Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Medicine Lyon 1, Lyon, France.
Department of Internal Medicine, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Medicine Lyon 1, Lyon, France.
Br J Ophthalmol. 2018 Oct;102(10):1454-1458. doi: 10.1136/bjophthalmol-2017-311528. Epub 2018 Jan 17.
Ocular toxoplasmosis (OT) is a common cause of posterior uveitis worldwide. The diagnosis of OT is based on clinical findings, but in most cases, laboratory tests are required to confirm the aetiology, especially when other diseases are suspected. The aim of this study was to evaluate which methods, between the Goldmann-Witmer coefficient (GWC) and immunoblotting (IB) with both IgG and IgA, in aqueous humour (AH) samples, can be the most sensitive to diagnose OT, in current practice, especially in the first three weeks.
Retrospectively reviewed records of 87 consecutive patients who had underwent AH and serum sample, 42 patients with suspected OT and 45 patients with suspected other ocular inflammatory diseases. All samples were analysed by both GWC and IB.
The GWC was significant in 47.6% of patients presenting with suspected OT. The intraocular production of specific antibody IgG and IgA was revealed by IB in 71.4% of samples. The combination of these two methods increased the sensitivity to 76.2%. Based on the interval between symptom onset and paracentesis, IB had a greater sensitivity than GWC when sample of AH was taken in the first three weeks (64.7% vs 23.5%, P=0.039), while the difference between the sensitivity of IB and GWC was less important in cases with an interval >3 weeks (76% vs 64% P=0.625).
IB seems to be more useful than the GWC if only one of these methods can be performed, especially during the first three weeks after symptom onset.
眼弓形体病（OT）是全球后葡萄膜炎的常见病因。OT 的诊断基于临床发现，但在大多数情况下，需要实验室检查来确认病因，尤其是在怀疑其他疾病时。本研究旨在评估 Goldmann-Witmer 系数（GWC）和免疫印迹（IB）与 IgG 和 IgA 联合在房水中检测哪种方法最敏感，尤其是在当前实践中，尤其是在发病后前三周。
回顾性分析了 87 例连续接受房水和血清样本检测的疑似 OT 患者（42 例）和疑似其他眼部炎症性疾病患者（45 例）的记录。所有样本均通过 GWC 和 IB 进行分析。
47.6%的疑似 OT 患者 GWC 阳性。IB 显示 71.4%的样本存在特异性抗体 IgG 和 IgA 的眼内产生。这两种方法的结合可将敏感性提高至 76.2%。根据症状出现与房水穿刺之间的间隔，IB 在发病后前三周采集房水样本时比 GWC 具有更高的敏感性（64.7%比 23.5%，P=0.039），而在间隔>3 周时 IB 和 GWC 的敏感性差异较小（76%比 64%，P=0.625）。
如果只能进行其中一种方法，则 IB 似乎比 GWC 更有用，尤其是在发病后前三周。
