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反复发作性葡萄膜炎合并高血压、Fuchs 异色性虹膜睫状体炎和 Posner-Schlossman 综合征患者的血流动力学和免疫参数特征。

Features of hemodynamic and immunological parameters in patients with recurrent uveitis complicated by hypertension, Fuchs heterochromic uveitis and Posner-Schlossman syndrome.

机构信息

SI "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine", Odesa, Ukraine.

Department of Ophthalmology and Optometry, "Nicolae Testemiţanu" State University of Medicine and Pharmacy, Republic of Moldova, Chişinău.

出版信息

Rom J Ophthalmol. 2023 Jan-Mar;67(1):20-32. doi: 10.22336/rjo.2023.5.

Abstract

Uveitis is a disease that manifests with increased vascular permeability and occlusion, with some ischemia and inflammatory mediators. It is characterized by a wide range of pathological processes, including inflammation, increased vascular permeability and occlusion, local ischemia and cell alteration by inflammatory mediators, and is characterized by the presence of complications. To study the state of ocular hemodynamics by rheoophthalmography, as well as the immune status in patients with idiopathic recurrent anterior uveitis complicated by intraocular hypertension, Fuchs heterochromic uveitis, Posner-Schlossman syndrome, during the relapse period. 93 patients with idiopathic recurrent anterior uveitis were included in this study, 8 patients with Fuchs' uveitis, and 6 patients with Posner-Schlossman syndrome. According to clinical signs, relapse and remission were considered. The control group (healthy volunteers of the same age) consisted of 27 people. In this regard, 5 groups of subjects were formed. The mean age of the patients was (M ± SD) 39.2 ± 14.6 years. According to the Median (range), the duration of the disease in patients was 2033 (350-3285) days, intraocular hypertension being recorded at P0 > 20 mm Hg. was carried out in spreadsheets using STATISTICA 8.0 (StatSoft.Inc) program. Quantitative indicators were evaluated according to the correspondence to the normal distribution and to the Kolmogorov-Smirnov criterion. With a normal distribution, arithmetic means (M) and standard deviations (SD), limits of the 95% confidence interval (95% CI) and Student's t-test were calculated. The volumetric blood filling of the eye according to the rheoophthalmographic indicator RQ during the period of remission of uncomplicated and complicated by hypertension anterior uveitis was reduced by 32.4%-40.5%, respectively, compared with the norm. During the period of relapse, RQ was significantly higher by 28% (p<0.05) than in remission, in the group of uncomplicated uveitis, and in the group of uveitis with increased IOP, no significant differences between the periods of remission and relapse were observed, which reflected the ischemic process in the relapse period. Volumetric blood filling in Fuchs and Posner-Schlossman syndromes in the acute period did not differ from the norm. Cellular immunity in the groups of uncomplicated and complicated by intraocular hypertension idiopathic uveitis, as well as with Fuchs and Posner-Schlossman syndromes, had a higher level of CD4 helper lymphocytes and a lower level of CD8 suppressor lymphocytes, which reflected higher values of the immunoregulatory index. The increase in the immunoregulatory index is most pronounced in Fuchs and Posner-Schlossman syndromes. In the presented study, the incidence of idiopathic recurrent anterior uveitis complicated by intraocular hypertension was 9,9% among all cases of idiopathic recurrent anterior uveitis in one-time period. According to literature, this complicated form of uveitis occurs in 11,5%-46,1% of cases. Most often (up to 92% of cases), the anterior chamber angle was open. Different activity of the mechanisms regulating the balance of cellular and humoral immunity, sensitivity of T-cells to eye antigens in idiopathic anterior uveitis, Fuchs and Posner-Schlossman syndromes was assumed. Peculiarities of eye hemodynamics in these forms of uveitis were also revealed. IOP = intraocular pressure, IOHS = inflammatory ocular hypertension syndrome, HSV = herpes simplex virus, CMV = cytomegalovirus, OCT = optical coherence tomography, OD = right eye, OS = left eye.

摘要

葡萄膜炎是一种以血管通透性增加和闭塞、局部缺血和炎症介质为特征的疾病。其病理过程广泛,包括炎症、血管通透性增加和闭塞、局部缺血和炎症介质引起的细胞改变,其特点是存在并发症。通过血流图研究特发性复发性前葡萄膜炎合并高眼压、Fuchs 异色性葡萄膜炎、Posner-Schlossman 综合征患者的眼部血液动力学状态以及免疫状态。在复发期,纳入了 93 例特发性复发性前葡萄膜炎患者,其中包括 8 例 Fuchs 葡萄膜炎患者和 6 例 Posner-Schlossman 综合征患者。根据临床体征,将复发和缓解视为两种状态。对照组(同年龄的健康志愿者)由 27 人组成。因此,形成了 5 组受试者。患者的平均年龄为(M ± SD)39.2 ± 14.6 岁。根据中位数(范围),患者的病程为 2033(350-3285)天,在 P0 时记录到眼压升高>20mmHg。使用 STATISTICA 8.0(StatSoft.Inc)程序在电子表格中进行分析。根据与正态分布和柯尔莫哥洛夫-斯米尔诺夫准则的对应关系评估定量指标。在正态分布的情况下,计算了算术平均值(M)和标准差(SD)、95%置信区间(95% CI)的限值和学生 t 检验。在无合并高血压的特发性前葡萄膜炎缓解期和合并高血压的特发性前葡萄膜炎缓解期,根据血流图指标 RQ 测量的眼容量血填充分别减少了 32.4%-40.5%,与正常值相比。在复发期间,RQ 显著升高 28%(p<0.05),与缓解期相比,在无合并葡萄膜炎的组和合并眼压升高的组中,缓解期和复发期之间没有观察到显著差异,这反映了复发期的缺血过程。在 Fuchs 和 Posner-Schlossman 综合征的急性期,眼容量血填充与正常值无差异。无合并高血压的特发性葡萄膜炎和合并高血压的特发性葡萄膜炎以及 Fuchs 和 Posner-Schlossman 综合征组的细胞免疫均表现出较高水平的 CD4 辅助淋巴细胞和较低水平的 CD8 抑制性淋巴细胞,这反映了较高的免疫调节指数。免疫调节指数的增加在 Fuchs 和 Posner-Schlossman 综合征中最为明显。在本研究中,特发性复发性前葡萄膜炎合并高眼压的发生率在同期所有特发性复发性前葡萄膜炎病例中为 9.9%。根据文献,这种合并形式的葡萄膜炎在 11.5%-46.1%的病例中发生。最常见(高达 92%的病例)是前房角开放。在特发性前葡萄膜炎、Fuchs 和 Posner-Schlossman 综合征中,假设调节细胞和体液免疫平衡的机制、T 细胞对眼抗原的敏感性存在不同的活性。还揭示了这些葡萄膜炎形式的眼部血液动力学的特点。IOP=眼内压,IOHS=炎症性眼高压综合征,HSV=单纯疱疹病毒,CMV=巨细胞病毒,OCT=光学相干断层扫描,OD=右眼,OS=左眼。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ea0/10117184/8171455ac1bf/RomJOphthalmol-67-20-g001.jpg

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