發(fā)布時間：2018-04-22 10:10

  本文選題：ARN + VZV��； 參考：《中國協(xié)和醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 目的：研究急性視網(wǎng)膜壞死(acute retinal necrosis, ARN)患者臨床表現(xiàn)、治療及預(yù)后之間的關(guān)系。 方法：對1999年1月至2009年12月期間我院收治的31例ARN患者(42只患眼)的臨床資料進行非對照性回顧性分析,其中19名患者取玻璃體液查單純皰疹病毒(herpes simplex virus, HSV)和巨細胞病毒(cytomegalovirus, CMV)抗體,并計算Goldmann-Witmer系數(shù)(C),9名患者玻璃體液采用酶聯(lián)免疫吸附試驗(enzyme-linked immunosorbent assay, ELISA)查水痘帶狀皰疹病毒(varicella zoster virus, VZV)抗體。 干預(yù)：靜脈滴注更昔洛韋或阿昔洛韋和玻璃體腔注射更昔洛韋進行抗病毒治療,口服糖皮質(zhì)激素進行抗炎治療,行眼底視網(wǎng)膜激光光凝術(shù)預(yù)防視網(wǎng)膜脫離(retinal detachment, RD),行玻璃體切除術(shù)聯(lián)合氣體或硅油填充術(shù)治療RD。 結(jié)果：雙眼發(fā)病患者共11例,均在全身抗病毒治療之前發(fā)病,所有單眼發(fā)病患者(20例)行全身抗病毒治療后對側(cè)眼均未發(fā)病。57.9%(11/19)的患眼有明確致病病毒,其中4只患眼HSV的Goldmann-Witmer系數(shù)(CHsv)8,1只患眼CMV的Goldmann-Witmer系數(shù)(CcMV)8,1只患眼CHSv和CCMV同時8,此外還有玻璃體HSV和CMV的IgM抗體陽性的患眼各1只,以及VZV的igM抗體陽性的患眼3只。RD組患眼發(fā)病距離全身抗病毒治療時間間隔比無RD組長(P=0.001)。無RD組中初診矯正視力≥0.1的患眼(71.4%,15/21)比RD組(38.1%,8/21)多(P=0.03)。視網(wǎng)膜主干血管白線(P=0.009)、視乳頭蒼白(P=0.045)和增殖性玻璃體視網(wǎng)膜病變(proliferative vitreoretinopathy, PVR)(P=0.001)在RD組中更為常見。繼發(fā)RD前行視網(wǎng)膜激光光凝術(shù)(P=0.13)或玻璃體腔注射更昔洛韋(P=0.76)與RD無明顯關(guān)系。行玻璃體切除聯(lián)合硅油填充術(shù)的患眼(共20只)末次隨診視網(wǎng)膜均在位,30.0%(6/20)的患眼末次隨診矯正視力≥0.1。57.1%(8/14)的無PVR患眼和14.3%(4/28)的PVR患眼末次隨診矯正視力較初診矯正視力提高(P=0.011)。末次隨診矯正視力≥0.1的22只患眼中,初診矯正視力≥0.1(23只)的患眼有19只,0.1(19只)的患眼有3只(P=0.000)。與末次隨診矯正視力≥0.1的患眼相比,RD(P=0.000)、視網(wǎng)膜主干血管白線(P=0.005)和PVR(P=0.000)在末次隨診矯正視力0.1的患眼中更為常見。 結(jié)論:ARN的致病病毒包括VZV、HSV和CMV。視網(wǎng)膜激光光凝術(shù)和玻璃體腔注射更昔洛韋不能預(yù)防RD。發(fā)生RD的ARN預(yù)后較差,影響視力提高的主要因素為PVR。在病變嚴重威脅視力之前盡早予靜脈滴注更昔洛韋能降低發(fā)生RD和累及健眼的風(fēng)險,維持有用視力。玻璃體切除聯(lián)合硅油填充術(shù)有助于改善預(yù)后。
[Abstract]:Objective: to study the relationship among clinical manifestation, treatment and prognosis of acute retinal necrosis (ARN) patients. Methods: the clinical data of 31 patients with ARN from January 1999 to December 2009 were analyzed retrospectively. The antibodies against herpes simplex virus (HSV) and cytomegalovirus (CMV) were detected in vitreous body fluid of 19 patients, and the Goldmann-Witmer coefficient was calculated. The antibodies against varicella zoster virus (VZVV) were detected by enzyme-linked immunosorbent assay (ELISAs) in vitreous body fluid of 9 patients with chickenpox herpes zoster virus by enzyme-linked immunosorbent assay (Elisa). Interventions: intravenous drip of ganciclovir or acyclovir and intravitreal injection of ganciclovir for antiviral therapy, oral glucocorticoid for anti-inflammatory treatment, Retinal laser photocoagulation was performed to prevent retinal detachment (RDV) and vitrectomy combined with gas or silicone oil implantation was performed for the treatment of RD. Results: 11 patients with binocular disease were diagnosed before systemic antiviral therapy, and 20 patients with monocular disease were treated with systemic antiviral therapy. There was no disease in the contralateral eye after systemic antiviral therapy. The Goldmann-Witmer coefficients of HSV in 4 eyes were as follows: the Goldmann-Witmer coefficients of CMV in 1 eye and the Goldmann-Witmer coefficient of CMV in 8 eyes. In addition, both CHSv and CCMV were found in 8 eyes. In addition, there were 1 patient eyes with positive HSV and CMV IgM antibody in vitreous body, 1 eye with IgM antibody positive in vitreous body, and 1 eye with IgM antibody positive in vitreous body. And 3 eyes with positive igM antibody in VZV. Rd group had a shorter interval from systemic antiviral therapy than that without Rd group (P < 0. 001). In the non-Rd group, 71.4% of the patients with primary corrected visual acuity 鈮，

本文編號：1786739