慢性丙型肝炎患者干眼临床特征

Clinical characteristics of dry eye in patients with chronic hepatitis C

目的分析慢性丙型肝炎(CHC)患者干眼的临床特征。方法收集2021年2月至2022年1月于首都医科大学附属北京地坛医院肝病科确诊并于眼科筛查的CHC患者共69例(138只眼),年龄23~75岁,平均(45.39±12.88)岁。收集患者病史、血小板计数(PLT)、丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)检测值,并计算AST/PLT比值指数(APRI)。对患者行干眼相关检查,即国际标准眼表疾病指数(OSDI)干眼问卷调查、泪液分泌(SchirmerⅠ)试验及干眼眼表分析仪检查[平均非接触式泪膜破裂时间(NIBUT_(av))和泪河高度测定(TMH)]。患者OSDI得分0~12分为无症状组(36例)和OSDI≥13分为有症状组(33例)。依据数据类型采用独立样本t检验、秩合检验及Pearsonχ^(2)检验进行统计学处理。结果无症状组患者SchirmerⅠ为12.5(8.25,17.75)mm/5 min,NIBUT_(av)为12.1(6.35,20.65)s,TMH为0.26(0.19,0.34)mm;有症状组患者SchirmerⅠ为11(6,19.25)mm/5 min,NIBUT_(av)为7.95(4.78,13.32)s,TMH为0.24(0.20,0.28)mm。27例患者诊断为干眼,以NIBUT结果异常为主要表现,两组患者NIBUT差异有统计学意义(Z=-3.77、P<0.001),SchirmerⅠ差异无统计学意义(Z=-1.15、P=0.25),TMH差异无统计学意义(Z=-0.96、P=0.34)。无症状组患者丙型肝炎病毒(HCV)感染病程为7(3.25,12)年,有症状组患者为11(7,16)年,差异有统计学意义(Z=-2.40、P=0.02)。无症状组和有症状组患者ALT水平分别为79(45.75,128.75)U/L和77.00(42.5,117.5)U/L,差异无统计学意义(Z=-0.14、P=0.89)。无症状组患者APRI为0.62(0.34,0.88),有症状组患者为0.78(0.61,1.03),差异有统计学意义(Z=-0.20、P=0.04)。结论CHC患者干眼的发病率较高,该类患者应定期进行干眼相关检查,以改善患者的眼表状态。

Objective To investigate the prevalence of dry eye in patients with chronic hepatitis C(CHC).Methods Total of 69 patients(138 eyes)with CHC,who were 23 to 75 years old,with the average of(45.39±12.88)years old,diagnosed in Department of Hepatology of Beijing Ditan Hospital,Capital Medical University from February 2021 to January 2022 were collected.Medical history,levels of platelet count(PLT),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)of the patients were collected and the AST/PLT ratio index(APRI)was calculated.All patients received the international standard ocular surface disease index(OSDI)dry eye questionnaire,and the observation indexes included SchirmerⅠtest,noninvasive breakup time average(NIBUT_(av)),tear meniscus height(TMH).According to the OSDI score,patients with 0-12 score were divided into asymptomatic group(36 cases),and with the score≥13 were considered as symptomatic group(33 cases).Statistical treatment was performed by independent sample t-test,rank combination test and Pearsonχ^(2) test according data type.Results SchirmerⅠof patients in asymptomatic group was 12.5(8.25,17.75)mm/5 min,NIBUT_(av) was 12.1(6.35,20.65)s,TMH was 0.26(0.19,0.34)mm;For patients in symptomatic group,SchirmerⅠwas 11(6,19.25)mm/5 min,NIBUT_(av) was 7.95(4.78,13.32)s,TMH was 0.24(0.20,0.28)mm.Total of 27 cases were diagnosed as dry eyes,with abnormal results of NIBUT as the main manifestation.There was significant difference in NIBUT between the two groups(Z=-3.77,P<0.01).But there were no significant difference in SchirmerⅠ(Z=-1.15,P=0.25)and TMH(Z=-0.96,P=0.34).The course of hepatitis C virus(HCV)infection was 7(3.25,12)years in asymptomatic group and 11(7,16)years in symptomatic group,with significant difference(Z=-2.40,P=0.02).ALT levels of patients in asymptomatic group and symptomatic groups were 79(45.75,128.75)U/L and 77.00(42.5,117.5)U/L,respectively,with significant difference(Z=-0.14,P=0.89).APRI of patients in asymptomatic group and symptomatic groups were 0.62(0.34,0.88)and 0.78(0.61,1.03),with significant difference(Z=-0.20,P=0.04).Conclusions The incidence rate of dry eye is high in CHC patients.CHC patients should be regularly examined for dry eye to improve their ocular surface status.