眼内压测定评估长期使用鼻用激素患者的眼部安全性

Value of intraocular pressure for assessment of ocular safety of intranasal steroids

目的:由于长期使用鼻用激素可能会引起各种不良反应,其中包括导致患者眼内压(intraocular pressure,IOP)升高。本研究通过观察2种临床常用鼻用激素(包括第一代和第二代鼻用激素)使用后患者的IOP变化情况,探讨IOP测定在长期使用鼻用激素患者眼部安全性评估中的重要价值。方法:将52例变应性鼻炎患者随机分为2组,分别使用第一代和第二代鼻用激素进行治疗,为时12周。在治疗前及治疗后3周、6周、9周、12周分别测量患者的IOP,分别对2组内治疗前和治疗后各时期的IOP进行比较。结果:使用第一代鼻用激素治疗组,治疗后3周、6周、9周时患者的IOP与治疗前比较,略有缓慢升高的趋势,但差异尚无统计学意义(P>0.05);而在治疗后12周,患者的IOP则明显高于治疗前,差异有统计学意义(P=0.02)。而使用第二代鼻用激素治疗组,治疗后各时期的IOP与治疗前比较,差异均无统计学意义(P>0.05)。结论:对于长期使用鼻用激素,尤其是第一代鼻用激素的人群,随访监测IOP可以作为评估其眼部安全性的重要指标。

Objective: Many side effects including elevation of intraocular pressure(IOP) due to long-term use of intranasal steroids were reported, especially with the first generation intranasal steroids, yet the second generation intranasal steroids were believed only having a minimal impact on IOP because of low bioavailability. The object of this study was to assess the value of IOP for assessing the ocular safety of two intranasal steroids(the first generation and the second genera-tion) for treatment of 12-week period. Methods: Fifty two allergic rhinitis patients were divided randomly into two groups using either the first or second generation intranasal steroids for 12 weeks, respectively. IOPs were measured before treat-ment and after the 3 rd, 6 th, 9 th, and 12 th weeks of treatment. The IOPs of the two groups were compared. Results: The IOP of the first-generation intranasal steroids at 3, 6 and 9 weeks after treatment were not statistically different from those before treatment, while the IOP at 12 weeks after treatment were statistically different from those before treatment. Mean-while, there were no statistically significant differences between the IOP at various stages of treatment and that before treatment with the use of second generation intranasal steroids. Conclusions: For patient with long standing use of nasal steroids, IOP could be considered as an important index for assessing the ocular safety.