山东大学耳鼻喉眼学报 ›› 2018, Vol. 32 ›› Issue (2): 99-102.doi: 10.6040/j.issn.1673-3770.0.2017.354

• ·论著· • 上一篇    下一篇

IgG4相关性眼病伴继发性青光眼病例分析

谢洪彬,杨美娜,陈青山,刘旭阳,樊宁   

  1. 知识创新; JCYJ20150401163247234);
    深圳市科技计划项目基础研究(自由探索; JCYJ20160428144701106)第一作者:谢洪彬。 E-mail:401982083@qq.com通讯作者:樊宁。 E-mail:szfanning@126.comDOI:10.6040/j.issn.1673-3770.0.2017.354IgG4相关性眼病伴继发性青光眼病例分析谢洪彬, 杨美娜, 陈青山, 刘旭阳, 樊宁(深圳市眼科医院 暨南大学附属深圳眼科医院 深圳大学眼视光学院, 广东 深圳 518020
  • 收稿日期:2017-08-16 出版日期:2018-03-20 发布日期:2018-03-20
  • 通讯作者: 樊宁. E-mail:szfanning@126.com
  • 基金资助:
    深圳市科技计划项目基础研究(知识创新)(JCYJ20150401163247234);深圳市科技计划项目基础研究(自由探索)(JCYJ20160428144701106)

Analysis of immunoglobulin G4-related ophthalmic disease associated with secondary glaucoma

XIE Hongbin, YANG Meina, CHEN Qingshan, LIU Xuyang, FAN Ning   

  1. Shenzhen Eye Hospital, Affiliated Shenzhen Eye Hospital of Jinan University, Joint College of Optometry of Shenzhen University, Shenzhen 518020, Guangdong, China
  • Received:2017-08-16 Online:2018-03-20 Published:2018-03-20

HTML

PDF (PC)

300

摘要： 目的 免疫球蛋白G4-相关性疾病(IgG4-RD)是近年来逐渐被认识的一类相对少见的、与淋巴细胞密切相关的系统性疾病,IgG4-RD可累及一个或多个器官,当累及眼部组织时,则称为IgG4相关性眼病(IgG4-ROD)。本文分析IgG4相关性眼病伴继发性青光眼病例,探讨其治疗方法。 方法 分析IgG4相关性眼病伴继发性青光眼患者临床表现,综合组织活检、影像学检查、患者对激素治疗的应答以及长期观察等因素。 结果 血清IgG4水平升高是考虑该病最重要的血清学特征,具有较高的诊断价值,但特异性不高。本病需长期使用糖皮质激素治疗,多数患者对激素治疗应答良好,临床症状和器官功能均可得到改善,IgG4水平也有所降低。 结论 IgG4-ROD导致继发性青光眼是其并发症之一,其手术方式的选择和术后远期效果缺乏临床经验。该病变本身及长期使用激素所引起的眼部并发症值得关注。

关键词: IgG4相关性眼病, 糖皮质激素, 继发性青光眼

Abstract: Objective Immunoglobulin(Ig)G4-related disease has recently been recognized as a relatively rare systemic lesion with abnormal lymphocytes. IgG4-related disease can involve one or multiple organs, and is called IgG4-related ophthalmic disease(IgG4-ROD)when ocular tissue is involved. To analysis of IgG4-ROD associated with secondary glaucoma and to discuss its treatment method. Methods We analyzed clinical manifestations, biopsy, imaging examinations, the response to hormone therapy, and long-term observation. Results The serum IgG4 level is considered the most important serologic characteristic of the disease and has high diagnostic value but lacks specificity. Most patients respond to long-term glucocorticoid therapy, typically with symptomatic improvement, reductions in the size of masses or organ enlargement, improvement in organ function, and often a decrease in serum IgG4 levels. Conclusion Secondary glaucoma is one of the complications associated with IgG4-ROD, but there is still no consensus regarding the choice of surgical procedure, and the long-term postoperative outcome is unknown. It is important to recognize and address the complications of IgG4-ROD and the side effects associated with use of corticosteroids.

