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| 结核性葡萄膜炎初始抗结核治疗矛盾反应的临床特征 | |
| 引用本文： | 肖媛媛 毛羽 曹绪胜 彭晓燕. 结核性葡萄膜炎初始抗结核治疗矛盾反应的临床特征[J]. 眼科, 2022, 31(4): 277-281. DOI: 10.13281/j.cnki.issn.1004-4469.2022.04.006 |
| 作者姓名： | 肖媛媛 毛羽 曹绪胜 彭晓燕 |
| 作者单位： | 首都医科大学附属北京同仁医院 北京同仁眼科中心 眼科学与视觉科学北京市重点实验室 100730 |
| 摘 要： | 目的 总结结核性葡萄膜炎矛盾反应的临床特点。设计回顾性病例系列。研究对象2012-2020年北京同仁医院眼科结核性葡萄膜炎初始抗结核治疗后出现矛盾反应者8例(10眼)。方法 回顾患者的病历资料。平均随访(10.0±5.6)个月。主要指标眼前节、及眼底表现,治疗情况。结果 患者平均年龄(45.0±10.8)岁。8例患者中1例(12.5%)患活动性肺结核,6例(75.0%)可疑既往肺结核感染,1例(12.5%)无明确结核病史。矛盾反应发生于初始抗结核治疗后平均(0.9±0.3)个月(0.5～1.5个月)。其中脉络膜结核瘤2眼(20.0%),表现为瘤体扩大,表面视网膜脱离;全葡萄膜炎3眼(30%),表现为前房、玻璃体炎性反应加重,黄斑水肿加重;中间型葡萄膜炎2眼(20%),表现为玻璃体混浊加重;匐行样脉络膜炎3眼(30%),表现为眼底黄白色病灶增多、高自发荧光区域增多。所有患者在矛盾反应出现后在抗结核同时全身或局部加用糖皮质激素,炎性反应均得到有效控制。结论 结核性葡萄膜炎患者矛盾反应多发生于肺结核非活动期初始抗结核治疗1个月左右,规范抗结核和糖皮质激素联合应用可明显减轻矛盾反应。(眼科,2... |
| 关 键 词： | 结核性葡萄膜炎 抗结核治疗 矛盾反应 |
| 收稿时间： | 2022-05-08 |
Clinical features of paradoxical responses to initial anti-tuberculosis therapy in tuberculous uveitis |
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| Xiao Yuanyuan,Mao Yu,Cao Xusheng,Peng Xiaoyan. Clinical features of paradoxical responses to initial anti-tuberculosis therapy in tuberculous uveitis[J]. Ophthalmology in China, 2022, 31(4): 277-281. DOI: 10.13281/j.cnki.issn.1004-4469.2022.04.006 | |
| Authors: | Xiao Yuanyuan Mao Yu Cao Xusheng Peng Xiaoyan |
| Affiliation: | Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology & Visual Science, Beijing 100730, China |
| Abstract: | Objective To summarize the clinical features of paradoxical reactions in tuberculous uveitis. Design Retrospective case series. Participants 8 tuberculous uveitis patients (10 eyes) with paradoxical reactions after initial anti-tuberculosis treatment in Beijing Tongren Hospital from 2012 to 2020. Methods All the patients’ medical records were reviewed. Mean follow-up time was (10.0±5.6) months. Main Outcome Measures Anterior segment and fundus manifestation, treatment situation. Results The average age of 8 patients with paradoxical reactions was (45.0±10.8）years. One patient (12.5%) had active pulmonary tuberculosis, 6 patients (75.0%) had suspected previous pulmonary tuberculosis infection, and one patient (12.5%) had no clear history of tuberculosis. Paradoxical reactions occurred 0.5 to 1.5 months (average 0.9±0.3 months) after the initial anti-tuberculosis treatment. Among the 10 eyes with tuberculous uveitis, 2 eyes (20.0%) had choroidal tuberculoma, and the paradoxical reaction was manifested as tumor enlargement and superficial retinal detachment; 3 eyes (30.0%) had pan uveitis, manifested as aggravated inflammatory reaction of anterior chamber and vitreous body, and increased macular edema; 2 eyes (20.0%) had intermediate uveitis, manifested as aggravated vitreous opacity; 3 eyes (30.0%) had serpiginous choroiditis, which showed increased yellow-white lesions and increased areas of high autofluorescence in the fundus. All patients received regular antituberculosis drugs and systemic or local glucocorticoids after the occurrence of paradoxical reactions, and the inflammatory reactions were effectively controlled. Conclusion The paradoxical reactions in patients with tuberculous uveitis mostly occurred within 1 month after initial anti-tuberculosis treatment for tuberculosis latent infection or previous infection. The combined application of standardized anti-tuberculosis drugs and anti-inflammatory drugs could significantly reduce the paradoxical reactions. (Ophthalmol CHN, 2022, 31: 277-281) |
| Keywords: | tuberculous uveitis antituberculosis treatment paradoxical reaction |
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