结核性脉络膜视网膜病变应用抗新生血管内皮生长因子治疗一例并文献复习

doi:10.19983/j.issn.2096-8493.20220043

摘要/Abstract

摘要：

目的:探讨眼内结核中结核性脉络膜视网膜病变合并脉络膜新生血管患者应用抗血管内皮生长因子治疗的效果。方法:回顾性分析河北省胸科医院2019年2月收治的1例17岁眼内结核患者,患者同时合并急性血行播散性肺结核和结核性脑膜炎,分析其治疗过程中各项指标改善及眼内结核改善情况。以“ocular tuberculosis”“choroidal neovascularization”为检索词检索PubMed数据库;以“眼结核”“脉络膜新生血管”为检索词检索万方、维普、中国知网数据库,结合检索到的文献进行复习,对结核性脉络膜视网膜病变的症状、诊断、治疗,以及出现脉络膜新生血管等情况的处理措施进行分析。结果:患者为女性,17岁,以右眼视物不清4个月为主要表现,首诊于河北省胸科医院眼科,追问病史发现有间断低热、咳嗽伴头痛等全身症状。患者结核菌素皮肤试验强阳性、γ干扰素释放试验阳性,最终确诊为急性血行播散性肺结核、结核性脑膜炎、右眼脉络膜结核瘤并脉络膜新生血管、左眼脉络膜结节。针对结核性葡萄膜炎,共检索到17篇相关文献,其中合并脉络膜新生血管的眼内结核文献,检索到2篇,共纳入9例患者,通过光学相干断层扫描观察眼底病变,3例患者在单纯抗新生血管玻璃体腔给药后有改善,但病变有反复,最终9例患者给予全身抗结核、皮质类固醇及抗新生血管联合治疗后,眼内结核及脉络膜新生血管无进展及复发。结论:眼内结核合并脉络膜新生血管患者的规范治疗需要采用全身抗结核药物和皮质类固醇口服,以及局部抗血管内皮生长因子玻璃体腔注射联合应用,可控制感染及结核性脉络膜新生血管的发展,规范治疗后能避免眼内结核致盲的发生。

关键词: 结核,眼, 体征和症状, 综述文献(主题), 总结性报告(主题)

Abstract:

Objective: To explore the effect of anti-neovascular endothelial growth factor therapy in patients of tuberculous chorioretinopathy with choroidal neovascularization in intraocular tuberculosis. Methods: A 17-year-old girl with intraocular tuberculosis and systemic tuberculosis infection admitted to Hebei Chest Hospital in February 2019 was retrospectively analyzed, including the improvement of various indicators and the improvement of macular tuberculosis. PubMed database was searched using “ocular tuberculosis” and “choroidal neovascularization” as keywords; Wanfang, VIP and CNKI were searched using “ocular tuberculosis” and “choroidal neovascularization” as the search terms. Review the retrieved literature, symptoms, diagnosis, treatment of tuberculous chorioretinopathy and treatment measures of choroidal neovascularization were analyzed. Results: The 17-year-old patient was female, with the main manifestation of unclear vision in the right eye for 4 months. She was first diagnosed in the Ophthalmology Department of Hebei Chest Hospital. After questioning the medical history, it was found that she had systemic symptoms such as intermittent low fever, cough and headache. It was strong positive in the tuberculin skin test, positive in the gamma interferon release test, and the final diagnosis was acute hematogenous disseminated pulmonary tuberculosis, tuberculous meningitis, choroidal tuberculoma in the right eye with choroidal neovascularization and choroidal nodule in the left eye. In view of the tuberculous uveitis, 17 relevant literatures were retrieved, including 2 literatures of intraocular tuberculosis combined with choroidal neovascularization. A total of 9 patients were included. The fundus lesions were observed by optical coherence tomography. Three patients improved after simple anti-neovascularization intravitreal therapy, but recurrent. Nine patients underwent systemic anti-tuberculosis treatment and combined treatment of corticosteroids and anti-neovascularization, there was no recurrence or deterioration of intraocular tuberculosis and choroidal neovascularization. Conclusion: Standard treatment of intraocular tuberculosis patients complicated with choroidal neovascularization requires a combination of systemic anti-tuberculosis drugs, corticosteroids, and local intravitreal injection of anti-vascular endothelial growth factor, which can effectively control the infection and the development of tuberculous choroidal neovascularization. After standardized treatment, the recovery of anatomy and function of fundus lesions can avoid blindness caused by intraocular tuberculosis.

Key words: Tuberculosis,ocular, Signs and symptoms, Review literature as topic, Consensus development conferences as topic

中图分类号:

张彦坤, 关艳, 翟静洁, 韩朝. 结核性脉络膜视网膜病变应用抗新生血管内皮生长因子治疗一例并文献复习[J]. 结核与肺部疾病杂志, 2022, 3(3): 222-226. doi: 10.19983/j.issn.2096-8493.20220043

ZHANG Yan-kun, GUAN Yan, ZHAI Jing-jie, HAN Zhao. Application of anti-neovascular endothelial growth factor therapy in tuberculous chorioretinopathy: a case report and literature review[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(3): 222-226. doi: 10.19983/j.issn.2096-8493.20220043

图/表 4

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表1

表2

图9~11

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指标	2月8日	2月16日	2月19日
颅内压(mm H₂O)	240	150	130
脑脊液蛋白(g/L)	1.18↑	0.58↑	0.55↑
脑脊液葡萄糖(mmol/L)	2.11↓	3.25	3.02
脑脊液氯化物(mmol/L)	115↓	122	123
腺苷脱氨酶(U/L)	2.0	1.0	0.8

指标	抗结核治疗前	抗结核治疗1个月	加用抗血管内皮生长因子后3个月
右眼视力(cm)	手动/10	手动/10	0.2
眼压(mm Hg)	18	16	15
眼前节	未见异常	未见异常	未见异常
眼底	黄斑区黄白色盘状水肿	黄斑区黄白色盘状水肿	黄斑区水肿消失