Key words: IgG4-related ophthalmic disease, Corticosteroid, Secondary glaucoma

中图分类号: 

  • R775.3
[1] Masaki Y, Dong L, Kurose N, et al. Proposal for a new clinical entity, IgG4-positive multiorgan lymphoproliferative syndrome:analysis of 64 cases of IgG4-related disorders[J]. Ann Rheum Dis, 2009, 68(8):1310-1315.
[2] Takahashi H, Yamamoto M, Suzuki C, et al. The birthday of a new syndrome:IgG4-related diseases constitute a clinical entity[J]. Autoimmun Rev, 2010, 9(9):591-594.
[3] Smit WL, Culver EL, Chapman RW. New thoughts on immunoglobulin g4-related sclerosing cholangitis[J]. Clin Liver Dis, 2016, 20(1):47-65.
[4] Sa HS, Lee JH, Woo KI, et al. IgG4-related disease in idiopathic sclerosing orbital inflammation[J]. Br J Ophthalmol, 2015, 99(11):1493-1497.
[5] Leivo T, Koskenmies S, Uusitalo M, et al. IgG4-related disease mimicking chalazion in the upper eyelid with skin manifestations on the trunk[J]. Int Ophthalmol, 2015, 35(4):595-597.
[6] Kanari H, Kagami S, Kashiwakuma D, et al. Role of Th2 cells in IgG4-related lacrimal gland enlargement[J]. Int Arch Allergy Immunol, 2010, 152(Suppl 1):47-53.
[7] Shimosegawa T, Chari ST, Frulloni L, et al. International consensus diagnostic criteria for autoimmune pancreatitis:guidelines of the International Association of Pancreatology[J]. Pancreas, 2011, 40(3):352-358.
[8] Mulay K, Aggarwal E, Jariwala M, et al. Orbital immunoglobulin-G4-related disease: case series and literature review[J]. Clin & Exper Ophthalmol, 2014, 42(7):682-687.
[9] Fukui M, Ogawa Y, Shimmura S, et al. Possible involvement of epithelial-mesenchymal transition in fibrosis associated with IgG4-related Mikuliczs disease[J]. Mod Rheumatol, 2015, 25(5):737-743.
[10] Mejico LJ. IgG4-related ophthalmic disease[J]. Saudi J Ophthalmol, 2015, 29(1):53-56.
[11] Soussan JB, Deschamps R, Sadik JC, et al. Infraorbital nerve involvement on magnetic resonance imaging in European patients with IgG4-related ophthalmic disease:a specific sign[J]. Eur Radiol, 2017, 27(4):1335-1343.
[12] Sogabe Y, Ohshima K, Azumi A, et al. Location and frequency of lesions in patients with IgG4-related ophthalmic diseases[J]. Graefes Arch Clin Exp Ophthalmol, 2014, 252(3):531-538.
[13] McNab AA, McKelvie P. IgG4-related ophthalmic disease. Part I:background and pathology[J]. Ophthal Plast Reconstr Surg, 2015, 31(2):83-88.
[14] Behbehani RS, Al-Nomas HS, Al-Herz AA, et al. Bilateral intracranial optic nerve and chiasmal involvement in igg4-related disease[J]. J Neuroophthalmol, 2015, 35(2):229-231.
