hong Jing;Dou Hongliang;Ma Baikai;Wang Changguan(Department of Ophthalmology,Peking University Third Hospital,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve,Beijing 100191,China)

机构地区：[1]北京大学第三医院眼科、眼部神经损伤的重建保护与康复北京市重点实验室,北京100191

出　　处：《中华眼科杂志》2024年第7期611-617,共7页Chinese Journal of Ophthalmology

摘　　要：目的探讨新型冠状病毒感染后的急性神经视网膜病变(AMN)的临床特征。方法回顾性病例系列研究。收集2022年11月至2023年1月在北京大学第三医院眼科诊断为AMN的15例(28只眼)新型冠状病毒感染者资料作为AMN组,其中男性4例,女性患者11例,年龄为(31.36±8.08)岁。同期选择新型冠状病毒感染后未发生AMN者15名作为对照组,其中男性5例,女性10例,年龄为(33.20±5.10)岁。收集所有患者的最佳矫正视力(BCVA)、裂隙灯检查、散瞳后眼底检查、彩色眼底照相、荧光素眼底血管造影术(FFA)、相干光层析成像术(OCT)检查结果。对两组受试者进行血清细胞因子检测,包括白细胞介素(IL)类、干扰素(IFN)类以及肿瘤坏死因子α的水平。结果28只眼中,严重视力下降(BCVA≤0.3)者3只眼(10.7%),中度视力下降(BCVA>0.3且≤0.5)者2只眼(13.3%),轻度视力下降(BCVA>0.5且≤1.0)者23只眼(82.1%)。所有28只眼在OCT上均表现为外核层高反射及外层视网膜结构的不连续,其中有3只眼同时伴有后极部视网膜1处或多处棉絮斑(10.7%),2只眼伴有轻度黄斑囊样水肿和视网膜内高反射点(7.1%),1只眼同时伴有旁中心性急性黄斑病变(3.6%)。有2例(4只眼,14.3%)FFA检查结果提示伴有视网膜血管炎。AMN组和对照组血清IL-4分别为4.49(3.66,6.08)和1.40(0.62,1.68)pg/ml、IL-5分别为7.34(5.04,14.06)和0.17(0.11,1.86)pg/ml、IFN-α分别为8.42(6.31,14.89)和0.50(0.30,0.83)pg/ml、IFN-γ分别为17.93(12.75,32.44)和7.43(0.00,14.74)pg/ml,两组差异均有统计学意义(均P<0.05)。结论新型冠状病毒感染后AMN除表现为黄斑区楔形暗红色病灶外,还可合并棉絮斑以及视网膜血管炎,同时伴有血清多种炎症因子的升高。Objective To investigate the clinical features of acute macular neuroretinopathy(AMN)following coronavirus disease 2019(COVID-19).Methods This retrospective case series study included 15 patients(28 eyes)diagnosed with AMN at the Department of Ophthalmology,Peking University Third Hospital,from November 2022 to January 2023.The AMN group comprised 4 males and 11 females,with a mean age of(31.36±8.08)years.A control group of 15 individuals[5 males,10 females;mean age(33.20±5.10)years]who had COVID-19 but did not develop AMN was also included.Data collected for all patients included best-corrected visual acuity(BCVA),slit-lamp examination,dilated fundus examination,color fundus photography,fluorescein fundus angiography(FFA),and optical coherence tomography(OCT)results.Serum cytokine levels,including interleukins(ILs),interferons(IFNs),and tumor necrosis factor-alpha(TNF-α),were measured for both groups.Results Among the 28 eyes,severe vision loss(BCVA≤0.3)was observed in 3 eyes(10.7%),moderate vision loss(BCVA>0.3 and≤0.5)in 2 eyes(13.3%),and mild vision loss(BCVA>0.5 and≤1.0)in 23 eyes(82.1%).OCT findings in all 28 eyes revealed hyperreflectivity of the outer nuclear layer and disruption of outer retinal structure.Additionally,3 eyes(10.7%)exhibited cotton wool spots in the posterior pole,2 eyes(7.1%)showed mild cystoid macular edema with intraretinal hyperreflective dots,and 1 eye(3.6%)presented with paracentral acute middle maculopathy.FFA indicated retinal vasculitis in 2 cases(4 eyes,14.3%).Serum levels of IL-4,IL-5,IFN-α,and IFN-γwere significantly higher in the AMN group compared to the control group:IL-4[4.49(3.66,6.08)vs.1.40(0.62,1.68)pg/ml],IL-5[7.34(5.04,14.06)vs.0.17(0.11,1.86)pg/ml],IFN-α[8.42(6.31,14.89)vs.0.50(0.30,0.83)pg/ml],and IFN-γ[17.93(12.75,32.44)vs.7.43(0.00,14.74)pg/ml],with all differences being statistically significant(all P<0.05).Conclusion AMN following COVID-19 can present with wedge-shaped dark red lesions in the macular area,often accompanied by cotton wool spots and

关 键 词：新型冠状病毒感染 白点综合征 黄斑变性 视网膜血管炎 细胞因子类 

分 类 号：R511[医药卫生—内科学] R774.1[医药卫生—临床医学]