单眼牵引性视网膜脱离患儿房水与血清中犬弓蛔虫抗体的检测
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摘要
目的检测单眼牵引性视网膜脱离患儿房水与血清中犬弓蛔虫特异性IgG抗体,探究单眼牵引性视网膜脱离患儿眼弓蛔虫病的发病率。方法选取2015-2017年就诊于上海新华医院眼科单眼牵引性视网膜脱离的患儿42例为研究对象(试验组),另取20例确诊患者为阳性对照。收集血清及患侧房水样本,用ELISA试剂盒检测所有样本中犬弓蛔虫特异性IgG抗体。比较试验组与对照组抗体效价的差异,同时比较试验阳性组与阴性组临床资料的差异,并计算血清特异性抗体检测在诊断眼弓蛔虫病中的灵敏度及特异度。结果 42例患儿中有25例(59. 5%)是由眼弓蛔虫病导致的牵引性视网膜脱离,25例患儿与另外17例相比,性别比例、年龄分布、临床表现均无特异性改变。表现为牵引性视网膜脱离的眼弓蛔虫病与阳性对照组相比,血清阳性率和房水效价值均无明显差异。血清检测诊断眼弓蛔虫病的灵敏度为76. 0%,特异度为88. 2%。结论单眼牵引性视网膜脱离患儿中,眼弓蛔虫病所致的牵引性视网膜脱离患儿占59. 5%,单从临床表现无法区分,房水特异性IgG抗体检测可确诊。
Objective To investigate the incidence rate of ocular toxocariasis (OT)in children with unilateral tractive retinal detachment by detecting the toxocaracanis specific antibody(T-IgG) of the patients' aqueous and serum. Methods Totally 42 pediatric patients with monocular traction retinal detachment who came to Shanghai Xinhua Hospital between 2015 and 2017 were selected as study subjects (experimental group),and another 20 patients who were confirmed as OT were selected as positive controls. All the patients were tested for T-IgG in the peripheral blood and aqueous samples by enzyme-linked immunosorbent assay. The differences of antibody titers between the experimental group and the positive control group were compared, and the differences of clinical data between the positive control group and the experimental group were also compared. The sensitivity and specificity of serum specific antibody detection in the diagnosis of OT were calculated. Results In the total 42 patients, 25 of them(59.5%) were OT caused by tractive retinal detachment, and they had no specific difference in gender ratio, age distribution and clinical manifestations with the other 17 patients. Compared with the positive control group,the 25 patients had no significant difference in the serum positive rate and the value of T-IgG. The sensitivity and specificity of serum test in diagnosis of OT was 76.0% and 88.2%, respectively. Conclusion The rate of OT in children with unilateral tractive retinal detachment is 59.5%. They can't be clearly diagnosed by clinical presentation alone, but T-IgG test can help to determine the diagnosis.
Objective To investigate the incidence rate of ocular toxocariasis (OT)in children with unilateral tractive retinal detachment by detecting the toxocaracanis specific antibody(T-IgG) of the patients' aqueous and serum. Methods Totally 42 pediatric patients with monocular traction retinal detachment who came to Shanghai Xinhua Hospital between 2015 and 2017 were selected as study subjects (experimental group),and another 20 patients who were confirmed as OT were selected as positive controls. All the patients were tested for T-IgG in the peripheral blood and aqueous samples by enzyme-linked immunosorbent assay. The differences of antibody titers between the experimental group and the positive control group were compared, and the differences of clinical data between the positive control group and the experimental group were also compared. The sensitivity and specificity of serum specific antibody detection in the diagnosis of OT were calculated. Results In the total 42 patients, 25 of them(59.5%) were OT caused by tractive retinal detachment, and they had no specific difference in gender ratio, age distribution and clinical manifestations with the other 17 patients. Compared with the positive control group,the 25 patients had no significant difference in the serum positive rate and the value of T-IgG. The sensitivity and specificity of serum test in diagnosis of OT was 76.0% and 88.2%, respectively. Conclusion The rate of OT in children with unilateral tractive retinal detachment is 59.5%. They can't be clearly diagnosed by clinical presentation alone, but T-IgG test can help to determine the diagnosis.
引文
[1]TAYLOR M R.The epidemiology of ocular toxocariasis[J].J Helminthol,2001,75(2):109-118.
[2]STEWART J M,CUBILLAN L D,CUNNINGHAM E T.Prevalence,clinical features,and causes of vision loss among patients with ocular toxocariasis[J].Retina,2005,25(8):1005-1013.
[3]YOKOI K,GOTO H,SAKAI J,USUI M.Clinical features of ocular toxocariasis in Japan[J].Ocul Immunol Inflamm,2003,11(4):269-275.