[15] Elner VM, Demirci H. IgG4-related orbital inflammation[M] // Orbital Inflammatory Diseases and Their Differential Diagnosis. London: Springer Berlin Heidelberg, 2015.
[16] Ohno K, Sato Y, Ohshima KI, et al. IgG4-related disease involving the sclera[J]. Mod Rheumatol, 2014, 24(1):195-198.
[17] Goto H, Takahira M, Azumi A, et al. Erratum to: Diagnostic criteria for IgG4-related ophthalmic disease[J]. Jpn J Ophthalmol, 2015, 59(3):201.
[18] Okazaki K, Umehara H. Are classification criteria for igg4-rd now possible? The concept of IgG4-related disease and proposal of comprehensive diagnostic criteria in Japan[J]. Int J Rheumatol, 2012: 357071.
[19] Lu LX, Della-Torre E, Stone JH, et al. IgG4-related hypertrophic pachymeningitis:clinical features, diagnostic criteria, and treatment[J]. JAMA Neurol, 2014, 71(6):785-793.
[20] Yamamoto M, Awakawa T, Takahashi H. Is rituximab effective for IgG4-related disease in the long term? Experience of cases treated with rituximab for 4 years[J]. Ann Rheum Dis, 2015, 74(8):46.
[21] 许晓. Ex-PRESS引流器植入术治疗青光眼的临床观察[J]. 山东大学耳鼻喉眼学报, 2017, 31(4):90-93. XU Xiao. Clinical observations of Ex-PRESS glaucoma filtration device implantation in patients with glaucoma[J]. J Otolaryngol Ophthalmol Shandong Univ, 2017, 31(4):90-93.
[1] 黄凯丰. 糖皮质激素短疗程雾化吸入对嗜酸粒细胞性鼻窦炎伴鼻息肉患者鼻部症状及肾上腺皮质功能的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 28-31.
[2] 李华斌, 赖玉婷. 慢性鼻-鼻窦炎的发病机制及诊疗进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 4-9.
[3] 高进良,年婉清,李烁. 鼻内镜手术联合鼻用糖皮质激素治疗腺样体肥大性[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 38-42.
[4] 史丽,赵莉,张红萍. 变应性鼻炎的长期抗炎治疗[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 9-12.
[5] 张革化,李文婷. 变应性鼻炎的药物治疗策略[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 10-14.
[6] 王增智. 免疫抑制对非感染性葡萄膜炎的治疗作用及对细胞因子的影响[J]. 山东大学耳鼻喉眼学报, 2015, 29(6): 64-67.
[7] 姜海华. S-100蛋白和HLA-DR在鼻息肉组织中的表达[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 43-45.
[8] 卢娜. 三种不同给药途径治疗突发性感音神经性耳聋的效果对比[J]. 山东大学耳鼻喉眼学报, 2015, 29(2): 24-27.
[9] 王卫之1，张丙峰2，刘少华1，王欣2. 系统性糖皮质激素+沙利度胺治疗口咽部重型阿弗他溃疡[J]. 山东大学耳鼻喉眼学报, 2013, 27(6): 72-73.
[10] 刘守丽，韩凤芹. 11例Behcet病的临床特征和治疗分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(2): 64-65.
[11] 丁凤奎1，苏万远2，李巧云1，李传宝2. 复合小梁切除术治疗前葡萄炎继发青光眼[J]. 山东大学耳鼻喉眼学报, 2011, 25(5): 105-.
[12] 李臻. 糖皮质激素对鼻息肉缺氧诱导因子-1α及血管内皮生长因子表达的影响[J]. 山东大学耳鼻喉眼学报, 2011, 25(1): 53-.
[13] 任秀敏，张燕，段乃超，杨彦忠. 局部应用糖皮质激素对鼻息肉组织中水通道蛋白8表达的影响[J]. 山东大学耳鼻喉眼学报, 2010, 24(4): 45-47.
[14] 李丽丽1，毕宏生2，解孝锋2，郭俊国3. 清开灵眼用凝胶治疗慢性葡萄膜炎80例[J]. 山东大学耳鼻喉眼学报, 2010, 24(4): 62-.
[15] 梁军1,滕克禹2, 嵇高德1. Cogan综合征临床分析[J]. 山东大学耳鼻喉眼学报, 2009, 23(6): 71-72.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发