眼睑结核一例并眼部结核文献复习与分析

目的 总结分析眼部结核患者的临床特点,以提高临床诊疗水平。方法 对1例眼睑结核患者的临床表现、实验室检查结果、治疗及预后进行报道,并回顾分析国内外文献。以“ocular tuberculosis”、“eye;tuberculosis”为检索词检索PubMed数据库;以“眼,结核”、“眼部结核”为检索词检索万方、维普及知网数据库,检索时间为2000年1月至2017年12月。收集患者的一般情况、病程时间、眼部结核累及部位、临床表现、基础状态及并发症、其他部位结核、主要诊断方法、治疗及转归。纳入临床资料完整的文献,剔除综述类文献、重复发表及资料不全文献。通过筛选获得文献57篇,报道眼部结核患者61例。结果 患者,男,36岁,以右下睑无痛性包块、破溃流脓为主要表现,未并发其他部位结核,分泌物经抗酸染色及荧光定量PCR检查,证实为结核分枝杆菌感染,经抗结核及局部换药治疗后预后良好。通过文献复习与筛选共获得眼部结核患者61例,加上本例患者共计62例;其中,男27例,女35例,年龄3~83岁。62例患者中,35例并发其他部位结核;双眼结核9例,单眼结核53例。眼内结核41例,主要表现为视力改变,治疗后病情改善19例,失明9例,视力受损5例,治愈5例;眼眶及眼附属器结核23例,主要表现为局部包块及异常分泌物,治愈8例,病情改善7例。结论 眼部结核临床表现不典型,眼眶及眼附属器结核预后良好,眼内结核对视力影响大,临床医生应警惕眼部结核,以避免漏诊及误诊。

A case report of eyelid tuberculosis and literatures review on ocular tuberculosis

Objective The clinical features of ocular tuberculosis patients were summarized and analyzed in order to improve clinical diagnosis and treatment.Methods The clinical manifestations, laboratory findings, treatment and prognosis of one case with eyelid tuberculosis were reported, and the corresponding domestic and foreign literatures were reviewed and analyzed. The PubMed, Wanfang, Weipu, and CNKI databases were searched by using “ocular tuberculosis” and “eye; tuberculosis” as search terms and the date of retrieval was set from January 2000 to December 2017. The patients’ general condition, duration of disease, ocular tuberculosis involving site, clinical manifestations, basal status and complications, tuberculosis infections on other sites, major diagnostic methods, treatment, and outcomes were collected. The literatures with complete clinical data were included in this analysis, while the review literatures, duplicate publications, and literatures having incomplete data were excluded. A total of 57 articles were obtained through screening and 61 cases of ocular tuberculosis were reported in these articles.Results The 36-year-old male patient showed painless masses of the right lower eyelid and ulcerated suppurative pus as the main manifestations. No concurrent other parts of tuberculosis infection was found. The secretions were checked by acid-fast staining and real-time quantitative PCR to confirm the presence of Mycobacterium tuberculosis infection. The prognosis was good after anti-tuberculosis and local dressing treatment. Through literatures review, data on 61 patients with ocular tuberculosis were obtained. The total number of subjects was 62 cases including the case reported in this study. There were 27 males and 35 females, who aged from 3-83 years. 35 cases were complicated with tuberculosis in other sites. 9 cases were binocular tuberculosis and 53 cases were monocular tuberculosis. There were 41 cases with intraocular tuberculosis, mainly manifested as changes in vision; among them, 19 cases improved, 9 were blind, 5 had impaired vision, and 5 were cured after treatment. As for the 23 cases with orbital and ocular adnexal tuberculosis, local mass and abnormal secretions were the main manifestations; among them, 8 cases were cured, and 7 cases improved.Conclusion The clinical manifestations of ocular tuberculosis are not typical. The prognosis of orbital and ocular adnexal tuberculosis is good. The intraocular tuberculosis has a great impact on visual acuity. Clinicians should be alert to ocular tuberculosis so as to avoid missed diagnosis and misdiagnosis.