HLA-B27相关的前葡萄膜炎眼后节并发症的临床特点

目的探讨HLA—B27阳性的前葡萄膜炎眼后节并发症的临床特点及治疗。方法2002年1月至2005年10月就诊的前葡萄膜炎患者采用流式细胞术进行外周HLA-B27的检测，筛选出71-例82眼HLA-B27阳性前葡萄膜炎患者，分为两组：实验组为眼后节受累的患者24例31眼，对照组为眼后节未受累的患者47例51眼。另有HLA—B27阴性前葡萄膜炎患者74例116眼作参考。所有患者均进行裂隙灯、眼底镜等常规眼科查体，部分行眼底荧光血管造影。分析了HLA—B27相关的前葡萄膜炎眼后节并发症的临床特点。采用x^2检验及t检验进行统计学分析。结果71例82眼HLA—B27阳性前葡萄膜炎中有24例31眼占37．8％出现眼后节并发症者，包括：黄斑囊样水肿12例15眼占48．4％，视乳头水肿7例8眼占25．8％，而玻璃体炎最多见为21例27眼占87．1％，8例10眼占32．3％患者存在两种或两种以上的眼后节表现。74例116眼HLA—B27阴性者有8例12眼占10．3％有眼后节表现。实验组中发生前房成型纤维素渗出31眼中18眼占58．06％和积脓31眼中9眼占29．03％明显高于对照组（前房纤维素渗出51眼中3眼，5．88％，X^2=27．56，P〈0．01；前房积脓51眼中1眼，1．96％，X^2=13．20，P〈0．01）；实验组中伴发相关全身性疾病24例中有16例占66．67％的几率高于对照组（47例中有17例，31．66％，X^2=5．94，P〈0．05）。出现眼后节并发症的患者经全身及局部应用糖皮质激素治疗，31眼中有11眼最佳矫正视力≥1．0。结论HLA-B27阳性前葡萄膜炎易出现眼后节并发症，HLA—B27相关的前葡萄膜炎眼后节受累的患者发生相关全身性疾病和前房纤维素渗出与积脓的几率较高。     

合并成型性渗出的急性前葡萄膜炎与HLA-B27的相关性研究

目的 探讨急性渗出性前葡萄膜炎与HLA-B27的相关性。方法 对53例前房内出现成型性渗出的急性前葡萄膜炎（AAUPE）患者及61例前房内无成型性渗出的急性前葡萄膜炎（AAU）患者进行HLA-B27的检测,并结合临床表现加以分析。结果 成型性渗出的AAUPE患者的HLA-B27阳性率为100％,而无成型性渗出的AAU患者的HLA-B27阳性率仅为50.8％。二者有显著差异性（P<0.01）。两组HLA-B27阳性的病人强直性脊柱炎发生率分别为50.0％和42.9％。结论 结果进一步证实了HLA-B27与成型性渗出密切相关的论点。提示检测AAU患者HLA-B27的阳性率,发现成型性渗出裂隙灯检查似与血清法检测同样准确。     

HLA-B27相关前葡萄膜炎的研究进展

HLA-B27阳性前葡萄膜炎是前葡萄膜炎最常见的类型,患者多为青壮年,反复发作,常引起一些并发症,严重影响视力,并可伴有其他系统性疾病。但其发病机制目前仍不清楚,尚无特效的治疗方法。近年来,建立了一些前葡萄膜炎动物模型,如内毒素诱导的前葡萄膜炎和HLA-B27转基因动物模型,并进行了一系列的研究。一些新的治疗方法在临床及动物实验中也取得了很好的疗效。就HLA-B27相关前葡萄膜炎的发病机制、流行病学、动物模型及一些新的治疗方法进行综述。     

急性前葡萄膜炎的HLA-B27阳性与阴性患者的临床对比

目的:用微量淋巴细胞毒试验对急性前葡萄膜炎(acuteanterioruveitis,AAU)HLA-B27抗原基因进行检测,观察HLA-B27阳性与阴性患者的临床特征有无差异及临床意义。方法:用微量淋巴细胞毒试验对100例AAU患者进行HLA-B27检测,并随机抽取20例阳性和20例阴性AAU患者进行临床特征观察。结果:在100例AAU患者中HLA-B27阳性64例,阴性36例,分别抽取的20例经比较,HLA-B27阳性患者多见于男性,单眼多见,以粉尘状KP,发病时视力下降明显,易复发,且并发症多为其特征,激素治疗效果佳。结论:对AAU患者进行HLA-B27检测,对评价葡萄膜炎的病因和预后有一定价值。HLA-B27阳性与阴性患者的临床特征有一定程度差异。     

