| Background:Anterior uveitis(AU)is an inflammation that occurs in the iris and anterior ciliary body,with the inflammation primarily located in the anterior chamber.It is the most common type of uveitis,accounting for more than half of all cases.Traditional Chinese Medicine(TCM)has long recognized AU,and the TCM concepts of"tightening of the pupil" and "dryness of the pupil" correspond to this condition in Western medicine.TCM explains the etiology and pathogenesis of AU as external wind-heat or wind-cold invasion,liver and kidney yin deficiency,or the invasion of internal toxins in the eye or damage to the iris.Numerous clinical studies have shown that TCM syndrome differentiation and treatment of AU has advantages and characteristics in shortening the course of the disease and reducing recurrence.However,there is currently a relative lack of clinical research on TCM syndromes in AU and it is confusing.With the development of modern medicine,more and more research has found that genes and their polymorphisms are closely related to clinical phenotypes of diseases,such as the HLA-B27 gene subtype strongly associated with ankylosing spondylitis(AS).In recent years,studies have gradually discovered that different subtypes of the gene have significant differences in clinical phenotypes.For example,HLA-B*2704 and HLA-B2705 subtypes,known as "pathogenic genes," have been proven to be positively correlated with AS,while the HLA-B2706 and HLA-B2709 subtypes,known as "protective genes," have been proven to be negatively correlated with AS.Therefore,the detection of these gene subtypes has been applied to the clinical diagnosis and prognosis of AS.In recent years,research on the correlation between gene subtypes and TCM syndromes has also gradually been given more attention.Some scholars have found that male patients with liver depression and yin deficiency syndrome and the ND4 G11778A point mutation in Leber’s hereditary optic neuropathy have the worst vision.Multiple studies have shown that AU is closely related to human leukocyte antigen-27(HLA-B27).40%-70%of patients with uveitis are HLA-B27 positive,and this type of uveitis is clinically named HLA-B27-associated uveitis.Its main clinical manifestation is acute non-granulomatous iridocyclitis,which is more common in young adults,has a rapid onset,obvious symptoms,and a high recurrence rate.Posterior segment involvement is rare,and bilateral involvement is more common.As an important and common type of AU,the diagnosis of HLA-B27-associated uveitis is closely related to the gene.However,there are currently few clinical reports on the correlation between different subtypes of HLA-B27-associated uveitis and clinical TCM syndromes.Therefore,it is necessary to conduct research on the TCM syndromes of AU-related literature and observe the differences in clinical phenotypes and TCM syndromes of AU among different HLA-B27 gene subtypes.Objective:Researching and summarizing the characteristic features of AU’s syndrome elements will provide a reference for the standardized clinical differentiation and treatment of AU.Observing the correlation between the clinical phenotype of HLA-B27 different subtypes in AU patients and TCM syndrome patterns,and providing a biological basis for TCM differentiation of this disease from the perspective of genetic polymorphism.Methods:1 A literature review was conducted using the key words of the western medicine name,traditional Chinese medicine name,and traditional Chinese medicine alias of AU based on the "Thirteenth Five-Year Plan" Traditional Chinese Medicine Ophthalmology Textbook published by the Chinese Medicine Press and the database associations.The search formula was determined.The Chinese Journal Full-Text Database(CNKI),Wanfang Database(WANFANG DATA),and VIP Chinese Journal Database were used to retrieve relevant literature on AU using the keywords.The extracted clinical materials and syndrome elements of the obtained AU literature were analyzed using SPSS 26.0 statistical analysis software for frequency,distribution characteristics,and cluster analysis.SPSS Modeler 18.0 software was used to analyze the association rules,and the syndrome characteristics of AU were summarized and analyzed using traditional Chinese medicine theory.2 A prospective cross-sectional observational study was conducted on patients diagnosed with uveitis and confirmed as HLA-B27 positive in our hospital from December 2021 to February 2023.General information,eye-related information,traditional Chinese medicine syndromes,and blood samples were collected from the patients,and genomic DNA was extracted to detect the HLA-B27 subtypes.SPSS 26.0 statistical analysis software was used for calculations and statistical processing to analyze the differences in clinical phenotypes and traditional Chinese medicine syndromes among patients with different subtypes.Results:1 Analysis of different types of syndromes of anterior uveitisA total of 1685 cases of AU were included in this study.According to different classification criteria,35 syndromes were recorded,with the top 10 syndromes in frequency being the liver meridian wind-heat syndrome,liver and gallbladder fire syndrome,liver fire flaming up syndrome,yin deficiency with excessive fire syndrome,liver and gallbladder damp-heat syndrome,wind and dampness with heat syndrome,internal damp-heat syndrome,wind-heat with dampness syndrome,internal heat due to yin deficiency syndrome,liver qi stagnation syndrome,and liver-kidney deficiency syndrome(the last two syndromes had the same frequency and ranked tenth).Among these,the liver meridian wind-heat syndrome,liver and gallbladder fire syndrome,and liver fire flaming up syndrome were the main syndromes,with a total frequency of 44.99%.It is evident that these three syndromes play an important role in the pathogenesis of AU and all belong to the solid and hot types.2 Analysis of different types of pathogenic factors in anterior uveitisIn the 1685 cases of AU,the liver was the top affected organ,with a frequency of 