抗病毒联合糖皮质激素治疗单纯疱疹病毒感染相关角膜内皮炎的临床效果  

Clinical effect of antiviral therapy combined with glucocorticoids on treatment of patients with HSV infection-related corneal endotheliitis

作　　者：俞国孝 周晓强[1] 姜蕾[1] 姚莉 唐丹燕[1] YU Guo-xiao;ZHOU Xiao-qiang;JIANG Lei;YAO Li;TANG Dan-yan(Yuhang District First People′s Hospital,Hangzhou,Hangzhou,Zhejiang 311100,China)

机构地区：[1]杭州市余杭区第一人民医院眼科,浙江杭州311100

出　　处：《中华医院感染学杂志》2021年第1期129-133,共5页Chinese Journal of Nosocomiology

基　　金：浙江省科研基金资助项目(2018AK089)。

摘　　要：目的分析抗病毒联合糖皮质激素治疗对单纯疱疹病毒(herpes simplex virus,HSV)感染致角膜内皮炎患者视力恢复及复发率的影响。方法选取2017年2月-2019年2月杭州市余杭区第一人民医院收治的HSV感染致角膜内皮炎患者120例(120只病眼)为研究对象,采用随机数字表法将其分为研究组、对照组各60例(每组均60只病眼),对照组予以抗病毒治疗,研究组采用抗病毒联合糖皮质激素治疗,比较两组治疗后症状、角膜内皮形态指标(细胞计数、细胞多形性变异率、角膜厚度)变化、1年内视力恢复情况、复发率及不良反应发生率。结果患者治疗结束后研究组总有效率为91.67%,高于对照组的78.33%(P<0.05);研究组治疗后6个月病眼灼烧感、视觉疲劳、干涩感、流泪、眼痛、异物感评分分别为(0.71±0.09)分、(0.48±0.06)分、(0.84±0.09)分、(0.50±0.07)分、(0.43±0.06)分、(0.85±0.09)分均低于对照组(P<0.05);治疗后两组视力均显著改善(P<0.05),且研究组治疗后视力值构成优于对照组(P<0.05);研究组治疗后角膜细胞计数(2462.47±230.65)个/mm~2、角膜厚度(486.12±50.67)μm低于对照组,而细胞多形性变异率(45.07±4.63)%高于对照组(P<0.05);研究组治疗后1年内复发率为8.33%(5/60)与对照组的11.67%(7/60)比较无显著差异(χ^(2)=0.370,P>0.05);患者发生眼痒、针刺感、视力模糊、白内障等不良反应,均未停药且自行缓解。结论抗病毒联合糖皮质激素治疗HSV感染致角膜内皮炎疗效较好,可显著改善患者症状,促进视力及角膜内皮形态恢复,且不增加复发率与不良反应,值得在临床推广实践。OBJECTIVE To observe the effect of antiviral therapy combined with glucocorticoids on vision and recurrence rate of the patients with corneal endotheliitis caused by herpes simplex virus(HSV)infection.METHODS A total of 120 patients(120 diseased eyes)with HSV infection-induced corneal endotheliitis who were treated in Yuhang District First People′s Hospital from Feb 2017 to Feb 2019 were recruited as the study objects and randomly divided into the study group and the control group,with 60 cases in each group(60 diseased eyes).The control group was given antiviral therapy,and the study group was given antiviral therapy combined with glucocorticoids.The symptoms,crneal endothelium morphology indexes(cell counts,cell pleomorphism variation rate,corneal thickness),recovery of vision within 1 year,recurrence rate and incidence of adverse reactions were compared between the two groups after the treatment.RESULTS The total effective rate of treatment of the study group was 91.67%,significantly higher than 78.33%of the control group(P<0.05).The scores of burning sensation,visual fatigue,sensation of dryness,lacrimal punctum,sore and foreign body sensation of the diseased eyes of the study group were respectively(0.71±0.09)points,(0.48±0.06)points,(0.84±0.09)points,(0.50±0.07)points,(0.43±0.06)points and(0.85±0.09)points after the treatment for 6 months,significantly lower than those of the control group(P<0.05).The vision of both groups was significantly improved after the treatment(P<0.05),and the visual acuity composition of the study group was significantly better than that of the control group after the treatment(P<0.05).The corneal cell counts and corneal thickness of the study group were respectively(2462.47±230.65)cells/mm^(2) and(486.12±50.67)μm after the treatment,significantly lower than those of the control group,however,the cell pleomorphism mutation rate of the study group was(45.07±4.63)%,significantly higher than that of the control group(P<0.05).The recurrent rate within 1 year was 8.33%(5/60)

关 键 词：抗病毒 糖皮质激素 单纯疱疹病毒 角膜内皮炎 视力 复发率 

分 类 号：R772.2[医药卫生—眼科]