本文選題：梅毒　切入點(diǎn)：葡萄膜炎　出處：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:總結(jié)就診于我院葡萄膜炎與免疫相關(guān)眼病門診的梅毒葡萄膜炎及梅毒鞏膜炎病例的臨床資料,探討梅毒性眼病的流行病學(xué)、臨床表現(xiàn)、臨床診療及預(yù)后的相關(guān)因素。方法:回顧性分析回顧性分析2011年3月~2016年3月就診于我院葡萄膜炎與免疫相關(guān)眼病門診的梅毒性葡萄膜炎21例33眼及梅毒性鞏膜炎7例7眼的臨床資料。所有患者均經(jīng)臨床及血清學(xué)檢查確診,總結(jié)梅毒性眼病患者的全身表現(xiàn)和眼部臨床特征,對(duì)比探討易被誤診為梅毒性葡萄膜炎的其他相關(guān)眼病。針對(duì)所有病例初診時(shí)的最佳矯正視力(BCVA)、梅毒的治療時(shí)機(jī)、及視力預(yù)后等方面進(jìn)行相關(guān)性分析,探討影響疾病發(fā)展、治療及視力預(yù)后的相關(guān)因素。采用單變量分析法,分析在常規(guī)驅(qū)梅治療前全身應(yīng)用免疫抑制劑與最終BCVA的相關(guān)性;采用線性相關(guān)分析法,分析患者年齡、疾病持續(xù)時(shí)間及初診BCVA與最終BCVA的相關(guān)性;采用多元線性回歸法,分析所有變量與預(yù)后視力相關(guān)的危險(xiǎn)因素,及梅毒延遲治療與視力預(yù)后的相關(guān)性。結(jié)果:28例病例(33眼)診斷為梅毒性眼病,梅毒性葡萄膜炎21例,梅毒性鞏膜炎7例;27例病例血清學(xué)檢測(cè)RPR和TPPA均為陽性,1例患者RPR陰性,TPPA陽性。其中,在21例梅毒性葡萄膜炎中,首次確診梅毒18例,11例為雙眼,7例為單眼,平均年齡為(48.1±11.7)歲,8例為男性(38.1%),13例為女性(61.9%);31眼(93.9%)主訴視物模糊,其次是閃光感(14眼,42.4%),眼紅(11眼,33.3%),眼痛(7眼,21.2%),畏光(7眼,21.2%)。21例病例病程持續(xù)6天~24個(gè)月,10例病例病程長達(dá)6個(gè)月,僅2例病例病程少于1個(gè)月;33只眼中,后葡萄膜炎19只眼(57.6%),全葡萄膜炎13只眼(39.4%),中間葡萄膜炎1只眼(3.0%);后部葡萄膜炎主要表現(xiàn)為彌漫性脈絡(luò)膜視網(wǎng)膜炎,其他類型主要表現(xiàn)為視神經(jīng)視網(wǎng)膜炎、視乳頭炎、視網(wǎng)膜炎及后盾鱗狀脈絡(luò)膜視網(wǎng)膜炎。在7例梅毒性鞏膜炎,男性5例(71.4%),女性2例(28.6%),7例病例均是首次確診梅毒,7例均為單眼,平均年齡(46.6±9.90)歲;7眼(100%)主訴眼紅、眼痛,1例患者夜間疼痛加重,1例患者伴有視力下降;7例患者的病程持續(xù)時(shí)間在7天~24月,5例患者病程均大于1月,2例患者病程小于1個(gè)月。前部結(jié)節(jié)性鞏膜炎是最常見的鞏膜炎類型,其次是為表層鞏膜炎、彌漫性前鞏膜炎、彌漫性前部表層鞏膜炎,且1例鞏膜炎伴有后部鱗性脈絡(luò)膜視網(wǎng)膜病變。分析結(jié)果顯示:單變量分析表明,在驅(qū)梅治療前應(yīng)用全身免疫抑制劑治療與較差BCVA結(jié)果相關(guān);在線性相關(guān)分析中,疾病的持續(xù)時(shí)間和年齡與最終BCVA呈負(fù)相關(guān),然而最初的BCVA與最終的BCVA呈正相關(guān);然而,多元線性回歸發(fā)現(xiàn)最初低矯正視力BCVA(P=0.022)和梅毒延遲治療(P0.001)與視力預(yù)后顯著相關(guān)性。結(jié)論:在我國,梅毒感染發(fā)病呈上升趨勢(shì),梅毒患者可無全身表現(xiàn)而僅以眼部梅毒為首發(fā)癥狀就診,若不加以警惕則容易貽誤診治。臨床上,結(jié)合眼部和全身表現(xiàn)、血清學(xué)檢查及驅(qū)梅治療效果可以幫助醫(yī)生盡早明確診斷,從而制定正確、合理且有效的治療方案,對(duì)縮短病程及改善預(yù)后起到至關(guān)重要的作用。
[Abstract]:Objective: To summarize the clinical data in the treatment of uveitis and immune associated ophthalmopathy in our hospital outpatient syphilis syphilis cases of uveitis and scleritis, epidemiology, clinical manifestations of syphilis disease related factors, clinical diagnosis and prognosis. Methods: a retrospective analysis of clinical data were retrospectively analyzed in March 2011 ~2016 year in March in our hospital treatment of uveitis and immune related the eye clinic of syphilitic uveitis in 21 cases 33 eyes and 7 eyes of 7 cases of syphilis scleritis. All patients were diagnosed by clinical and serological examination, summarize syphilis patients ophthalmopathy is systemic and ocular clinical features, compare easy to be misdiagnosed as other diseases of syphilitic uveitis. The best corrected visual acuity of all cases when newly diagnosed (BCVA), the timing of treatment of syphilis, and visual acuity and correlation analysis, to explore the influence of the development of the disease, treatment and The related factors of the visual prognosis. By univariate analysis, correlation analysis in conventional antisyphilitic treatment before systemic immunosuppression and eventually BCVA; using linear correlation analysis method, analysis of patient age, disease duration and newly diagnosed BCVA and eventually BCVA; using multiple linear regression analysis, all variables associated with prognosis the vision of risk factors, correlation of syphilis and delayed treatment and the prognosis of visual acuity. Results: 28 cases (33 eyes) for the diagnosis of syphilitic ophthalmopathy, syphilitic uveitis in 21 cases, 7 cases of syphilis scleritis; 27 cases of serological detection of RPR and TPPA were positive, 1 cases of patients with RPR negative and TPPA positive. Among them, in 21 cases of inflammation, first diagnosed 18 cases of syphilis, 11 cases were bilateral, 7 cases were unilateral, average age (48.1 + 11.7) years old, 8 cases were male (38.1%), 13 cases were female (61.9%); 31 eyes (93.9%) complained of blurred vision ,鍏舵鏄棯鍏夋劅(14鐪，

本文編號(hào)：1688494