原发性肾病综合征患儿激素治疗后高眼压对眼轴的影响

EFFECTS OF CORTICOSTEROID-INDUCED OCULAR HYPERTENSION ON OCULAR AXIS IN CHILDREN WITH PRIMARY NEPHROTIC SYNDROME

目的研究原发性肾病综合征患儿应用糖皮质激素治疗后眼压和眼轴改变情况。方法2016年7月—2018年1月在唐山市妇幼保健院住院的108例原发性肾病综合征患儿,应用糖皮质激素治疗,22例出现眼压升高(观察组),86例未出现眼压升高(对照组),记录激素治疗6个月内二组之间眼压及眼轴变化情况。结果应用激素后1个月观察组眼压平均(28.16±9.81)mmHg,对照组平均(19.84±0.56)mmHg,二组差异有统计学意义(P<0.05),观察组经降眼压药物治疗后眼压降至正常范围;应用激素后3个月起观察组眼轴较基线明显升高(P<0.05),6个月时,观察组眼轴平均(23.05±0.33)mm,对照组平均(22.63±0.28)mm,二组间比较、组内与基线眼轴比较,差异均有统计学意义(均P<0.05)。Logistic回归分析提示观察组患儿眼压升高为眼轴增长的独立影响因素(P<0.05)。结论原发性肾病综合征患儿应用糖皮质激素治疗,存在高眼压风险,有可能造成眼轴增长。

Objective To investigate the changes of intraocular pressure(IOP)and ocular axis length(AL)in children with primary nephrotic syndrome after application of steroid.Methods A total of one hundred andeight children with primary nephrotic syndrome,applied with a steroid therapy over 6 months,were enrolled,from July 2016 to January 2018,in Tangshan Maternal and Child Health Care Hospital.According to the results of with or without elevated intraocular pressure,the patients were divided into two groups,observation group(22 cases,20.37%)and the control group(86 cases,79.63%).Outcomes of AL and IOP were recorded at baseline and steroid during a 6-month follow-up period.Results Among all patients,IOP were(28.16±9.81)mmHg and(19.84±0.56)mmHg,in observation group and the control group,respectively,after 1 month.The difference between the two groups was statistically significant(P<0.05).The intraocular pressure in the observation group decreased to the normal range after the treatment of antihypertensive drugs.The ocular axis in the observation group increased significantly from the baseline(P<0.05)3 months after the application of hormone.At 6 months,the average ocular axis in the observation group was(23.05±0.33)mm,and that in the control group was(22.63±0.28)mm.There was significant difference between the two groups(P<0.05).Logistic regression analysis indicated that the increase of IOP in the observation group was an independent factor(P<0.05).Conclusion There is a risk of high intraocular pressure in children with primary nephrotic syndrome treated with glucocorticoid,which may cause axial growth.