人类白细胞抗原与急性前葡萄膜炎的相关性

目的:探讨急性前葡萄膜炎(acute anterior uveitis,AAU)与人类白细胞抗原(human leucolyte antigen,HLA-B27)的相关性。方法:应用聚合酶链反应(sequence special prime polymer-ase chain reaction,SSP-PCR)基因检测技术,对AAU患者进行HLA-B27基因检测,观察HLA-B27阳性与阴性AAU临床特征并加以分析。结果:在36例AAU患者中,HLA-B27抗原阳性29例,阳性率81%,37例健康对照组,阳性9例,阳性率24%,两者有显著性差异(χ2=23.12,P<0.01)。结论:HLA-B27与AAU明显相关,HLA-B27阳性与阴性患者有一定程度的差异,常伴有全身脊柱关节病,采用SSP-PCR基因检测技术测定HLA-B27快速、简单、准确性高、客观性强,值得推广应用。     

ANA、ANCA、HLA-B27、anti-dsDNA在诊断免疫相关性葡萄膜炎中的价值

目的：探讨抗核抗体(ANA)、抗中性粒细胞胞质抗体(ANCA)、人类白细胞抗原B27(HLA-B27)、抗双链DNA抗体(anti-dsDNA)在诊断免疫相关性葡萄膜炎中的价值。

方法：选取70例免疫相关性葡萄膜炎患者,收集患者的临床资料,检测患者血清中ANA、ANCA、anti-dsDNA和外周血淋巴细胞HLA-B27的表达水平。

结果：男性患者年龄低于女性(t=2.845,P<0.05); 70例免疫相关性葡萄膜炎患者中,脊柱关节炎、原发性系统性血管炎、系统性红斑狼疮、原发性干燥综合征、类风湿性关节炎及幼年性特发性关节炎分别有42、12、6、5、4、1例,男女之间其中脊柱关节炎和系统性红斑狼疮比例差异有统计学意义(P=0.019、0.008)。ANA阳性率为16%(11/70),ANCA阳性率为10%(7/70),HLA-B27阳性率为59%(41/70),anti-dsDNA阳性率为6%(4/70); 其中,男性的ANA、ANCA、anti-dsDNA阳性率均低于女性(P<0.05),男性HLA-B27阳性率高于女性(χ²=4.427,P<0.05),差异均具有统计学意义。70例免疫相关性葡萄膜炎发病部位主要是前葡萄膜(49%)和全葡萄膜(46%)。ANA主要在系统性红斑狼疮(83%)和原发性干燥综合征(60%)中表达; ANCA在免疫相关性葡萄膜炎中均有表达(除外脊柱关节炎和幼年性特发性关节炎); HLA-B27主要在脊柱关节炎(93%)中表达; anti-dsDNA主要在系统性红斑狼疮(67%)和类风湿性关节炎(25%)中表达。

结论：ANA、ANCA、HLA-B27、anti-ds DNA的阳性率在不同免疫相关性葡萄膜炎的表现类型具有差异,对于免疫相关性葡萄膜炎的分类具有一定的辅助诊断作用。     

HLA-B27阳性急性前葡萄膜炎的临床特征

目的 :探讨HLA B2 7阳性急性前葡萄膜炎的诊断及临床特征。方法 :应用磁珠酶联免疫吸附试验对 74例急性前葡萄膜炎患者和 36例健康对照者血液中HLA B2 7抗原进行测定 ,并对HLA B2 7抗原阳性和阴性急性前葡萄膜炎患者的临床特征进行对比分析。结果 :急性前葡萄膜炎患者 74例中 ,HLA B2 7抗原阳性 35例 ,阳性率为 4 7 30 % ;健康对照者 36例 ,阳性 3例 ,阳性率为 8 33% ;两者有显著性差异 (χ2 =16 2 6 ,P <0 0 1)。HLA B2 7阳性急性前葡萄膜炎的临床特点有起病急、前房内有大量纤维渗出和细胞、角膜后沉着物呈细小、灰白色。一般为单眼发病 ,症状重于常见的特发性前葡萄膜炎 ,复发率较高。常伴有玻璃体混浊、黄斑囊样水肿和全身关节病变。结论 :HLA B2 7抗原与急性前葡萄膜炎明显相关 ,HLA B2 7相关性前葡萄膜炎的临床表现重于HLA B2 7阴性前葡萄膜炎 ,并常伴有全身脊柱关节病变。     

