原发性肾病综合征患儿应用糖皮质激素治疗所致眼损害的临床特点

Clinical features of eye damage caused by glucocorticoid treatment in children with primary nephrotic syndrome

目的探讨原发性肾病综合征患儿应用糖皮质激素治疗导致眼损害的临床特点。方法回顾性分析2016年9月至2018年4月郑州儿童医院收治的49例原发性肾病综合征患儿应用糖皮质激素后出现激素相关性高眼压或白内障的临床资料,观察相关眼损害与临床用药之间的关系。结果49例患儿中,男37例,女12例;起病年龄(7.6±3.0)岁;49例患儿中糖皮质激素性高眼压22例,糖皮质激素性白内障19例,8例患儿同时合并糖皮质激素性高眼压及白内障,49例患儿中无青光眼患者。糖皮质激素使用时间为15~3 240 d[(863.33±871.46) d],糖皮质激素累积剂量为(7 865±3 691.66) mg/m2,患儿左眼压为(26.68±5.95) mmHg(1 mmHg=0.133 kPa),右眼压为(27.71±5.82) mmHg,糖皮质激素使用时间、累积剂量与高眼压无相关性(r=-0.158、-0.264、-0.237、-0.361,均P>0.05)。19例糖皮质激素性白内障及同时合并糖皮质激素性高眼压及白内障的8例患儿均表现为晶体后囊下混浊,其中男23例,女4例;激素使用时间为(1 296.67±903.35) d,均持续随访中。结论糖皮质激素性高眼压和白内障起病隐匿,应引起临床医师重视,一旦高眼压或白内障出现后,应逐渐减量或停用激素,同时积极给予眼部治疗,避免眼部严重病变发生。

Objective To explore the clinical characteristics of glucocorticoid induced eye damage in children with primary nephrotic syndrome. Methods The clinical data of steroid-induced high intraocular pressure or cataract in 49 children who were from Zhengzhou Children′s Hospital with primary nephrotic syndrome admitted from September 2016 to April 2018 were analyzed retrospectively in order to observe the relationship between relevant eye damage and clinical medication. Results There were 37 boys and 12 girls in the 49 cases, of which the average age of onset was (7.6±3.0) years old, and among them there were 22 cases with glucocorticoid high intraocular pressure, 19 cases with glucocorticoid cataract, 8 cases with glucocorticoid high intraocular pressure combined with cataract, but no glaucoma in 49 cases.The shortest time of using glucocorticoid was 15-3 240 days[(863.33±871.46) days];the cumulative dose of glucocorticoid was (7 865±3 691.66) mg/m2, the left eye pressure was (26.68±5.95) mmHg(1 mmHg=0.133 kPa) and the right eye pressure was (27.71±5.82) mmHg.There was no significant correlation between glucocorticoid using time, cumulative dose and high intraocular pressure(r=-0.158,-0.264,-0.237,-0.361, all P>0.05). All the 19 patients with glucocorticoid cataract and 8 patients with glucocorticoid high intraocular pressure combined with cataract presented posterior capsular opacity, including 23 males and 4 females, and their time of using glucocorticoid was(1 296.67±903.35)days, who were followed up continuously. Conclusions Glucocorticoid-induced high intraocular pressure and cataract should be paid attention to by clinicians.Once high intraocular pressure or cataract occurs, the dosage of glucocorticoid should be gradually reduced or stopped, at the same time, ophthalmologic treatment should be actively performed to avoid serious eye diseases.