张立峰　蔡水奇

[摘要] 目的 通過分析边缘性角膜溃疡的发病情况以及血清学指标，选择恰当的治疗方法，提高患者治愈成功率。方法 选取于2015年3月～2016年12月来我院就诊的边缘性角膜溃疡患者60例，通过观察患者发病情况，评价其血清学指标选择适合的治疗方案，分析不同治疗方案的不同临床疗效，提高患者治愈成功率。 结果 所有患者初期均有眼红、流泪、异物感等不适症状，随着病程增加症状不断严重，角膜出现浸润和水肿现象。风湿三项检查异常者有27例，占45%，其中包括类风湿因子阳性18例（30%），血沉阳性9例（15%）；免疫五项检查中异常者有21例，占35%，其中包括免疫球蛋白 A阳性3例（5%），免疫球蛋白G阳性12例（20%），免疫球蛋白M阳性6例（10%）。单纯药物治疗共36例，治疗有效率为58.3%；药物联合手术治疗共24例，治疗有效率为100.0%。 结论 边缘性角膜炎发病原因多样化，与自身免疫疾病密切相关；血清学指标是常规的参考依据，类风湿因子和血沉对诊断结果较为敏感；对于患者的治疗需根据患者发病情况采取不同治疗手段，以提高治疗成功率，改善患者预后情况。

[关键词] 边缘性角膜溃疡；血清学指标；手术治疗；药物治疗；疗效分析

[中图分类号] R772.21 [文献标识码] B [文章编号] 1673-9701（2017）16-0058-04

[Abstract] Objective To analyze the incidence of marginal corneal ulcer and the serological index， select the appropriate treatment methods， and improve the cure rate for the patients. Methods 60 patients with marginal corneal ulcer who were admitted to our hospital from March 2015 to December 2016 were selected. By observing the incidence of patients， their serological indices were evaluated， so as to select the appropriate treatment protocol. Different clinical efficacy of different treatment protocols was analyzed， in a bid to improve the cure rate for the patients. Results All patients showed red eyes， lacrimation， foreign body sensation and other symptoms at the initial stage. The symptoms began to become more severe along with the course of disease， and infiltration and edema were observed in cornea. There were 27 patients with abnormal rheumatism three-item test， accounting for 45% of the total number of patients， including 18 cases （30%） of positive rheumatoid factor and 9 cases （15%） of positive erythrocyte sedimentation rate （ESR）； There were 21 abnormal cases in immunization five-item test， accounting for 35% of the total number of patients， including 3 cases of immunoglobulin A positive （5%）， 12 cases of immunoglobulin G positive （20%）， and 6 cases of immunoglobulin M positive （10%）. There were 36 cases receiving medication alone， with the effective rate of 58.3%. There were 24 cases receiving medication combined with surgical treatment， with the effective rate of 100%. Conclusion The causes of marginal keratitis are diversified and closely related to autoimmune diseases； serological indices are for routine references， and rheumatoid factor and ESR are more sensitive to the diagnosis； for patients' treatment， different treatment measures should be taken according to the patient's conditions， so as to improve the cure rate and improve the prognosis.

[Key words] Marginal corneal ulcer； Serological indices； Surgical treatment； Medication； Efficacy analysis

边缘性角膜溃疡（peripheral ulcerative keratitis，PUK）即周边溃疡性角膜炎，是指近角膜缘处角膜基质出现月牙形溃疡性病变，并且常伴有角膜上皮受损、基质出现变性和大量炎性细胞产生浸润的疾病总称[1-5]。该类疾病患者通常会出现眼痛、畏光、流泪等症状，并且时常出现眼有异物的不适感，严重时可导致结膜充血、角膜坏死，对患者的视力造成不可挽回的损失。……