Wegener肉芽肿病的眼部表现及其与鼻部的关系

目的探讨韦格纳肉芽肿病（Wegener granulomatosis，WG）的眼部表现及其与鼻部的关系。方法收集2005年6月至2009年9月解放军总医院收治的有眼部表现的19例WG患者，回顾分析其眼部临床表现、实验室指标和确诊途径。结果在WG患者中，眼部受累的表现多样，且常伴发鼻部和鼻窦的改变。19例患者中，10例（52．6％）有眼眶受累的表现并同时伴有鼻窦的改变；有2例（10．5％）为慢性泪囊炎，1例（5．3％）为鼻泪管狭窄。17例（89．5％）通过对不同部位的病变组织进行活检得到证实，其中鼻粘膜活检有12例（63．2％）；19例患者均行影像学检查，16例（84．2％）患者符合WG影像学的表现，其中14例（73．7％）单纯或合并有鼻窦的表现。所有患者的ANCA结果阳性。结论WG是一种严重的临床疾病．需要得到早期的诊断和正确的治疗，该病常伴发鼻部和异窦的改变，可考虑将鼻粘膜的活检、鼻窦的影像学检查和ANCA检查作为该病的常规检查手段之一。

Wegener's granulomatosis:ophthalmic manifestations and accompanying nasal conditions

Objective To study the ophthalmic manifestations of Wegener's granulomatosis and to address the implication of simultaneous involvement of eye and nose by Wegener's granulomatosis.Methods A retrospective study of 19 patients of Wegener's granulomatosis with ophthalmic manifestations was carried out.Results For the Wegener's granulomatosis,there were many kinds of ophthalmic manifestations,often accompanied with nasal and sinus involvement.In all 19 patients,there were 10 cases (52.6%) involving the orbital structure and paranasal sinuses,2 cases (10.5%) with chronic dacryocystisis,1 case (5.3%) with nasolacrimal canal stenosis.17 cases (89.5%) were finally diagnosed by biopsy,and of them 12 (63.2%) by nasal mucosa biopsy.All 19 patients were examined by radiography,and 16 cases (84.2%) were diagnosed by CT or MRI,14 cases (73.7%) were demonstrated with nasal involvement alone or in combination with orbitae.All patients had a positive ANCA (antineutrophil cytoplasmic antibodies) test results.Conclusion Wegener's granulomatosis is an important clinical entity that needs to be recognized early and treated appropriately.Nasal and sinus manifestations are common.It is suggested to make nasal mucosa biopsy,sinus imaging and ANCA as a routine examination for Wegener's granulomatosis.