A型肉毒毒素不同注射位置治疗眼睑痉挛的疗效观察

Effects of different injection sites of type A botulinum toxin in the treatment of blepharospasm

目的:比较A型肉毒毒素不同注射位置治疗眼睑痉挛的治疗效果。方法:选择我院2012-06/2015-06收治的85例136眼眼睑痉挛患者作为研究对象,按随机数字表分为A组(43例66眼)与B组(42例70眼)。两组患者均应用注射用A型肉毒毒素进行治疗,A组采取完全注射模式,B组采取豁免下睑内侧组模式。比较两组患者治疗前、治疗后3wk的Jankovic评定量表(Jankovic Rating Scale,JRS)评分、眼睑痉挛残疾指数(Blepharospasm Disability Index,BSDI)指数、泪膜破裂时间(break-up time,BUT)、前段OCT泪河高度(tear meniscus height,TMH)、副反应发生率及随访90d复发率。结果:两组患者治疗前的JRS评分、BSDI指数、BUT与TMH无统计学差异(均P>0.05);治疗后1wk两组患者BUT与TMH均增大,治疗后3wk两组患者JRS评分、BSDI指数均下降,组内前后差异有统计学意义(P<0.05);治疗后两组患者JRS评分、BSDI指数、BUT的组间差异无统计学意义(P>0.05);A组TMH高于B组,组间差异有统计学意义(P<0.05)。90d随访结果显示,A组和B组复发率分别为14.0%、11.9%,副反应发生率分别为23.3%和16.7%,两组比较均无统计学差异(P>0.05)。结论:A型肉毒毒素采取完全注射模式及豁免下睑内侧注射模式治疗眼睑痉挛均可有效缓解患者症状,并减轻其对日常生活的影响,随访90d复发率接近,豁免下睑内侧注射模式可减轻对泪膜稳定及泪液引流的干扰,具有微小优势。

AIM：To compare the effects of different injection sites of type A botulinumtoxin in the treatment of blepharospasm. METHODS： Eighty- five patients（ 136 eyes） with blepharospasmtreated in our hospital between June 2012 and June 2015 were selected as the study subjects and were divided into group A（ 43 cases,66 eyes） and group B（ 42 cases, 70 eyes） by the randomnumber table method. Both groups were treated with type A botulinumtoxin injection. Complete injection model was adopted in group A while injection sites except lower eyelid was adopted in group B. The Jankovic rating scale（ JRS）scores,blepharospasmdisability index（ BSDI）,break-up time（ BUT） and tear meniscus height（ TM H） before treatment and at 3wk after treatment,incidence of side effects and recurrence rate in 90 d of follow- up were compared between the two groups.RESULTS： There were no significant differences in JRS score and BSDI between two groups before treatment（ all P0. 05）; 1 week after treatment,BUT and TM H increased in both groups. Three weeks after treatment,JRS scores and BSDI were lower than those before treatment（ P 0. 05） but there were no significant differences between groups（ P 0. 05）. After treatment, there were no significant differences in JRS scores, BSDI and BUT between groups（ P 0. 05）. TM H of group A was higher than that of groups B（ P0. 05）. Ninety days of follow-up showed that the recurrence rates in group A and group B were 14. 0% and 11. 9%,respectively,and the incidencerates of side effects were 23. 3% and 16. 7%,respectively（ P0. 05）.CONCLUSION： Both of complete injection and injection sites except lower eyelid of botulinumtoxin type A in the treatment of blepharospasmcan effectively relieve symptoms and the effects on daily life. The 90 d recurrence rates are similar. Injection sites except lower eyelid can reduce the interference to the stability of tear filmand lacrimal fluid drainage,with slight advantage.