梅毒眼病的临床特征及预后相关因素分析
发布时间：2018-03-31 01:14
本文选题：梅毒 切入点：葡萄膜炎 出处：《天津医科大学》2017年硕士论文
【摘要】：目的:总结就诊于我院葡萄膜炎与免疫相关眼病门诊的梅毒葡萄膜炎及梅毒巩膜炎病例的临床资料,探讨梅毒性眼病的流行病学、临床表现、临床诊疗及预后的相关因素。方法:回顾性分析回顾性分析2011年3月~2016年3月就诊于我院葡萄膜炎与免疫相关眼病门诊的梅毒性葡萄膜炎21例33眼及梅毒性巩膜炎7例7眼的临床资料。所有患者均经临床及血清学检查确诊,总结梅毒性眼病患者的全身表现和眼部临床特征,对比探讨易被误诊为梅毒性葡萄膜炎的其他相关眼病。针对所有病例初诊时的最佳矫正视力(BCVA)、梅毒的治疗时机、及视力预后等方面进行相关性分析,探讨影响疾病发展、治疗及视力预后的相关因素。采用单变量分析法,分析在常规驱梅治疗前全身应用免疫抑制剂与最终BCVA的相关性;采用线性相关分析法,分析患者年龄、疾病持续时间及初诊BCVA与最终BCVA的相关性;采用多元线性回归法,分析所有变量与预后视力相关的危险因素,及梅毒延迟治疗与视力预后的相关性。结果:28例病例(33眼)诊断为梅毒性眼病,梅毒性葡萄膜炎21例,梅毒性巩膜炎7例;27例病例血清学检测RPR和TPPA均为阳性,1例患者RPR阴性,TPPA阳性。其中,在21例梅毒性葡萄膜炎中,首次确诊梅毒18例,11例为双眼,7例为单眼,平均年龄为(48.1±11.7)岁,8例为男性(38.1%),13例为女性(61.9%);31眼(93.9%)主诉视物模糊,其次是闪光感(14眼,42.4%),眼红(11眼,33.3%),眼痛(7眼,21.2%),畏光(7眼,21.2%)。21例病例病程持续6天~24个月,10例病例病程长达6个月,仅2例病例病程少于1个月;33只眼中,后葡萄膜炎19只眼(57.6%),全葡萄膜炎13只眼(39.4%),中间葡萄膜炎1只眼(3.0%);后部葡萄膜炎主要表现为弥漫性脉络膜视网膜炎,其他类型主要表现为视神经视网膜炎、视乳头炎、视网膜炎及后盾鳞状脉络膜视网膜炎。在7例梅毒性巩膜炎,男性5例(71.4%),女性2例(28.6%),7例病例均是首次确诊梅毒,7例均为单眼,平均年龄(46.6±9.90)岁;7眼(100%)主诉眼红、眼痛,1例患者夜间疼痛加重,1例患者伴有视力下降;7例患者的病程持续时间在7天~24月,5例患者病程均大于1月,2例患者病程小于1个月。前部结节性巩膜炎是最常见的巩膜炎类型,其次是为表层巩膜炎、弥漫性前巩膜炎、弥漫性前部表层巩膜炎,且1例巩膜炎伴有后部鳞性脉络膜视网膜病变。分析结果显示:单变量分析表明,在驱梅治疗前应用全身免疫抑制剂治疗与较差BCVA结果相关;在线性相关分析中,疾病的持续时间和年龄与最终BCVA呈负相关,然而最初的BCVA与最终的BCVA呈正相关;然而,多元线性回归发现最初低矫正视力BCVA(P=0.022)和梅毒延迟治疗(P0.001)与视力预后显著相关性。结论:在我国,梅毒感染发病呈上升趋势,梅毒患者可无全身表现而仅以眼部梅毒为首发症状就诊,若不加以警惕则容易贻误诊治。临床上,结合眼部和全身表现、血清学检查及驱梅治疗效果可以帮助医生尽早明确诊断,从而制定正确、合理且有效的治疗方案,对缩短病程及改善预后起到至关重要的作用。
[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，
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