单疱病毒性角膜炎新分型及其治疗.docVIP

单疱病毒性角膜炎新分型及其治疗 　 作者：冯运红，李志辉，赵亚玉 【关键词】 单疱病毒性角膜炎；新分型；皮质类固醇 　　［摘要］ 目的 评价Holland等提出的单疱病毒性角膜炎(HSK)新分类法在诊治HSK时的指导意义及皮质类固醇类药物在治疗HSK时的作用。方法 在临床诊治的73例（92眼）HSK患者时应用Holland等提出的新分类法进行分类，再根据不同类型的HSK在抗病毒治疗的基础上灵活应用皮质类固醇类药物进行治疗，观察其临床疗效。结果 本组73例（92眼）HSK患者中，感染性角膜上皮炎型42眼，均治愈。基质型角膜炎34眼中，26眼免疫性基质型角膜炎均治愈。3眼坏死性角膜基质炎药物治疗无效行穿透性角膜移植2眼，行深板层角膜移植术1眼。内皮型角膜炎16眼，均治愈。结论 Holland等提出的HSK新分类法在临床诊治HSK时具有很好的指导作用，灵活巧妙应用皮质类固醇类药物在治疗HSK时能收到满意的治疗效果。 　　［关键词］ 单疱病毒性角膜炎；新分型；皮质类固醇 　　A new classification and its treatment of herpes simplex keratitis 　　［Abstract］ Objective To evaluate the implications of a new classification of herpes simplex keratitis(HSK),proposed by Holland et al in diagnosis and treatment of the disease,and the effect of steroids in treatment of HSK.Methods 73 HSK cases (92 eyes) diagnosed and treated were classified by the new classification system.And according to different types of HSK,steroids were used on the basis of antivirus treatments.Then observe the clinical effect.Results Of the 73 HSK cases (92 eyes),42 cases were diagnosed as infectious epithelial ketatitis,which were all cured.34 eyes were diagnosed as stromal keratitis,26 eyes were diagnosed as immune stromal keratitis,which were all cured.3 eyes were diagnosed as necrotizing stromal keratitis.2 eyes were treated with penetrating keratoplasty and 1 eye was treated with full-thickness lamellar keratoplasty after drug treatment failed.16 eyes were diagnosed as endothelitis,which were all cured.Conclusion The new classification system proposed by Holland et al has a good implication,and will have a satisfactory result with steroids in treatment of HSK. 　　［Key words］ herpes simplex keratitis,new classification,steroids,clinical effect 　　单疱病毒性角膜炎（herpes simplex keratitis,HSK）是由单疱病毒（herpes simplex virus,HSV）引起的致盲性角膜病。以往的研究表明HSK的发生不仅与被感染的HSV株的毒力有明确的关系，且与机体的免疫功能状态相关联，机体的免疫功能状态对HSK发病后的临床表现类型有十分重要的影响［1］。而以往的HSK临床分型使临床医生在诊治HSK的过程中感到困惑，因此Holland等［2］于1999年根据解剖学和病理生理学的特点提出了一种新的分型法，我们在临床应用中感觉到新的临床分型法能很好的指导HSK的诊断与治疗。现将我院自2001年以来诊治的各型HSK总