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目的 探讨幼年型慢性关节炎(JCA)伴发葡萄膜炎的临床特征、诊断及治疗。方法对1996至2002年间于中山大学中山眼科中心葡萄膜炎专科就诊的26例JCA伴发葡萄膜炎患者采集病史,进行常规裂隙灯显微镜、检眼镜、抗核抗体(ANA)、红细胞沉降率(ESR)、类风湿因子(RF)、C反应蛋白(CRP)及抗链球菌溶血素“O”(ASO)等检查。根据临床需要,部分患者进行人类白细胞相关抗原B27(HLA B27)检测和骶髂关节及脊柱X线检查,并分析患者的治疗、预后及并发症等情况。结果 26例患者中男性11例,女性15例;JCA和葡萄膜炎的中位发病年龄分别为(8±7)岁和(9±5)岁;其中慢性前葡萄膜炎21例,急性前葡萄膜炎3例,慢性全葡萄膜炎2例; 22例患者双眼患病, 4例单眼患病,患眼共有48只;其中33只眼有轻至中度前房闪辉, 24只眼有少至中等量房水细胞, 39只眼发生虹膜后粘连; 30只眼并发白内障, 20只眼并发角膜带状变性, 12只眼继发青光眼。实验室检查发现18例患者呈ANA阳性,ASO均为阴性,RF仅1例为阳性。炎性反应急性期给予睫状肌麻痹剂、糖皮质激素滴眼治疗。病情较顽固的6例患者中, 3例加用环孢霉素A口服治疗, 3例加用苯丁酸氮芥口服治疗,炎性反应均良好控制。16只眼由于治疗前已合并严重的并发症,视力无显著提高;余32只眼视力均有不同程度提高。
Objective To investigate the clinical features, diagnosis and treatment of juvenile chronic arthritis (JCA) associated with uveitis. Methods A total of 26 patients with JCA associated uveitis were enrolled in the Department of Ophthalmology, Sun Yat-sen University Center for Ophthalmology, Zhongshan University from 1996 to 2002. The patients underwent routine slit lamp microscopy, ophthalmoscopy, anti-nuclear antibody (ANA), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), C-reactive protein (CRP) and anti-streptolysin “O” (ASO) According to clinical needs, some patients were tested for human leukocyte antigen B27 (HLA B27) and sacroiliac joint and spinal X-ray examination, and analysis of the patient’s treatment, prognosis and complications. Results Among the 26 patients, 11 were male and 15 were female. The median age of onset of JCA and uveitis were (8 ± 7) years and (9 ± 5) years respectively. Among them, 21 cases had chronic anterior uveitis, 3 cases of uveitis, 2 cases of chronic uveitis, 22 cases of binocular disease, 4 cases of monocular disease, a total of 48 eyes; 33 eyes with mild to moderate anterior chamber glint, 24 eyes There were as few as moderate aqueous cells and 39 eyes had posterior iris adhesions. Thirty eyes had cataract, 20 eyes had corneal degeneration and 12 eyes had glaucoma secondary to glaucoma. Laboratory tests found that 18 patients were ANA-positive, ASO were negative, only 1 RF positive. The acute phase of inflammatory response is given cycloplegia, corticosteroids eye drops. Among the 6 patients who were more stubborn, 3 were treated with cyclosporin A orally and 3 were treated with chlorambucil orally. The inflammatory reactions were well controlled. There were no significant improvement of visual acuity in 16 eyes with serious complications before treatment. The visual acuity of the other 32 eyes all improved to some extent.