HLA-B27陽性のぶどう膜炎の臨床像

Clinical features of HLA-B27-positive uveitis

　北大眼科ぶどう膜炎外来を受診したぶどう膜炎患者でHLA検査を行った450例のうちHLA-B27陽性の13例の臨床像を検討した．

　13例中2例はベーチェット病，5例は強直性脊椎炎（AS）で，2例は両疾患の合併例であった．残る4例は原因不明の急性前部ぶどう膜炎（AAU）であった．ベーチェット病の4例を除く9例はすべてAAUの臨床像で，全例男性であった．眼症状としては片眼性，再発性の症例が多く，前房蓄膿，線維素析出，小さな角膜後面沈着物と虹彩後癒着が高頻度にみられた．しかし，眼合併症は少なく，視力予後は良好であった．また，ASに伴ったAAUと他のAAUとの間には臨床像の差はみられなかった．

　HLA-B27陽性AAUと陰性AAUとの比較では，B27陽性群では男性が多く，発症年齢が低く，再発率が高かった．しかし，視力予後は両群とも良好であった．

We detected 13 cases with HLA-B27 tissue type out of a series of 450 patients with various types of uveitis. These 13 cases consisted of 4 cases with Behget disease, 5 with ankylosing spondylitis and 4 with acute anterior uveitis of unidentified etiology. Two cases with Behçet disease also manifested ankylosing spondylitis. All the 9 non-Behçet cases were males and manifested acute anterior uveitis. They were further characterized by unilateral involvement, frequent attacks, tendency to form hypoypon and fibrinous exudation in the anteior chamber, absence of larger peratic precipitates, and tendency to form posteior synechia. Severe complica-tions were rare, resulting in favorable prognosis. There was no difference in the clinical manifestation of acute anterior uveitis whether associated with or without ankylosing spondylitis.

We compared the 9 cases with positive HLA-B27 and acute anteior uveitis with 20 cases with negative HLA-B27 and acute anterior uveitis. The HLA-B27-positive cases were characterized by a larger predominance of males, younger age of onset, and a higher rate of recur-rence.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(6) : 589-592,1986