房水检测在青光眼睫状体炎综合征诊断中应用的临床研究

目的观察青光眼睫状体炎综合征(PSS)的临床表现特点，评估应用房水检测在PSS早期诊断中的效果。 方法回顾性分析2019年5月至2021年7月于北京首都医科大学附属北京朝阳医院眼科确诊PSS患者41例(41只眼)和老年性白内障患者30例(30只眼)的病例资料。其中，男性38例(38只眼)，女性33例(33只眼)；年龄15~86岁，平均年龄(54.4±10.3)岁。患有PSS者定义为PSS组；老年性白内障患者定义为对照组。使用非接触式眼压计检查患者的眼压；使用光学相干断层扫描仪检查患者的视盘杯盘比；使用裂隙灯显微镜观察房水的性状，包括羊脂状角膜后沉着物(KP)、Tyndall征及前房浮游细胞。采集所有患者的房水，检测其病毒载量、病毒抗体及细胞因子浓度。病毒包括巨细胞病毒(CMV)、单纯疱疹病毒(HSV)、带状疱疹病毒(VZV)及EB病毒(EBV)；细胞因子包括白细胞介素(IL)-6、IL-8、IL-10、血管内皮生长因子(VEGF)、血管细胞黏附分子(VCAM)及碱性成纤维细胞生长因子(bFGF)。对患者的年龄和以房水为标本检测的HSV、VZV、CMV、EBV、IL-6、IL-8、IL-10、VEGF、VCAM及bFGF等指标的检测结果行正态性分布检验，符合正态分布的计量资料以±s表示，组间比较采用独立样本t检验；偏态分布的计量资料以中位数和上下四分位数表示，组间比较采用Mann-Whitney秩和检验。房水病原体阳性率以例数和百分比表示，组间比较采用Mcnemar配对卡方检验。 结果PSS组患者行房水生物显微镜观察羊脂状KP、Tyndall征及前房浮游细胞者分别为33例、32例及29例；行眼压测量者33例；行光学相干断层扫描检查杯盘比者32例。其中，羊脂状KP(+)者24例，占72.7%；Tyndall征(+)者12例，占37.5%；前房浮游细胞(+)者5例，占17.2%；眼压增高(>21 mmHg)(1 mmHg＝0.133 kPa)者15例，占45.5%；杯盘比≥0.6者7例，占21.9%。PSS组患者行HSV、VZV、CMV及EBV核酸检测者分别为22例、22例、38例及25例。其中，CMV(+)者9例，占23.7%，其余均为阴性。PSS组患者行HSV、VZV、CMV及EBV的免疫球蛋白(Ig)G抗体检测者分别为23例、21例、31例及20例。其中，HSV-IgG(+)、VZV-IgG(+)及CMV-IgG(+)抗体者分别为2例、1例及16例，分别占8.7%、4.8%及51.6%。其余均为阴性。对照组30例HSV、VZV、CMV及EBV核酸和IgG抗体检测阳性者均为0。PSS组患者中同一病例同时检测CMV核酸与CMV-IgG抗体者29例。PSS患眼房水CMV的核酸检测阳性检出率为24.1%，CMV-IgG抗体的阳性检出率为48.3%，高于前者。经Mcnemar配对卡方检验，组间比较的差异无统计学意义(P>0.05)。PSS患眼房水IL-6、IL-8、IL-10、VEGF、VCAM及bFGF的含量分别为22.5(5.1，212.7)pg/ml、18.1(8.4，54.1)pg/ml、3.6(0.5，9.0)pg/ml、20.2(14.7，28.0)pg/ml、1212.4(369.9，3617.9)pg/ml及5.9(0.0，7.3)pg/ml。对照组患眼分别为9.9(3.7，34.9)pg/ml、9.6(2.0，24.2)pg/ml、1.6(1.0，5.2)pg/ml、20.5(11.2，24.5)pg/ml、116.4(83.8，178.5)pg/ml及7.1(1.0，15.6)pg/ml。经Mann-Whitney秩和检验，两组患者IL-8、VCAM及bFGF比较的差异有统计学意义(Z＝-2.57，-4.77，-2.07；P<0.05)；两组患者IL-6、IL-10及VEGF比较的差异无统计学意义(Z＝-1.56，-1.18，-0.25；P>0.05)。 结论PSS的主要临床表现为羊脂状KP(+)、眼压升高。房水中CMV核酸阳性、IgG抗体阳性、细胞因子IL-8升高及VCAM升高在诊断PSS时灵敏度高，对PPS的辅助诊断有临床价值。

