小儿葡萄膜炎--临床表现的独特性和生物制剂治疗的疗效。

IF 2.9 Q1 OPHTHALMOLOGY
Mei Kwan Yiu, Mary Ho, Assunta C H Ho, Winnie K Y Chan, Wing Yung, Wilson W K Yip, Alvin L Young
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引用次数: 0

摘要

目的:评估本地区儿童葡萄膜炎的独特临床特征和治疗结果,尤其是生物制剂的疗效:这是一项回顾性队列研究:结果:共纳入37例儿童葡萄膜炎病例,涉及67只眼睛。男女比例为 1:1.3。葡萄膜炎的平均发病年龄为 11 ± 3.7 (4-18)岁。81.1%的病例患有双侧葡萄膜炎。75.7%的病例为慢性葡萄膜炎。近一半的病例(40.5%)表现为前葡萄膜炎。在我们的队列中,葡萄膜炎的主要诊断是特发性的。与其他人群的研究不同,在这个以中国人为主的队列中,伴发的全身性疾病有贝赫切特氏病(8.1%)、肾小管间质性肾炎和葡萄膜炎(8.1%)以及 HLA-B27 相关性葡萄膜炎(8.1%)。类固醇反应是一种常见现象,在40.5%的病例中观察到。最常见的并发症是后眼睑裂伤(45.9%),其次是白内障(37.8%)、青光眼(27.0%)、带状角膜病(18.9%)和黄斑水肿(13.5%)。3/37的患者在接种COVID-19疫苗后出现葡萄膜炎首次发作或复发。54.1%的患者需要全身使用类固醇来控制病情。大多数患者需要使用避免使用类固醇的免疫疗法,包括甲氨蝶呤(43.2%)、霉酚酸酯(24.3%)、环孢素A(8.1%)、硫唑嘌呤(5.4%)和他克莫司(2.7%)。耐药病例需要使用生物制剂,包括肿瘤坏死因子α抑制剂(阿达木单抗 32.4%、英夫利昔单抗 2.7%)和白细胞介素-6抑制剂(托昔单抗 2.7%):结论:本地小儿葡萄膜炎的临床表现与之前在白种人和其他人群中描述的特征有所不同。根据我们作为三级眼科中心的经验,贝赫切特氏病、肾小管间质性肾炎和葡萄膜炎以及与 HLA-B27 相关的葡萄膜炎比与青少年特发性关节炎相关的葡萄膜炎更常见。我们的报告评估了免疫调节疗法和生物制剂在控制葡萄膜炎和减少眼部并发症方面的疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Paediatric Uveitis - the uniqueness in clinical presentation and the efficacy of biologics treatment.

Aims: To evaluate unique clinical characteristics of paediatric uveitis in our locality and treatment outcomes especially the efficacy of biologics.

Methods: This was a retrospective cohort.

Results: 37 paediatric uveitis cases involving 67 eyes were included. Male-to-female ratio was 1:1.3. Mean age of uveitis onset was 11 ± 3.7 (4-18). 81.1% cases suffered from bilateral uveitis. 75.7% cases were chronic uveitis. Nearly half of the cases (40.5%) presented with anterior uveitis. The predominant diagnosis of uveitis in our cohort was idiopathic. Unlike studies from other populations, the associated systemic conditions in this mostly Chinese cohort were Behçet's disease (8.1%), tubulointerstitial nephritis and uveitis (8.1%) and HLA-B27 associated uveitis (8.1%). Steroid response was a common phenomenon, observed in 40.5% of cases. The most common complication was posterior synechiae (45.9%), followed by cataract (37.8%), glaucoma (27.0%), band keratopathy (18.9%) and macular oedema (13.5%). 3/37 patients encountered either first attack of uveitis or flare after receiving COVID-19 vaccine. 54.1% of patients required systemic steroid for disease control. The majority required steroid sparing immunotherapy, including Methotrexate (43.2%), Mycophenolate Mofetil (24.3%), Cyclosporine A (8.1%), Azathioprine (5.4%) and Tacrolimus (2.7%). Resistant cases required biologics including tumour necrosis factor alpha inhibitors (Adalimumab 32.4%, Infliximab 2.7%) and interleukin-6 inhibitors (Tocilizumab 2.7%).

Conclusions: Clinical presentation of the local paediatric uveitis differs from previously described features in Caucasian and other populations. According to our experience as a tertiary eye centre, Behçet's disease, tubulointerstitial nephritis and uveitis and HLA-B27 associated uveitis were more often encountered than Juvenile Idiopathic Arthritis associated uveitis. Our report evaluated the efficacy of immunomodulatory therapy and biologics in controlling uveitis and reducing ocular complications.

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