他克莫司在治疗外周血干细胞移植术后移植物抗宿主病干眼症的应用研究

Application of Tacrolimus in the Treatment of Graft-Versus-Host Disease Dry Eye after Peripheral Blood Stem Cell Transplantation

目的:探究他克莫司在治疗外周血干细胞移植术后移植物抗宿主病干眼症(Dry eye associtated with graft-versus-host disease,GVHD-DE)的应用价值。方法:收集2022年3月—2023年5月在中山市人民医院血液科确诊GVHD并因干眼相关症状首次就诊眼科的患者50例(100只眼),采用随机数字法分为观察组及对照组,各25例(50眼)。对照组常规予以0.3%玻璃酸钠滴眼液,4次/天;观察组基于对照组用药予以0.1%他克莫司滴眼液,4次/天,两组每3个月随访1次,持续随访半年。比较两组治疗前后美国国立卫生研究院(National Institutes of Health,NIH)GVHD眼睛受损评价表评分、泪液分泌实验情况、泪膜破裂时间(break-up time,BUT)、眼表疾病指数(ocular surface disease index,OSDI)调查表评分、舒适度问卷评分。结果:在治疗后,两组NIH GVHD眼睛受损评分、OSDI评分及舒适度问卷评分较治疗前下降,BUT、泪液分泌实验长度较治疗前上升(P<0.05),且观察组NIH GVHD眼睛受损评分、BUT、泪液分泌实验长度、OSDI评分及舒适度问卷评分的改善程度优于对照组(P<0.05)。结论:外周血干细胞移植术后移植物抗宿主病干眼症通过0.1%他克莫司滴眼液治疗后,干眼症状缓解,泪膜稳定性提升,能促进眼表修复,提高视觉质量及患者舒适度。

Objective:To investigate the application value of tacrolimus in the treatment of Dry eye associtated with graft-versus-host disease(GVHD-DE)after peripheral blood stem cell transplantation.Methods:A total of 50 patients(100 eyes)diagnosed with GVHD in the hematology Department of Zhongshan People's Hospital from March 2022 to May 2023 who visited the ophthalmology department for the first time due to dry eye related symptoms were collected and divided into observation group and control group by random number method,with 25 patients(50 eyes)in each group.The control group was routinely given 0.3%sodium hyaluronate eye drops 4 times a day;The observation group was given 0.1%tacrolimus eye drops 4 times a day based on the control group,and the two groups were followed up once every 3 months for 6 months.The National Institutes of Health(NIH)GVHD eye damage assessment scale score,tear secretion test,tear film break up time before and after treatment were compared between the two groups.(BUT),ocular surface disease index(OSDI)score,and comfort questionnaire score.Results:After treatment,NIH GVHD eye damage score,OSDI score and comfort questionnaire score decreased in both groups compared with before treatment,BUT,tear secretion test length increased compared with before treatment(P<0.05).NIH GVHD eye damage score,BUT,tear secretion test length,OSDI score and comfort questionnaire score in observation group were better than those in control group(P<0.05).Conclusion:After peripheral blood stem cell transplantation,GVHD dry eye disease is treated with 0.1%tacrolimus eye drops,dry eye symptoms can be relieved,tear film stability can be improved,ocular surface repair can be promoted,visual quality and patient comfort can be improved.