[4]WOODHALL D,STARR M C,MONTGOMERY S P,JONES J L,LUM F,READ R W,et al.Ocular toxocariasis:epidemiologic,anatomic,and therapeutic variations based on a survey of ophthalmic subspecialists[J].Ophthalmology,2012,119(6):1211-1217.
[5]KWON S I,LEE J P,PARK S P,LEE E K,HUH S,PARK I W.Ocular toxocariasis in Korea[J].Jpn J Ophthalmol,2011,55(2):143-147.
[6]RUBINSKY-ELEFANT G,YAMAMOTO J H,HIRATA C E,PRESTES-CARNEIRO L E.Toxocariasis:critical analysis of serology in patients attending a public referral center for ophthalmology in Brazil[J].Jpn J Ophthalmol,2018,62(1):77-83.
[7]CHIEFFI P P,SANTOS S V,QUEIROZ M L,LESCANO S A.Human toxocariasis:contribution by Brazilian researchers[J].Rev Inst Med Trop Sao Paulo,2009,51(6):301-308.
[8]RUBINSKY-ELEFANT G,HIRATA C E,YAMAMOTO J H,FERREIRA M U.Human toxocariasis:diagnosis,worldwide seroprevalences and clinical expression of the systemic and ocular forms[J].Ann Trop Med Parasitol,2010,104(1):3-23.
[9]de VISSER L,ROTHOVA A,de BOER J H,van LOON A M,KERKHOFF F T,van CANNINGA D M R,et al.Diagnosis of ocular toxocariasis by establishing intraocular antibody production[J].Am J Ophthalmol,2008,145(2):369-374.
[10]WANG Z J,ZHOU M,CAO W J,JI J,BI Y W,HUANG X,et al.E-valuation of the Goldmann-Witmer coefficient in the immunological diagnosis of ocular toxocariasis[J].Acta Trop,2016,158(1):20-23.
[11]HOTEZ P J,WILKINS P P.Toxocariasis:America’s most common neglected infection of poverty and a helminthiasis of global importance[J]?PLoS Negl Trop Dis,2009,3(3):e400.
[12]MACPHERSON C N.The epidemiology and public health importance of toxocariasis:a zoonosis of global importance[J].Int JParasitol,2013,43(12-13):999-1008.
[13]LIU Y,ZHANG Q,LI J,JI X,XU Y,ZHAO P.Clinical characteristics of pediatric patients with ocular toxocariasis in China[J].Ophthalmologica,2016,235(2):97-105.
[14]ZHOU M,CHANG Q,GONZALES J A,CHEN Q,ZHANG Y,HUANG X,et al.Clinical characteristics of ocular toxocariasis in Eastern China[J].Graefes Arch Clin Exp Ophthalmol,2012,250(9):1373-1378.
[15]YANG P Z.Essentials of the diagnosis&treatment of uveitis[M].Beijing:People’s Medical Publishing House,2016:192-196.杨培增.葡萄膜炎诊治概要[M].北京:人民卫生出版社,2016:192-196.
[16]DESPOMMIER D.Toxocariasis:clinical aspects,epidemiology,medical ecology,and molecular aspects[J].Clin Microbiol Rev,2003,16(2):265-272.
[17]MARTINEZ-PULGARIN D F,MUNOZ-URBANO M,GOMEZ-SU-TA L D,DELGADO OM,RODRIGUEZ-MORALES A J.Ocular toxocariasis:new diagnostic and therapeutic perspectives[J].Rec Pat Ant Drug Discov,2015,10(1):35-41.
[18]CORTEZ R T,RAMIREZ G,COLLET L,GIULIARI G P.Ocular parasitic diseases:a review on toxocariasis and diffuse unilateral subacute neuroretinitis[J].J Pediatr Ophthalmol Strab,2011,48(4):204-212.
[19]AREVALO J F,ESPINOZA J V,AREVALO F A.Ocular toxocariasis[J].J Pediatr Ophthalmol Strab,2013,50(2):76-86.
[20]HAYASHI E,AKAO N,FUJITA K.Evidence for the involvement of the optic nerve as a migration route for larvae in ocular toxocariasis of Mongolian gerbils[J].J Helminthol,2003,77(4):311-315.
[21]OTHMAN A A.Therapeutic battle against larval toxocariasis:are we still far behind[J]?Acta Trop,2012,124(3):171-178.
[2]STEWART J M,CUBILLAN L D,CUNNINGHAM E T.Prevalence,clinical features,and causes of vision loss among patients with ocular toxocariasis[J].Retina,2005,25(8):1005-1013.
