거대세포바이러스 양성 및 음성 고안압포도막염환자군들의 임상적 특징 비교
Comparison of Clinical Characteristics between Patients with Cytomegalovirus Positive and Negative Hypertensive Uveitis
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목적: 고안압포도막염환자들 중에서 거대세포바이러스의 감염이 있는 군과 없는 군에서의 임상적 특징을 비교하고자 하였다. 대상과 방법: 총 61명의 고안압포도막염환자들 중 안방수에서 cytomegalovirus (CMV) polymerase chain reaction (PCR) 검사를 시행하여 양성 반응이 나온 환자군과 음성 반응이 나온 환자군으로 나누었다. 두 군 사이의 성별, 첫 발작 시 및 현재의 나이, 처음 진단받은 시기, 유병 기간, 발작 횟수, 발작 간격, 수술력을 조사하였고, 시력, 안압, 각막내피세포 밀도를 측정하였다. 또한, 염증 지수, CMV, Herpes simplex virus, Toxoplasma, Toxocariasis에 대한 항체 역가를 확인하기 위한 혈액검사를 시행하였다. 이러한 검사 결과들을 통하여 두 군 사이의 차이를 확인하였다. 결과: CMV PCR 양성 반응을 보인 환자군에서 CMV 음성 환자군에 비하여 최저 안압이 유의하게 높았고(p=0.007), 각막내피세포 수의 양안 차이가 컸다(p=0.048). 또한 CMV 양성 고안압포도막염환자군에서는 73.3%에서 홍채변성 소견이 확인되었고, CMV 음성 환자군에서는 47.8%에서 홍채변성 소견을 보였다(p=0.085). 반면, 두 환자군에서 혈액을 채취하여 시행한 백혈구 수, 염증 수치, 항체역가 검사상에서는 통계학적으로 유의한 차이는 확인되지 않았다. 결론: CMV 포도막염은 안압상승과 함께 각막내피세포의 손상을 동반하였다. 또한 CMV 양성 환자군에서 음성 환자군에 비교하였을 때 두 군 간에 유의미한 혈청학적 차이를 보이지 않았다. 전형적으로 고안압포도막염의 임상양상을 보이는 경우 정기적인 각막내피검사와 함께 안방수를 통한 CMV PCR 검사를 시행하여 안압 및 염증 조절과 함께 항바이러스 제제의 사용이 병행되어야 한다.
Abstract
Purpose: To compare the clinical characteristics of hypertensive uveitis patients, with and without cytomegalovirus (CMV) infection. Methods: CMV polymerase chain reaction (PCR) was performed on the aqueous humor of 61 patients with hypertensive uveitis. Patients were divided into CMV positive and negative groups. Sex, age, age at first attack and at first diagnosis, duration of attack, number of attacks, interval between attacks, and surgical history were investigated, and the visual acuity, intraocular pressure (IOP), and corneal endothelial cell density were measured. Blood tests were conducted to determine the inflammation index, antibody titers of CMV, and herpes simplex virus, with toxoplasma and toxocariasis evaluations. With these results, the differences between the two groups were confirmed. Results: Compared with the CMV negative group, the CMV positive group showed a significantly higher trough IOP (p = 0.007) and a greater difference in corneal endothelial cell counts of the affected eye and the fellow eye (p = 0.048). The CMV positive group exhibited iris degeneration (73.3%), whereas the CMV negative group showed lesions in 47.8% (p = 0.085). No statistically significant differences between the two groups were evident in terms of leukocyte count, inflammation index, antibody titers to CMV, HSV, toxoplasma, or toxocariasis. Conclusions: CMV anterior uveitis was characterized by high IOP and corneal endothelial cell loss in the affected eyes. The CMV positive group had more corneal lesions and iris degeneration than the CMV negative group; however, the two groups showed no significant serological differences. When the clinical features of hypertensive uveitis are present, a routine corneal endothelium test and CMV PCR should be performed periodically, to initiate antiviral agent treatments along with IOP and inflammation controls.
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