Department of Ophthalmology, University of Washington, Seattle, Washington, USA.
Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia; Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
Surv Ophthalmol. 2021 Sep-Oct;66(5):802-825. doi: 10.1016/j.survophthal.2021.02.002. Epub 2021 Feb 10.
Uveitis encompasses a heterogeneous group of clinical entities with the common feature of intraocular inflammation. In addition to patient history and examination, a focused set of laboratory investigations is frequently necessary to establish a specific diagnosis. There is limited consensus among uveitis specialists regarding appropriate laboratory evaluation for many distinct patient presentations. The appropriateness of a laboratory test for a given case of uveitis will depend on patient-specific as well as epidemiologic factors. Bayesian analysis is a widely used framework for the interpretation of laboratory testing, but is seldom adhered to in clinical practice. Bayes theorem states that the predictive value of a particular laboratory test depends on the sensitivity and specificity of that test, as well as the prevalence of disease in the population being tested. In this review we will summarize the performance of commonly-utilized laboratory tests for uveitis, as well as the prevalence of uveitic diagnoses in different geographic practice settings. We will propose a logical framework for effective laboratory testing in uveitic disease through rigorous application of Bayesian analysis. Finally, we will demonstrate that while many highly sensitive laboratory tests offer an effective means to rule out associated systemic disease, limited test specificity and low pretest probability often preclude the diagnosis of systemic disease association with any high degree of certainty, even in the face of positive testing.
葡萄膜炎是一组具有共同特征的临床实体，即眼内炎症。除了患者的病史和检查外，通常还需要进行一组重点实验室检查，以确定特定的诊断。对于许多不同的患者表现，葡萄膜炎专家之间在适当的实验室评估方面存在有限的共识。特定病例中实验室检查的适当性将取决于患者的具体情况和流行病学因素。贝叶斯分析是解释实验室检测的广泛使用框架，但在临床实践中很少遵循。贝叶斯定理指出，特定实验室检测的预测值取决于该检测的敏感性和特异性，以及检测人群中疾病的流行率。在这篇综述中，我们将总结常用的用于葡萄膜炎的实验室检测的性能，以及在不同的地理实践环境中葡萄膜炎诊断的流行率。我们将通过严格应用贝叶斯分析，为葡萄膜炎疾病中的有效实验室检测提出一个合理的框架。最后，我们将证明，虽然许多高敏感的实验室检测提供了一种有效的方法来排除相关的系统性疾病，但有限的检测特异性和低的术前概率通常排除了系统性疾病与任何高度确定性的关联诊断，即使在检测阳性的情况下也是如此。
