Service d'Ophtalmologie IV, Centre National d'Ophtalmologie des Quinze-Vingts, 28 rue de Charenton, 75012, Paris, France.
Graefes Arch Clin Exp Ophthalmol. 2011 Dec;249(12):1837-46. doi: 10.1007/s00417-011-1724-7. Epub 2011 Jul 6.
The aim of this work was to determine the diagnostic performance of real-time polymerase chain reaction (RT-PCR) and to assess intraocular specific antibody secretion (Goldmann-Witmer coefficient) on samples from patients with signs of posterior uveitis presumably of infectious origin and to target the use of these two biologic tests in the diagnostic of Toxoplasma/viral Herpesviridae posterior uveitis by the consideration of clinical behavior and delay of intraocular sampling.
Aqueous humour and/or vitreous fluid were collected from patients suspected of having posterior uveitis of infectious origin at presentation (140 samples). The diagnosis was confirmed by quantification of antibodies with the Goldmann-Witmer coefficient (GWC) and for detection of Herpesviridae and Toxoplasma gondii genomes with RT-PCR. Forty-one patients had final diagnosis of uveitis of non-Toxoplasma/non-viral origin and 35 among them constituted the control group. The main outcome measures were sensitivity, specificity, and positive and negative predictive values (PPV and NPV).
When pre-intraocular testing indication was compared with final diagnosis, GWC was a more sensitive and specific method than RT-PCR, and was successful in detecting T. gondii, especially if the patient is immunocompetent and the testing is carried out later in the disease course, up to 15 months. For viral Herpesviridae uveitis, the sensitivity and PPV of PCR evaluation was higher than detected with GWC with respectively 46% compared with 20% for sensitivity and 85% versus 60% for PPV. In either viral retinitis or toxoplasmosis infection, RT-PCR results were positive from 24 h, although GWC was not significant until 1 week after the onset of signs. In toxoplasmosis patients, positive RT-PCR results were statistically correlated with the chorioretinitis area (more than three disc areas; p = 0.002), with the age older than 50 (p = 0.0034) and with a clinical anterior inflammation (Tyndall ≥1/2+) and panuveitis; (p = 0.0001).
For the diagnosis of viral or toxoplasmosis-associated intraocular inflammation, the usefulness of laboratory diagnosis tools (RT-PCR and GWC) depends on parameters other than the sensitivity of the tests. Certain patient characteristics such as the age of the patients, immune status, duration since the onset of symptoms, retinitis area, predominant site and extent of inflammation within the eye should orientate the rational for the choice of laboratory testing in analysis of intraocular fluids.
本研究旨在确定实时聚合酶链反应（RT-PCR）的诊断性能，并评估疑似感染性后葡萄膜炎患者眼内特异性抗体分泌（Goldmann-Witmer 系数），通过考虑临床行为和眼内样本采集时间延迟，将这两种生物检测方法用于弓形虫/病毒疱疹病毒后葡萄膜炎的诊断。
收集 140 例疑似感染性后葡萄膜炎患者的房水和/或玻璃体液。通过 Goldmann-Witmer 系数（GWC）定量检测抗体和 RT-PCR 检测疱疹病毒和弓形虫基因组来确认诊断。41 例患者的葡萄膜炎最终诊断为非弓形虫/非病毒来源，其中 35 例患者构成对照组。主要观察指标为敏感性、特异性、阳性和阴性预测值（PPV 和 NPV）。
将眼内检测前的指标与最终诊断进行比较时，GWC 比 RT-PCR 更敏感、更特异，并且能够成功检测到弓形虫，特别是在免疫功能正常且检测在疾病过程后期进行时，甚至可延迟至 15 个月。对于病毒性疱疹病毒葡萄膜炎，PCR 评估的敏感性和 PPV 均高于 GWC，分别为 46%和 20%的敏感性，85%和 60%的 PPV。在病毒视网膜炎或弓形体病感染中，RT-PCR 结果在 24 小时内为阳性，而 GWC 在发病后 1 周内无明显变化。在弓形体病患者中，阳性 RT-PCR 结果与脉络膜视网膜病变面积（大于三个视盘面积；p=0.002）、年龄大于 50 岁（p=0.0034）和前炎症（Tyndall≥1/2+）和全葡萄膜炎有关（p=0.0001）。
对于病毒或弓形体病相关眼内炎症的诊断，实验室诊断工具（RT-PCR 和 GWC）的有用性取决于测试的敏感性以外的参数。患者的某些特征，如年龄、免疫状态、症状出现时间、视网膜炎面积、炎症在眼内的主要部位和程度，应指导在分析眼内液时合理选择实验室检测。
