全身糖皮质激素治疗儿童风湿免疫性疾病并发激素性高眼压及青光眼的临床特点  

Clinical features of systemic glucocorticoid therapy for rheumatic immune diseases complicating hormonal hypertension and glaucoma in children

作　　者：彭春霞 晏红改 檀晓华[2] 梁天蔚[1] 田利荣[1] 施维[1] 李莉[1] PENG Chunxia;YAN Honggai;TAN Xiaohua;LIANG Tianwei;TIAN Lirong;SHI Wei;LI Li(Department of Ophthalmology,Beijing Children´s Hospital,Capital Medical University,National Center for Children´s Health,100045 Beijing,China;Department of Rheumatology and Immunology,Beijing Children´s Hospital,Capital Medical University,National Center for Children´s Health,100045 Beijing,China)

机构地区：[1]首都医科大学附属北京儿童医院眼科,国家儿童医学中心,北京100045 [2]首都医科大学附属北京儿童医院风湿免疫科,国家儿童医学中心,北京100045

出　　处：《中国研究型医院》2021年第6期17-21,共5页Chinese Research Hospitals

摘　　要：目的探讨激素性高眼压(SIOH)及青光眼(SIG)发生的临床特点、药物治疗效果及预后,以降低和避免其致盲性。方法研究为前瞻性,收集2017年11月至2019年2月,于首都医科大学附属北京儿童医院风湿免疫科确诊为系统性免疫性疾病、需全身糖皮质激素治疗的患儿55例,根据纳入和排除标准纳入研究37例(74眼),随访截止时间2021年7月;随访由眼科完成,随访指标为激素性高眼压及青光眼的发病时间及发生率、药物控制眼压的情况以及视神经纤维层厚度的变化。并纳入年龄及性别匹配的正常儿童68名(136眼)为对照。研究对象的性别比较采用χ2检验,年龄比较采用秩和检验,光学相干断层成像(OCT)测量值比较采用独立样本t检验,P<0.05为差别有统计学意义。结果纳入的37例患儿年龄5.0~16.0岁、平均(11.0±2.9)岁,男25例、女12例;正常对照组健康儿童68名(136眼),平均年龄(10.4±2.2)岁,男39名、女29名。两组年龄和性别差异无统计学意义(P>0.05)。37例患儿发生SIOH 22例(59.5%),多数发病在糖皮质激素治疗后1~2个月。3例(8.1%)在糖皮质激素治疗后3年发生SIG,2眼因眼压失控致盲。其中严格纵向随访时间≥18个月的17例患儿,13例(76.5%)发生高眼压;9例(52.9%)激素治疗1个月内发生,至6个月时达12例(70.6%),18个月时为6例(35.3%)。SIOH患儿的视盘周神经纤维层厚度(103.3±13.6)μm与对照组(101.3±8.3)μm比较略有增厚,但是差别无统计学意义(P=0.428)。结论SIOH是风湿免疫性疾病患儿长期糖皮质激素治疗的常见并发症,SIOH发生时间为治疗后1个月(52.9%)、6个月(70.6%)及18个月(35.3%),少部分SIG发生在治疗后的3年。这些参数可对全身糖皮质激素治疗患儿眼压监测、药物控制以及防止视力损伤及致盲提供指导。Objective To investigate the clinical features,drugs treatment effects,and prognosis of the occurrence of steroid-induced ocular hypertension(SIOH)and steroid-induced glaucoma(SIG)to reduce and avoid their blindness.Methods In this prospective study,55 children diagnosed with systemic immune diseases requiring systemic glucocorticoid therapy at the Department of Rheumatology and Immunology of Beijing Children´s Hospital,Capital Medical University,from November 2017 to February 2019 were recruited.Thirty-seven cases(74 eyes)were included in the study according to the inclusion and exclusion criteria,with a follow-up deadline of July 2021;the ophthalmology department completed follow-up,and the follow-up indicators were the time of onset and incidence of hormonal hypertension and glaucoma,the control of IOP by medication,and changes in optic nerve fiber layer thickness.Sixty-eight age-and gender-matched normal children(136 eyes)were included as controls.The gender of the study subjects was compared byχ2 test,the age was compared by rank-sum test,and the optical coherence tomography(OCT)measurements were compared by independent samples t-test,and a(P<0.05)was considered statistically significant.Results The age of the 37 children included in the study ranged from 5.0 to 16.0 years,with a mean age of(11.0±2.9)years,25 males and 12 females;68 healthy children(136 eyes)in the normal control group,with a mean age of(10.4±2.2)years,39 males and 29 females.There was no statistically significant difference in age and gender between the two groups(P>0.05).SIOH occurred in 22 of 37 children(59.5%),mostly 1 to 2 months after glucocorticoid treatment.3 cases(8.1%)developed SIG 3 years after glucocorticoid treatment,and 2 eyes became blind due to uncontrolled IOP.Of the 17 children with longitudinal follow-up,13(76.5%)developed hypertension;9(52.9%)occurred within 1 month of hormone therapy,reaching 12(70.6%)by 6 months and 6(35.3%)by 18 months.The thickness of the peripapillary nerve fiber layer was slightly thicker in chi

关 键 词：糖皮质激素类 输注 静脉内 口服 青光眼 高眼压 

分 类 号：R725.9[医药卫生—儿科] R775[医药卫生—临床医学]