葡萄膜炎患者继发糖皮质激素性高眼压临床特点分析及遗传易感性研究  

Analysis of clinical characteristics and genetic susceptibility of steroid-induced ocular hypertension in patients with uveitis

作　　者：陶清沁 张歆怡 杨付花 刘峥 李筱荣 张晓敏 Tao Qingqin;Zhang Xinyi;Yang Fuhua;Liu Zheng;Li Xiaorong;Zhang Xiaomin(Tianjin Key Laboratory of Retinal Functions and Diseases,Tianjin Branch of National Clinical Research Center for Ocular Disease,Eye Institute and School of Optometry,Tianjin Medical University Eye Hospital,Tianjin 300384,China;Shanxi Eye Hospital,Taiyuan 030002,China)

机构地区：[1]天津医科大学眼科医院、眼视光学院、眼科研究所,国家眼耳鼻喉疾病临床医学研究中心天津市分中心,天津市视网膜功能与疾病重点实验室,天津300384 [2]山西省眼科医院,太原030002

出　　处：《中华眼底病杂志》2022年第5期353-358,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察葡萄膜炎患者继发糖皮质激素性高眼压(SIOH)的临床特点,初步分析其临床表型与基因多态性的相关性。方法回顾性病例对照研究。2019年7月至2020年12月于天津医科大学眼科医院就诊并接受糖皮质激素滴眼液治疗的葡萄膜炎患者576例纳入研究。其中,确诊糖皮质激素反应者(SRs)175例,糖皮质激素无反应者(NRs)401例。分别选取使用1%醋酸泼尼松龙滴眼液的SRs(年龄≥18岁)70例作为病例组,NRs 64例作为对照组。采用Sanger测序技术对两组患者人类白细胞抗原复合体(HCG)22基因rs2523864、rs3873352位点进行基因分型。观察糖皮质激素滴眼液使用后发生SIOH的临床特点,以及rs2523864、rs3873352与SIOH发生的相关性。组间比较采用χ2检验或Fisher精确概率法;SIOH发生及糖皮质激素使用后眼压升高范围与rs2523864、rs3873352位点的相关性采用比值比(OR)及其95%可信区间(95%CI)表示。结果576例患者中,发生SIOH 175例(30.4%,175/576)。其中,男性96例(54.9%,96/175),女性79例(45.1%,79/175);年龄(33.64±17.40)岁。糖皮质激素高反应者(HRs)、中反应者(MRs)分别为58(33.1%,58/175)、117(66.9%,117/175)例。引起眼压升高的用药时间,MRs、HRs分别为33(19,56)、28(14,36)d,差异有统计学意义(Z=-1.999,P=0.046)。使用1%醋酸泼尼松龙滴眼液引起眼压升高的用药频率,MRs、HRs分别为4.24(3.46,4.66)、4.32(3.84,5.36)次/d,差异无统计学意义(Z=-1.676,P=0.094)。病例组、HRs组患者rs3873352位点基因型及等位基因频率分布与对照组比较,差异均有统计学意义(P<0.05)。rs3873352 GG基因型患者用药后眼压高于GC基因型和CC基因型患者,差异有统计学意义(Z=2.855、2.628,P=0.013、0.026);rs2523864不同基因型患者间用药后眼压比较,差异无统计学意义(Z=3.580,P>0.05)。遗传模型分析结果显示,rs3873352位点G等位基因携带者(GG+GC)发生SIOH的风险是非G等位基因携带者的2.048倍(OR=2.048,95%CI 1.027Objective To observe the clinical characteristics of steroid-induced ocular hypertension(SIOH)in patients with uveitis,and explore the relationship between its clinical phenotype and gene polymorphism.Methods A retrospective case-control study.From July 2019 to December 2020,576 patients with uveitis who were treated with glucocorticoid eye drops in Tianjin Medical University Eye Hospital were included in the study.Among them,there were 175 confirmed glucocorticoid responders(SRs)and 401 glucocorticoid non-responders(NRs).Seventy cases of SRs(age≥18 years)using 1%prednisone acetate eye drops were selected as the experiment group and 64 cases of NRs were selected as the control group.The polymorphism of rs2523864 and rs3873352 of human leukocyte antigen complex group(HCG)22 gene were detected by Sanger sequencing.To observe the clinical characteristics of SIOH after the use of glucocorticoid eye drops,and the correlation between rs2523864 and rs3873352 and the occurrence of SIOH.Differences among groups were compared with the Chi-square test or Fisher's exact test.The correlation between the occurrence of SIOH and the range of intraocular pressure increases after glucocorticoid use and the rs2523864 and rs3873352 loci were compared using the odds ratio(OR)and its 95%confidence interval(CI).Results SIOH occurred in 175(30.4%,175/576)of 576 patients.Among them,there were 96 males(54.9%,96/175)and 79 females(45.1%,79/175);the average age was 33.64±17.40 years.Steroid high responders(HRs)and steroid moderate responders(MRs)were 58(33.1%,58/175)and 117(66.9%,117/175)cases.The medication time for the increase in intraocular pressure in MRs that was 33(19,56)days,and in HRs that was 28(14,36)days,the difference of which was significant(Z=-1.999,P=0.046).No differences were found in daily doses of ocular hypertension induced by 1%prednisone acetate eye drops between MRs which was 4.24(3.46,4.66)drops/day and HRs that was 4.32(3.84,5.36)drops/day(Z=-1.676,P=0.094).The genotype and allele frequency distribution of the rs

关 键 词：葡萄膜炎 糖皮质激素类 高眼压 疾病遗传易感性 多态性 单核苷酸 

分 类 号：R773[医药卫生—眼科]