重视眼部移植物抗宿主病的诊断和治疗  

Diagnosis and treatment of ocular graft-versus-host disease

作　　者：苗恒[1] 陶勇[1] 黎晓新[1] 

机构地区：[1]北京大学人民医院眼科教育部视觉损伤与修复重点实验室视网膜脉络膜疾病诊治研究北京市重点实验室,100044

出　　处：《中华眼科医学杂志（电子版）》2014年第1期1-6,共6页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

摘　　要：眼部移植物抗宿主病(GVHD)是造血干细胞移植(HSCT)术后常见的并发症之一,可影响多达80%的慢性移植物抗宿主病患者,并显著降低其生活质量。眼部GVHD可累及全部眼组织,且最常影响泪腺和结膜等眼表结构,引起难治性干眼症。眼部GVHD与移植术后患者的死亡率和病死率密切相关,其临床表现与其他存在眼部表现的自身免疫性疾病或胶原血管性疾病非常相似。眼部GVHD的评估、诊断和治疗需根据患者的全身情况综合进行,并应采用多途径和多方案联合的方式逐步进行治疗。除了进行常规的人工泪液、眼表糖皮质激素、泪小点栓子及接触软镜等干眼症治疗措施外,抗炎药物环孢素A和自体血清滴眼对眼部GVHD也有较好的疗效。近年来,多数研究者对眼部GVHD的诊断和治疗已达成共识,但对于GVHD的预防和后期随访研究较少。鉴于此,笔者对眼部GVHD的诊断和治疗进行述评,以促进GVHD的临床研究。Ocular graft-versus-host disease ( GVHD ) is a common complication of hematopoietic stem cell transplantation ( HSCT ) affecting up to 80% of chronic GVHD patients, which has a negative impact on quality of life. Ocular GVHD nearly affects every part of the eyes, especially in ocular surface structure such as lacrimal gland and conjunctiva,which results in refractory dry eye.The clinical features of ocular GVHD is similar with other autoimmune or collagen vascular disease which may affect ocular surface and is associated with mortality and morbidity after HSCT.The current evaluation,diagnosis and management of ocular GVHD should be approached in a multidisciplinary fashion in the context of patient′s overall GVHD,and treatment should be given step by step from lower to higher.In addition to common treatment such as artificial tears,topical steroids,punctual occlusion and contact lenses,which used to manage dry eye, both of cyclosporine A and autologous serum also show a promising result.In recent years,the treatments of ocular GVHD have been reached consensus,while the investigation of preventive measures and follow-up visit have been seldom reported.The diagnosis and treatment of GVHD were assessed in this paper.

关 键 词：眼部移植物抗宿主病 造血干细胞移植 伪膜性结膜炎 治疗 眼表疾病 

分 类 号：R457.7[医药卫生—治疗学] R771[医药卫生—临床医学]