前房相关性免疫偏离与葡萄膜炎防治的展望

前房相关性免疫偏离（ACAID）是抗原置入前房后诱发的一种系统免疫偏离现象，以迟发性超敏反应受抑为特征。本文介绍了近10多年来有关ACAID现象的实验研究概况，ACAID的特征，及其形成机制。ACAID形成必须有完整的眼-脾功能轴心，前房的微观环境是诱导ACAID的关键，房水中含有多种免疫调节因子，其中最主要的是转化生长因子---β.近年来有实验证明在活体内或培养皿中模拟前房的微观环境诱导ACAID能防治葡萄膜炎的发生、发展，给防治人类葡萄膜炎展示了希望和前景。 （中华眼底病杂志，1995，11：56-58）     

人类白细胞抗原B27亚型基因与急性前葡萄膜炎的相关性研究

目的 探讨人类白细胞抗原B27亚型基因与急性前葡萄膜炎(acute anterior uveitis,AAU)易感性的关系。 方法 对49例临床确诊的AAU患者,通过聚合酶链反应(polymerase chain reaction, PCR)特异性扩增技术检测B27;以B27阳性者的DNA为模板对其人类白细胞抗原HLA-B的第二、三外显子片段扩增。采用DNA测序技术对扩增产物做基因序列分析,经计算机处理获得受检者HLA-B27亚型的信息。 结果 受检者中29例为B27阳性,占59.39%,其中仅发现B2704(13例,占44.00%)和B27052(16例,占56.00%)二种亚型基因携带者。二者间多数临床表现差异不大,但携带B27052基因的AAU患者伴发强直性脊柱炎(ankylosing spondylitis, AS)的人数(7人,占24.24%)显著高于B2704基因携带者(1人,占3.74%)。 结论 B2704和B27052单独的亚型特异性与AAU无易感性关联;但B27052基因可能与并发AS有关。 (中华眼底病杂志, 1999, 15:139-142)     

Acute anterior uveitis and HLA-B27

Acute anterior uveitis is the most common form of uveitis. HLA-B27-associated acute anterior uveitis is a distinct clinical entity that has wide-ranging medical significance due to its ocular, systemic, immunologic, and genetic features. The association between HLA-B27 and the spectrum of HLA-B27-associated inflammatory diseases remains one of the strongest HLA-disease associations known to date. This review examines acute anterior uveitis with particular focus on HLA-B27-associated acute anterior uveitis, including the epidemiology, immunopathology, association with HLA-B27 and its subtypes, clinical features, complications, prognosis, and potential new therapies such as anti-TNFalpha therapy and oral HLA-B27-peptide tolerance. There have been substantial recent advances in both clinical and basic scientific research in this field, including studies of the various animal models of acute anterior uveitis and the HLA-B27 transgenic animals, and these are summarized in this review. To the ophthalmologist, HLA-B27-associated acute anterior uveitis is an important clinical entity that is common, afflicts relatively young patients in their most productive years, and is associated with significant ocular morbidity due to its typically recurrent attacks of inflammation and its potentially vision-threatening ocular complications. Furthermore, to the ophthalmologist and the internist, HLA-B27-associated acute anterior uveitis is also of systemic importance due to its significant association with extraocular inflammatory diseases.     

