更昔洛韦眼用凝胶对单纯疱疹病毒性角膜炎角膜上皮及泪膜稳定性的影响

Ganciclovir gel on corneal epithelial and stabilities of tear film in herpes simplex keratitis

目的探讨更昔洛韦眼用凝胶对单纯疱疹病毒性角膜炎角膜上皮及泪膜稳定性的影响。方法采用前瞻性随机双盲试验,将45例上皮型单纯疱疹病毒性角膜炎患者分3组:A组15例,用1.5g·L-1更昔洛韦凝胶滴眼;B组15例,用1g·L-1更昔洛韦滴眼液滴眼;C组15例,用1g·L-1阿昔洛韦滴眼液滴眼。双眼用药,均为每天4次,健眼观察局部用药对角膜上皮及泪膜稳定性的影响。用药前和用药后21d检查,记录健眼角膜上皮染色(fluorescein staining,FL)评分、泪膜破裂时间(break up time,BUT)、泪液分泌试验(Schirmer I test,SⅠt)和泪河高度(tear meniscus height,TMH)。结果A组用药前后FL、SⅠt及TMH均无明显改变,BUT延长;B组用药后有3例发生角膜上皮点状着色,BUT缩短率为33.33%,SⅠt和TMH改变不明显;C组用药后有6例发生角膜上皮点状着色,BUT缩短(缩短率为53·33%),SⅠt减少,TMH降低。A、C2组用药后各指标间差异有统计学意义,B组用药后BUT小于A组。结论1.5g·L-1更昔洛韦凝胶能保护眼表上皮细胞,减少药物毒性的作用,可提高泪膜稳定性,有利于促进疾病痊愈,缩短治疗时间。

Objective To investigate the topical application of ganciclovir gel on corneal epitheium and stability of tear film in herpes aimplex keratitis. Methods A randomised double blind prospective clinical trial was carried out on 45 cases with epithelial herpes simplex keratitis. All the cases were divided into three groups, Group A （ 15 cases） were treated with 1.5 g · L^-1 ganciclovir gel, Group B （ 15 cases） were treated with 1 g · L^-1 ganciclovir drop, and Group C（ 15 cases） were treated with 1 g · L^-1 aciclovir drop,four times a day on both eyes. Curative effect was observed on sick eyes, while the effect of topical application on corneal epithelium and stability of tear film was observed on healthy eyes. Fluorescein staining （ FL）, tear film break up time （BUT）, Schirmer I test （S I t） and tear meniscus height （TMH） were recorded pre-therapy and at 21 days post-therapy. Resuits The score of FL, ST and TMH in Group A had no difference after topical application of ganciclovir gel,however,BUT increased at 21 days post-therapy;3 cases in Group B had punctate epithelial staining, BUT was decreased to 33.33% ;6 cases in Group C had punctuate epithelial staining, either of BUT, S I t and TMH decreased （ P = 0. 020,0. 002,0. 005 respectively）. The difference of scores between Group A and Group C was significant, and BUT in Group B was shorter than that of Group A after application of ganciclovir gel. No obviously adverse drug reaction was found in all of the three groups. Conclusion Ganciclovir gel with 1.5 g · L^-1 can protect ocular epithelial cells effectively and increase the stabilities of tear film, and also can improve symptom early and shorten the curative time of herpes simplex keratitis.