Characteristics of aqueous humor detection in Posner-Schlossman syndrome

ObjectiveThe aim of this study was to observe the clinical features of Posner-Schlossman syndrome (PSS) and to explore the role of aqueous humor detection in the early diagnosis of PSS. Methods41 patients (41 eyes) with PSS, and 30 patients (30 eyes) with senile cataract who were diagnosed in the Department of Ophthalmology, Beijing Chaoyang Hospital affiliated to Capital Medical University from May 2019 to July 2021 were enrolled retrospectively. Among them, there were 38 males (38 eyes) and 33 females (33 eyes) with an average age of (54.4±10.3) years-old (ranged from 15 to 86 years-old). Patients with PSS were as PSS groups, and patients with senile cataract were as control group. The intraocular pressure (IOP) of patients was examined using indirect ophthalmoscope; cup to disk ratio was examined using optical coherence tomography; the mutton-fat keratic precipitates (KP), Tyndall sign, cells of the aqueous humor were examined using slit lamp microscope. The aqueous humor of all patients were collected; those virus load, virus anti-immunoglobulin G (IgG) and cytokine level were examined, including cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), vascular endothelial growth factor (VEGF), vascular cell adhesion molecule (VCAM), basic fibroblast growth factor (bFGF). The age of patients, aqueous humor HSV, VZV, CMV, EBV, IL-6, IL-8, IL-10, VEGF, VCAM and bFGF were tested for normal distribution. Measurement data conforming to normal distribution was expressed as ±s and compared by independent samples t-test; measurement data with skewed distribution was expressed as median and upper and lower quartiles and compared by Mann-Whitney rank-sum test. The positive rate of aqueous humor pathogens was described by the number of cases and percentages and compared by the Mcnemar paired chi-square test. ResultsIn the PSS group, there were 33 patients to observe mutton-fat KP using biomicro-scopy, 32 patients to observe Tyndal′s sign using biomicroscopy, 29 patients to observe cells in aqueous humors using biomicroscopy, 33 patients with IOP measurements, 32 patients with cup-to-disk ratio using optical coherence tomography. Among of them, there were 24 patients with mutton-fat KP (+ ), accounting for 72.7%, 12 cases with Tyndall′s sign (+ ), accounting for 37.5%, 5 cases with cells (+ ), accounting for 17.2%, 15 cases with an increased IOP (>21 mmHg)(1 mmHg=0.133 kPa), accounting for 45.5%, 7 cases with an increased cup-to-disk ratio (≥0.6), accounting for 21.9%. The number of patients in PSS group with virus nucleic acid testing in HSV, VZV, CMV, EBV was 22 cases, 22 cases, 38 cases, and 25 cases, respectively. Among of them, there were 9 cases with CMV(+ ), accouting for 23.7%; others were negative. The number of patients in PSS group with virus nucleic acid IgG testing in HSV, VZV, CMV, EBV was 23 cases, 21 cases, 31 cases, and 20 cases. Among of them, there were 2 cases with HSV-IgG (+ ), 1 case with VZV-IgG (+ ), 16 cases with CMV-IgG (+ ), accouting for 8.7%, 4.8%, 51.6%; others were negative. In the control group, the nucleic acid and their IgG of all virus in the aqueous humor were negative. In the PSS group, there were 29 cases detected simultaneously with CMV nucleic acid viral load and CMV-IgG. It was showed that the positive detection rate of CMV nucleic acid viral load was 24.1%, while the positive detection rate of CMV-IgG in aqueous humor was 48.3%, which was higher than the former. The Mcnemar paired chi-square test showed that there was no statistical difference between groups (P>0.05). The levels of aqueous humor IL-6, IL-8, IL-10, VEGF, VCAM and bFGF of patients with PSS were 22.5(5.1, 212.7) pg/ml, 18.1(8.4, 54.1)pg/ml, 3.6(0.5, 9.0)pg/ml, 20.2(14.7, 28. 0)pg/ml, 1212.4(369.9, 3617.9)pg/ml and 5.9(0.0, 7.3)pg/ml, respectively. Those indice of patients in the control group were 9.9(3.7, 34.9)pg/ml, 9.6(2.0, 24.2)pg/ml, 1.6(1.0, 5.2)pg/ml, 20.5(11.2, 24.5)pg/ml, 116.4(83.8, 178.5)pg/ml and 7.1(1 .0, 15.6)pg/ml, respectively. The Mann-Whitney rank sum test showed that there were significant differences in IL-8, VCAM and bFGF between two groups (Z=-2.57, -4.77, -2.07; P<0.05). There was no significant difference in IL-6, IL-10 and VEGF between the two groups (Z=-1.56, -1.18, -0.25; P>0.05). ConclusionsThe main clinical mani-festations of patients with PSS were mutton-fat KP and elevated IOP. The positive CMV nucleic acid load, positive CMV-IgG, and increased levels of IL-8 and VCAM in the aqueous humor were sensitive in the diagnosis of PSS, which has a clinical value for the auxiliary diagnosis of PPS.