61.42%,accounting for more than half of the cases.The gallbladder,which is paired with the liver,ranked second with a frequency of 19.88%.Together,they accounted for 81.30%of the total frequency.Among the composite syndromes,liver and gallbladder(19.88%),liver and kidney(5.16%),and spleen and kidney(1.78%)were the three most common composite syndromes,with the liver being the main organ affected.Therefore,the affected organs in AU are closely related to the liver.In the correlation analysis of syndromes,a strong correlation rule for organ involvement was obtained.The support degree for the rule that gallbladder affects the liver was 19.86%,and the confidence level was 100%,indicating a strong association between the liver and gallbladder in AU.There were 13 disease-causing syndromes in total,including heat,external wind,yin deficiency,dampness,qi deficiency,yang deficiency,qi stagnation,blood deficiency,essence deficiency,toxicity,phlegm,blood stasis,and fluid deficiency.The disease-causing syndromes in AU were relatively rich,with more than 10%of cases being attributed to heat,external wind,yin deficiency,and dampness.Among them,the incidence of heat was the highest,with 1447 cases,accounting for 44.99%of the total cases.The other disease-causing syndromes had a lower proportion,indicating that heat was an important disease-causing syndrome in AU.The two-way correlation of disease-causing syndromes was dampness to heat,with a support degree of 21.81%and a confidence level of 88.86%,indicating a high correlation between heat and dampness in the disease-causing syndromes of AU.3 Basic characteristics between different subtypes of HLA-B27A total of 30 patients were included,of which only 12 cases were detected with HLA-B*2704 and 18 cases were detected with HLA-B*2705/07.Other subtypes detected in the Chinese population,such as HLA-B2702,HLA-B2703,and HLA-B2708,were not detected in this study.The male-to-female ratio in HLA-B*2705/07 subtype was 1:2.6,and in HLA-B*2704 subtype it was 1:0.5.The age of the patients ranged from 16 to 67 years old.The average duration of each episode of uveitis was 1.30 ± 0.34 months.The proportion of patients with associated ankylosing spondylitis(AS)was 27.78%in HLA-B*2705/07 subtype and 58.33%in HLA-B*2704 subtype.There was no significant difference in gender,age,duration of uveitis in a single episode,or whether there was associated stiffness(P>0.05).4 Ocular characteristics between different subtypes of HLA-B27In the included patients,both subtypes were more likely to occur in one eye during the current episode of uveitis,and there was no significant difference between the two(P>0.05).There was no significant difference in the occurrence of iris adhesion,anterior capsule pigmentation,or anterior chamber pyogenic accumulation between the two subtypes(P>0.05).However,in terms of visual acuity,HLA-B*2704 subtype patients had a higher proportion of visual impairment than HLA-B*2705/07 subtype patients,and the difference was statistically significant(P=0.025);most of the visual impairment in HLA-B*2705/07 subtype patients was mild or moderate,while in HLA-B*2704 subtype patients it was mostly severe,and the difference was statistically significant(P=0.006).In terms of local ocular symptoms,the ocular symptoms of HLA-B*2704 subtype patients were more severe than those of HLA-B*2705/07 subtype patients,and the difference was statistically significant(P=0.019).Regarding anterior chamber inflammatory cells,the median number of inflammatory cells in the anterior chamber of HLA-B*2705/07 subtype patients was 11.50,while in HLA-B*2704 subtype patients it was 25.00,and the difference was statistically significant(P=0.000).In terms of anterior chamber fiber exudation,HLA-B*2704 subtype patients had more anterior chamber fiber exudation than HLA-B*2705/07 subtype patients,and the difference was statistically significant(P=0.003).5 Characteristics of TCM syndromes between different subtypes of HLA-B27Based on the TCM ophthalmology textbook,the included patients were classified according to their TCM syndrome.The main syndrome of HLA-B*2705/07 subtype patients was liver and gallbladder fire syndrome,accounting for 61.11%(11/18),while the main syndrome of HLA-B*2704 subtype patients was rheumatism with heat syndrome,accounting for 66.67%(8/12).The number of patients with other syndromes was too small,and there was a statistically significant difference between the two types of syndromes and each of the other syndromes(P=0.034).Conclusions:1 The main syndrome types of ankylosing spondylitis(AU)patients are liver meridian wind-heat syndrome,liver and gallbladder fire syndrome,and liver fire excess syndrome,and the research on syndrome types of AU in literature is rather confusing.2 The important disease location syndrome element of AU is liver,and the important disease nature syndrome element is heat,with the characteristic of the disease nature being predominantly excess syndrome.3 HLA-B*2705/07 and HLA-B*2704 are the main gene subtypes of HLA-B27-associated uveitis(HLA-B27 AU).4 The two subtypes of HLA-B*2705/07 and HLA-B*2704 have certain differences in clinical manifestations of HLA-B27-associated uveitis,mainly in terms of visual acuity,degree of decrease,local ocular irritation symptoms,number of inflammatory cells in the anterior chamber,and presence of fibrin exudation in the anterior chamber.Overall,the inflammatory manifestations of the HLA-B*2704 subtype are more severe and may be a meaningful indicator for judging the degree and prognosis of the disease,but the specific mechanism still needs further research.5 The two subtypes of HLA-B*2705/07 and HLA-B*2704 also have some differences in traditional Chinese medicine(TCM)syndrome.Data shows that patients with HLA-B*2705/07 type uveitis are associated with liver and gallbladder fire syndrome of AU,while patients with HLA-B*2704 type uveitis are associated with wind-dampness heat syndrome(with heat being predominant)of AU. |
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