| 查伟,顾正宇,吴萌瑶,等.异基因造血干细胞移植术后病人眼表特征及相关因素分析[J].安徽医药,2026,30(10):2049-2055. |
| 异基因造血干细胞移植术后病人眼表特征及相关因素分析 |
| Ocular surface characteristics and related analysis of patients after allogeneic hematopoietic stem cell transplantation |
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| DOI：10.3969/j.issn.1009-6469.2026.10.027 |
| 中文关键词: 眼部移植物抗宿主病 干眼症 免疫抑制剂 睑板腺 异基因造血干细胞移植术 眼表现 |
| 英文关键词: Ocular graft-versus-host disease Dry eye disease Immunosuppressants Meibomian gland Allogeneic hematopoi-etic stem cell transplantation Eye manifestations |
| 基金项目:安徽高校(自然)科学研究项目( KJ2021A0298) |
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| 中文摘要: |
| 目的探究异基因造血干细胞移植( Allo-HSCT)术后病人的眼表特征及相关因素。方法横断面研究。纳入 2022年 7月至 2023年 8月就诊于安徽医科大学第一附属医院，已行 Allo-HSCT的病人 48例作为 HSCT组，及 2022年 7月至 2024年 2月就诊于该院无干眼相关基础疾病病人 43例作为对照组。进行一般资料、眼表疾病指数量表、角膜荧光素染色结果，泪河高度、非接触泪膜破裂时间、结膜充血(CI)分数、睑板腺缺失面积等数据，采用 Image J软件进行图像处理， SPSS 26.0软件进行统计学分析。结果 HSCT组眼表疾病指数量表总分及各子项评分均高于对照组( P<0.001)；首次非接触式泪膜破裂时间［ 4.90(3.23，7.13)s比 10.77(7.40，14.84)s，P<0.001］及平均非接触式泪膜破裂时间［ 8.40(5.80，11.73)s比 15.60(12.65，18.73)s，P<0.001］均短于对照组；角膜荧光素染色分数［ 3.5(0，5.2)分比 0(0，0)分， P<0.001］及 CI分数高于对照组［ 1.38(1.07，1.67)分比 0.76(0.23，1.19)分， P<0.001］泪河高度低于对照组［ 0.16(0.13，0.23)mm比 0.26(0.21，0.34)mm，P<0.001］干眼发病比例高于对照组(77.1%比 20.9%)混合型干眼占比高于对照组( 56.8%比 33.3%)。下眼睑睑板腺缺失面积百分比高于上眼睑［ 0.28(0.20，0.40)比 0.22(0.10.30)P<0.001］下睑鼻、颞侧睑板腺缺失面积百分比高于中央部分( P<0.001)。 HSCT组睑板泪河高度有较强相关性(P<0.05)腺缺失面积与P<0.05皮肤移植物抗宿主病( graft-versus-host disease，GVHD)、肺部感染、 EB病毒感染史与眼 GVHD发病呈正相关(P<0.05)。移植时间及各项眼表参数均能有效预测 Allo-HSCT术后眼部移植物抗宿主病发病情况( AUC>0.5，P<0.05)，其中移植时间临界值为 9.5个月，眼表疾病指数量表评分临界值为 16.5分， CI分数临界值为 1.4分。采取眼表疾病指数量表、移植时间、 CI分数两两联合预测效果较单一数值预测效果更佳，使用眼表疾病指数量表联合 CI分数时预测概率最高，且联合诊断与采取 NifBUT诊断 AUC比较差异无统计学意义( Z=0.75，P=0.453)。结论 Allo-HSCT术后人群主客观数值低于普通人水平，干眼症发病率高，以混合型干眼为主，睑板腺较普通人显著萎缩，且下眼睑板腺萎缩程度更高，干眼的发生与皮肤 GVHD、肺部感染、 EBV感染史关联密切，且能通过眼表疾病指数量表联合 CI有效预测 oGVHD的发生。 |
| 英文摘要: |
| Objective To explore the characteristics and related factors of the ocular surface in patients after allogeneic hematopoiet-ic stem cell transplantation.Methods Cross sectional study. A total of 48 patients who visited The First Affiliated Hospital of AnhuiMedical University between July 2022 and August 2023 and had undergone allogeneic hematopoietic stem cell transplantation (Allo-HSCT) were enrolled as the HSCT group. Additionally, 43 age-matched individuals without underlying diseases related to dry eye, whowere treated in the same hospital between July 2022 and February 2024, were included as the control group. General information, ocu-lar surface disease index (OSDI), corneal fluorescein staining results, tear meniscus height, average non-invasive tear breakup time,conjunctival injection, meibomian gland deficiency area were collected. Image processing was performed using ImageJ software, andstatistical analysis was performed using IBM SPSS Statistics 26.0.Results The total score of the OSDI and all sub-item scores in the HSCT group were higher than those in the control group (P < 0.001). The first non-invasive tear break-up time [4.90 (3.23,7.13) s vs. 10.77 (7.40,14.84) s, P < 0.001] and the average non-invasive tear break-up time [8.40 (5.80, 11.73) s vs. 15.60 (12.65,18.73) s, P< 0.001] were both shorter than those in the control group. The corneal fluorescein staining score [3.5 (0,5.2) points vs. 0 (0, 0) points, P< 0.001] and conjunctival hyperemia score [1.38 (1.07,1.67) points vs. 0.76 (0.23,1.19) points, P<0.001] were higher than those in the control group, while tear meniscus height was lower [0.16 (0.13,0.23) mm vs. 0.26 (0.21,0.34) mm, P<0.001]. The prevalence of dry eye was higher in the HSCT group (77.1% vs. 20.9%), and the proportion of mixed-type dry eye was also higher (56.8% vs. 33.3%). The per-centage area of meibomian gland loss in the lower eyelid was greater than that in the upper eyelid [0.28 (0.20, 0.40) vs. 0.22 (0.10, 0.30), P<0.001]. In the lower eyelid, the nasal and temporal regions showed a higher percentage of gland loss than the central region (P < 0.001). In the HSCT group, the area of meibomian gland loss was strongly correlated with tear meniscus height (P<0.05). Graft-ver-sus-host disease (GVHD), pulmonary infection, and history of EB virus infection were positively correlated with the incidence of ocularGVHD (P<0.05). Both transplantation time and various ocular surface parameters could effectively predict the onset of ophthalmic graft-versus-host disease following Allo-HSCT (AUC>0.5, P<0.05), with a cutoff value of 9.5 months for transplantation time, 16.5 points forthe OSDI score, and 1.4 points for the conjunctival congestion score. The combined prediction effect of pairwise parameters, the OSDIscore, transplantation time, and conjunctival congestion score, was better than that of any single parameter alone. The use of the OSDIscore combined with the conjunctival congestion score had the highest predictive probability, and there was no statistically significantdifference in AUC between the combined diagnosis and diagnosis using NifBUT (Z = 0.75, P = 0.453).Conclusions The subjective and objective values of the Allo-HSCT population after surgery are inferior to those of ordinary people, with a high incidence of dry eye disease, with mixed-type dry eye being the predominant form. Compared with normal individuals patients have significantly more atro-phic meibomian glands, with a higher degree of atrophy in the lower eyelid. The occurrence of dry eye is closely related to skin GVHD,pulmonary infection, and EBV infection history. Moreover, the development of oGVHD can be effectively predicted by the OSDI scorecombined with conjunctival congestion. |
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