Clinical features of ankylosing spondylitis associated with acute anterior uveitis in Chinese patients

AIM: To characterize the clinical features, diagnosis, treatment and prognosis of uveitis associated with ankylosing spondylitis (AS) in Chinese patients. METHODS: Two hundred and three patients with uveitis associated with AS followed-up in the Third Military Medical University Daping Hospital between 2005 and 2010 were retrospectively evaluated in this study. Complete ophthalmological examinations were evaluated at baseline and during the follow-up period. The gender, age, follow-up time, mean frequency of uveitis onset, and accompanying eye examination findings, history, demographical parameters were reviewed. All the patients presented complete clinical and radiologic (sacroiliac, lumbar, dorsal and cervical spine, knee, ankle, shoulder, hip, elbow) evaluation. HLA-B27 typing was also searched. RESULTS: There were 203 patients diagnosed with AS associated uveitis. All showed sacroiliac X-ray changes indicative of AS. There were 184 male and 19 female patients. The average age of patients was 35±12 (range 18–50). Mean follow-up period was 2.4 years (1-5 years). Acute anterior uveitis was the most common type of uveitis in both genders. 121 eyes presented unilateral involvement (55.2%), and 92 eyes presented bilateral involvement (45.3%) with onset alternately. 22 eyes occurred hypopyon, 16 eyes were found anterior vitreous cells, 7 eyes were noted reactive macular edema or exudation, 29 eyes presented posterior synechiae of iris, and 14 eyes presented cataract, 9 eyes presented secondary glaucoma, 2 eyes presented bend corneal degeneration and 1 eyes presented atrophy of eyeball. At the final visit, uveitis was well controlled in most patients. CONCLUSION: AS associated with uveitis in Chinese patients mainly manifests as acute anterior uveitis. A combination of corticosteroids with other mydriasis agents is effective for most AS associated with uveitis patients. In general, the prognosis is good in these cases.     

HLA-B27阳性急性前葡萄膜炎患者前房水细胞因子水平的研究

目的通过分析HLA-B27阳性急性前葡萄膜炎患者前房水中细胞因子的浓度,探讨急性前葡萄膜炎的发病机制。方法采用非随机对照临床观察型病例研究,选取2008年10月至2009年3月在我院眼科就诊的HLA-B27阳性前葡萄膜炎患者21例(21眼)为患病组,并选取同期住院行白内障手术的患者19例(19眼)为正常对照组。将所有入选病例通过酶联免疫技术测量前房水中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、干扰素-γ(interferon-γ,IFN-γ)、白细胞介素-10的浓度,并进行组间比较。结果TNF-α在患病组患者前房水中的浓度平均为(29.1±13.9)pg.L-1,而在正常对照组患者则为(19.8±7.2)pg.L-1,2组相比差异有统计学意义(P=0.011)。IFN-γ在患病组患者前房水中的浓度平均为(36.6±27.5)pg.L-1,而在正常对照组患者则为(14.6±12.9)pg.L-1,2组相比差异有统计学意义(P=0.003)。白细胞介素-10在患病组患者前房水中的浓度平均为(2.4±2.7)pg.L-1,而在正常对照组患者则为(3.3±3.9)pg.L-1,2...     

Clinical Features and Outcomes of HLA-B27-Positive and HLA-B27-Negative Acute Anterior Uveitis in a Turkish Patient Population

Purpose: To compare the clinical features and outcomes of HLA-B27-positive and HLA-B27-negative acute anterior uveitis (AAU) in a large Turkish patient population. Methods: Forty-four patients with HLA-B27-positive AAU and 65 with HLA-B27-negative AAU were reviewed retrospectively. HLA-B27 typing, gender, laterality, clinical features (fibrinous reaction, hypopyon formation), ocular complications, medical treatment, and final visual acuity were recorded. Statistical analyses included Student's t-test, Fisher's exact test, Yate's corrected χ test, and Mann-Whitney U test. A p-value of < 0.05 was considered statistically significant. Results: Forty percent of all patients with AAU were found to be positive for HLA-B27 antigen. HLA-B27-positive AAU was significantly more common in males and HLA-B27-negative AAU in females. Unilateral or bilateral alternating AAU as well as fibrinous reaction and hypopyon formation were more common in HLA-B27-positive patients. Posterior iris synechiae and cataract formation were more common and systemic immunosuppressive agents were exclusively required in patients with HLA-B27-negative AAU. Visual outcome did not differ significantly between the HLA-B27-positive and HLA-B27-negative groups. Conclusions: HLA-B27 association is less common in Turkish patients with AAU than in other populations reported in the literature. Although distinct features of HLA-B27 uveitis were confirmed in our study, visual outcome did not differ from idiopathic AAU. Therefore, we believe that HLA-B27 typing in patients with AAU helps the clinician with the diagnosis. However, it has a limited value in determining the prognosis.     