[3]YOKOI K,GOTO H,SAKAI J,USUI M.Clinical features of ocular toxocariasis in Japan[J].Ocul Immunol Inflamm,2003,11(4):269-275.
[4]WOODHALL D,STARR M C,MONTGOMERY S P,JONES J L,LUM F,READ R W,et al.Ocular toxocariasis:epidemiologic,anatomic,and therapeutic variations based on a survey of ophthalmic subspecialists[J].Ophthalmology,2012,119(6):1211-1217.
[5]KWON S I,LEE J P,PARK S P,LEE E K,HUH S,PARK I W.Ocular toxocariasis in Korea[J].Jpn J Ophthalmol,2011,55(2):143-147.
[6]RUBINSKY-ELEFANT G,YAMAMOTO J H,HIRATA C E,PRESTES-CARNEIRO L E.Toxocariasis:critical analysis of serology in patients attending a public referral center for ophthalmology in Brazil[J].Jpn J Ophthalmol,2018,62(1):77-83.
[7]CHIEFFI P P,SANTOS S V,QUEIROZ M L,LESCANO S A.Human toxocariasis:contribution by Brazilian researchers[J].Rev Inst Med Trop Sao Paulo,2009,51(6):301-308.
[8]RUBINSKY-ELEFANT G,HIRATA C E,YAMAMOTO J H,FERREIRA M U.Human toxocariasis:diagnosis,worldwide seroprevalences and clinical expression of the systemic and ocular forms[J].Ann Trop Med Parasitol,2010,104(1):3-23.
[9]de VISSER L,ROTHOVA A,de BOER J H,van LOON A M,KERKHOFF F T,van CANNINGA D M R,et al.Diagnosis of ocular toxocariasis by establishing intraocular antibody production[J].Am J Ophthalmol,2008,145(2):369-374.
[10]WANG Z J,ZHOU M,CAO W J,JI J,BI Y W,HUANG X,et al.E-valuation of the Goldmann-Witmer coefficient in the immunological diagnosis of ocular toxocariasis[J].Acta Trop,2016,158(1):20-23.
[11]HOTEZ P J,WILKINS P P.Toxocariasis:America’s most common neglected infection of poverty and a helminthiasis of global importance[J]?PLoS Negl Trop Dis,2009,3(3):e400.
[12]MACPHERSON C N.The epidemiology and public health importance of toxocariasis:a zoonosis of global importance[J].Int JParasitol,2013,43(12-13):999-1008.
[13]LIU Y,ZHANG Q,LI J,JI X,XU Y,ZHAO P.Clinical characteristics of pediatric patients with ocular toxocariasis in China[J].Ophthalmologica,2016,235(2):97-105.
[14]ZHOU M,CHANG Q,GONZALES J A,CHEN Q,ZHANG Y,HUANG X,et al.Clinical characteristics of ocular toxocariasis in Eastern China[J].Graefes Arch Clin Exp Ophthalmol,2012,250(9):1373-1378.
[15]YANG P Z.Essentials of the diagnosis&treatment of uveitis[M].Beijing:People’s Medical Publishing House,2016:192-196.杨培增.葡萄膜炎诊治概要[M].北京:人民卫生出版社,2016:192-196.
[16]DESPOMMIER D.Toxocariasis:clinical aspects,epidemiology,medical ecology,and molecular aspects[J].Clin Microbiol Rev,2003,16(2):265-272.
[17]MARTINEZ-PULGARIN D F,MUNOZ-URBANO M,GOMEZ-SU-TA L D,DELGADO OM,RODRIGUEZ-MORALES A J.Ocular toxocariasis:new diagnostic and therapeutic perspectives[J].Rec Pat Ant Drug Discov,2015,10(1):35-41.
[18]CORTEZ R T,RAMIREZ G,COLLET L,GIULIARI G P.Ocular parasitic diseases:a review on toxocariasis and diffuse unilateral subacute neuroretinitis[J].J Pediatr Ophthalmol Strab,2011,48(4):204-212.
[19]AREVALO J F,ESPINOZA J V,AREVALO F A.Ocular toxocariasis[J].J Pediatr Ophthalmol Strab,2013,50(2):76-86.
[20]HAYASHI E,AKAO N,FUJITA K.Evidence for the involvement of the optic nerve as a migration route for larvae in ocular toxocariasis of Mongolian gerbils[J].J Helminthol,2003,77(4):311-315.
[21]OTHMAN A A.Therapeutic battle against larval toxocariasis:are we still far behind[J]?Acta Trop,2012,124(3):171-178.