个体化综合治疗慢性移植物抗宿主病相关干眼的临床研究

摘要

目的 观察个体化综合治疗慢性移植物抗宿主病相关干眼的临床效果.方法 回顾性分析2013年3月至2016年11月在我院诊治的造血干细胞移植术后慢性移植物抗宿主病相关干眼患者19例(38眼),根据病情不同个体化地给予人工泪液、小牛血去蛋白提取物眼用凝胶、成纤维细胞生长因子眼用凝胶及lg·Ll氟米龙滴眼液等不同组合的复合用药方案进行综合治疗.治疗前后行裂隙灯检查、干眼症状评分、视力、角膜荧光素染色(fluorescent staining,FS)、泪膜破裂时间(break-up time, BUT)、基础泪液分泌试验(Schimer I test,SIT)等检查,观察治疗前及治疗2个月后干眼症状及体征的变化.结果 治疗前干眼症状评分项目中干涩感、异物感、烧灼感、疼痛、眼红分别为(2.72±0.78)分、(2.58±0.89)分、(2.46±0.64)分、(2.27±0.54)分、(2.54±0.66)分,治疗后均较治疗前有不同程度的改善,各症状评分分别为(1.68±0.82)分、(1.62±0.72)分、(1.57±0.59)分、(1.44±0.62)分、(2.09±0.58)分(均为P＜0.05);眼部视疲劳、畏光评分较治疗前略有改善,但差异均无统计学意义(均为P＞0.05);治疗后视力有所提高,差异有统计学意义;角膜FS评分由治疗前的(8.6±2.4)分减少为治疗后的(2.2±1.6)分,差异有统计学意义(P =0.000);BUT略有增加,SIT略有下降,但两者治疗前后的差异均无统计学意义(均为P＞0.05).结论 个体化地给予人工泪液、小牛血去蛋白提取物眼用凝胶、成纤维细胞生长因子眼用凝胶及lg·L-1氟米龙滴眼液等综合治疗能改善造血干细胞移植术后慢性移植物抗宿主病相关干眼症状和部分体征,提高视觉质量.%Objective To observe the clinical effects of individualized compre hensive treatment on dry eye disease secondary to chronic graft-versus-host disease.Methods A retrospective analysis was conducted on 19 patients (38 eyes) with dry eye disease associated with chronic graft-versus-host disease from March 2013 to November 2016 after treatment of hematopoietic stem cell transplantation,and the individualized comprehensive treatment including artificial tears,deproteinized calf blood extract eye gel,fibroblast growth factor eye gel and 1 g · L-1 fluorometholone eye drops were performed according to the severity of dry eye disease.Then slit lamp examination,the score on symptoms of dry eye,corneal fluorescein staining,tear break-up time (BUT) assay and Schirmer I test (SIT) were performed,and visual acuity was examined before and after treatment.Then,the changes of symptoms and signs of dry eye were observed completely before treatment and 2 months after treatment.Results The scores on partial symptoms of dry eye,including sensations of dryness,foreign mat ter,burning,pain,ocular hyperemia before and after treatment were 2.72 + 0.78 vs.1.68 + 0.82,2.58 + 0.89 vs.1.62 + 0.72,2.46 + 0.64 vs.1.57 + 0.59,2.27 + 0.54 vs.1.44 + 0.62,2.54 +0.66 vs.2.09 +0.58 respectively,presenting obviously improvement in these sensa tions (all P ＜0.05),while postoperative asthenopia and photophobia were slightly ameliorated,without statistical significance (P ＞ 0.05).Furthermore,visual acuity improved after treatment,and the difference was statistically siguificant;and there was significant difference in the score of corneal fluorescein staining between before treatment (8.6 + 2.4) to after treatment (2.2 + 1.6) (all P ＜0.05),but there was no significant difference in the score of BUT and SIT before and after treatment (all P ＞ 0.05).Conclusion The individual comprehensive medication can improve the subjective symptoms and signs of dry eye disease secondary to chronic graft-versus-host disease after hematopoi etic stem cell transplantation,and more importantly,ameliorate visual acuity.