Toll样受体4对HLA-B27相关前葡萄膜炎患者外周血单个核细胞分泌细胞因子的影响

目的通过对比正常人与HLA-B27相关前葡萄膜炎恢复期患者外周血单个核细胞(peripheral blood mononuclear cells,PBMC)受脂多糖(lipopolysaccharide,LPS)刺激及抗Toll样受体4(Toll like receptor4,TLR4)抗体(HTA125)干预后分泌细胞因子的变化,探讨TLR4在HLA-B27相关前葡萄膜炎发病机制中的作用。方法选取HLA-B27阳性前葡萄膜炎恢复期患者10例,相同性别及年龄段的HLA-B27阴性正常人10例作为对照。抽取研究对象外周血分为以下5组体外培养PBMC:(1)正常人非LPS刺激组:加入终浓度为1mg·L-1的PBS进行培养;(2)正常人LPS刺激组:加入终浓度为1mg·L-1的LPS进行培养;(3)HLA-B27阳性患者非LPS刺激组:加入终浓度为1mg·L-1的PBS进行培养;(4)HLA-B27阳性患者LPS刺激组:加入终浓度为1mg·L-1的LPS进行培养;(5)HLA-B27阳性患者LPS+HTA125干预组:终浓度为5mg·L-1的HTA125预先干预PBMC 30 min后再加入1mg·L-1的LPS共同培养。分别于培养4h、8h、12h、24h后,利用ELISA法测定细胞培养上清液中的TNF-a、IL-10和(4)(5)组中IL-6的浓度。结果 LPS未刺激组,PBMC培养4h、8h、12h、24h后,HLA-B27阳性患者TNF-α浓度分别为(1329.46±155.09)ng·L-1、(1926.76±163.28)ng·L-1、(1424.61±141.63)ng·L-1、(526.98±112.29)ng·L-1,正常人分别为(562.83±106.45)ng·L-1、(839.57±73.98)ng·L-1、(559.60±88.48)ng·L-1、(200.81±51.39)ng·L-1,两组各时间点相比差异均有统计学意义(均为P<0.05);HLA-B27阳性患者PBMC培养8h、12h、24h后,IL-10浓度分别为(145.51±26.91)ng·L-1、(259.16±32.71)ng·L-1、(435.98±134.54)ng·L-1,正常人分别为(63.57±17.28)ng·L-1、(123.21±15.73)ng·L-1、(247.82±32.10)ng·L-1,两组各时间点相比差异均有统计学意义(均为P<0.05)。LPS刺激后,正常人与HLA-B27阳性患者PBMC分泌TNF-α和IL-10水平在各时间点均比LPS刺激前明显升高,且HLA-B27阳性患者升高更明显。HLA-B27阳性患者PBMC在LPS刺激后与LPS+HTA125干预组相比,后者各时间点分泌TNF-α、IL-10的水平均显著降低,差异均有统计学意义(均为P<0.05),且HTA125干预组IL-6浓度在4h、8h时较单纯LPS刺激组低,差异均有统计学意义(均为P<0.05)。结论 HLA-B27阳性患者PBMC对LPS的刺激更加敏感,抗TLR4单克隆抗体能够抑制HLA-B27阳性患者PBMC分泌细胞因子的水平。     

Acute anterior uveitis and HLA-B27

All studies among acute anterior uveitis patients (AAU) agree on the importance of and high association with HLA-B27. However, the majority of the HLA-B27⁺ population will never develop AAU. The partial association of AAU and HLA-B27 is probably not based on a preferential association with a particular B27 subtype, since the HLA-B27 subtypes are equally distributed among normal controls and AAU patients. Therefore, other factors increase the susceptibility to HLA-B27 associated diseases. Family investigations among the relatives of AAU and AS patients suggest the existence of other pathogenic genetic factors in addition to HLA-B27. Due to extensive research, associations with other genes on chromosome 6 could almost be excluded and associations with genes on other chromosomes were not yet found. The only reproducible association between AAU and any genes or gene products is, at the moment, still the association with HLA-B27. However, its role, which most probably is functional, is far from clear.