环孢素滴眼液联合地夸磷索钠滴眼液治疗干燥综合征相关中、重度干眼的临床效果

Clinical efficacy of Cyclosporine Eye Drops combined with Diquafosol Sodium Eye Drops in the treatment of moderate or severe dry eye associated with SjOgren’s syndrome

目的探讨环孢素滴眼液联合地夸磷索钠滴眼液在干燥综合征相关中、重度干眼症患者中的治疗效果。方法选取2023年10月至2024年1月徐州医科大学附属医院风湿免疫科、眼科确诊为干燥综合征伴中、重度干眼的患者90例(90只眼)作为研究对象。采用随机数字表法将其分为CsA组、DQS组、联合组,每组30例(30只眼)。CsA组使用0.05%环孢素滴眼液、0.3%玻璃酸钠滴眼液点双眼。DQS组使用地夸磷索钠滴眼液、0.3%玻璃酸钠滴眼液点双眼。联合组联合用药。治疗12周。治疗前,治疗后2、4、12周比较三组眼表疾病指数(OSDI)评分、非接触式泪河高度(NITMH)、首次非侵入式泪膜破裂时间(NIBUTf)、睑板腺缺失评分、眼红分析、角膜染色评分。结果OSDI评分:治疗2、4、12周后,三组较治疗前降低(P<0.05);CsA和联合组治疗4、12周后时低于治疗2周后;联合组治疗12周后低于治疗4周后(P<0.05)。治疗2、4、12周后,联合组低于DQS组、CsA组(P<0.05)。NITMH评分:治疗12周后,三组高于治疗前,联合组治疗2、4、12周后各时间点比较,差异有统计学意义(P<0.05);CsA组治疗4周后高于治疗前,DQS组治疗12周后高于治疗2周后(P<0.05)。治疗4、12周后,联合组高于DQS组(P<0.05)。NIBUTf评分:联合组和CsA组各时间点比较,差异均有统计学意义(P<0.05);DQS组治疗12周后较治疗前、治疗2周后均升高(P<0.05)。治疗4、12周后,联合组高于DQS组、CsA组(P<0.05);治疗2周后,联合组高于DQS组(P<0.05)。脂质层厚度分级评分:联合组治疗12周后较治疗前,治疗2、4周后升高,治疗2、4周后较治疗前升高(P<0.05);CsA组治疗12周后较治疗前、治疗4周后升高,治疗4周后高于治疗2周后,治疗后2周高于治疗前(P<0.05);DQS组治疗12周后较治疗前、治疗2周后升高(P<0.05)。结膜等级评分:联合组和CsA组各时间点比较,差异均有统计学意义(P<0.05);DQS组治疗12周后较治疗2周后降低(P<0.05)。治疗4、12周后,联合组低于DQS组、CsA组(P<0.05)。角膜染色评分:治疗12周后三组评分较治疗前,治疗2、4周后降低,治疗4周后三组评分较治疗前、治疗2周后降低(P<0.05);联合组治疗2周后较治疗前降低(P<0.05)。治疗后2、4、12周,联合组角膜染色评分低于DQS组、CsA组(P<0.05)。结论环孢素滴眼液联合地夸磷索钠滴眼液治疗效果显著,明显改善患者干眼症的客观体征和症状,持续提高患者泪膜破裂时间,临床实用性较佳。

Objective To investigate the therapeutic effect of Cyclosporine Eye Drops combined with Diquafosol Sodium Eye Drops in patients with Sjogren’s syndrome associated with moderate or severe dry eye.Methods Ninety patients(90 eyes)with Sjogren’s syndrome associated with moderate or severe dry eye diagnosed by the Department of Rheumatology and Ophthalmology,the Affiliated Hospital of Xuzhou Medical University from October 2023 to January 2024 were selected for the study.They were divided into CsA group,DQS group,and combined group by random number table method,with 30 cases(30 eyes)in each group.In CsA group,0.05%Cyclosporin Eye Drops and 0.3%Sodium Hyaluronate Eye Drops were applied to both eyes.In DQS group,both eyes were injected with Diquafosol Sodium Eye Drops and 0.3%Sodium Hyaluronate Eye Drops. Combined group treated with combined medication. Treatment for 12 weeks. Before treatment, ocular surface disease index (OSDI) score, non-invasive tear meniscus height (NITMH), first non-invasive tear film break-up time (NIBUTf), meibomian gland loss score, red eye analysis, and corneal staining score were compared among the three groups at 2, 4, and 12 weeks after treatment. Results OSDI score: after 2, 4, and 12 weeks of treatment, the three groups were lower than before treatment(P<0.05);the CsA group and the combined group after 4 and 12 weeks of treatment were lower than after 2 weeks of treatment. After 12 weeks of treatment, the combined group was lower than DQS group and CsA group (P<0.05). NITMH score: after 12 weeks of treatment, the three groups were higher than before treatment, and the difference was statistically significant at each time point after 2, 4, and 12 weeks of treatment in the combined group (P<0.05). After 4 weeks of treatment in CsA group was higher than before treatment, after 12 weeks of treatment in DQS group was higher than after 2 weeks of treatment (P<0.05). After 4 and 12 weeks of treatment, the combined group was higher than the DQS group (P<0.05). NIBUTf score: there were statistically significant differences between combined group and CsA group at each time point (P<0.05). The DQS group after 12 weeks of treatment was higher than before and after 2 weeks of treatment (P<0.05). After 4 and 12 weeks of treatment, the combined group was higher than DQS group and CsA group (P<0.05);after 2 weeks of treatment, the combined group was higher than the DQS group (P<0.05). Lipid layer thickness grading score: After 2, 4, and 12 weeks of treatment the combined group was higher than before treatment;there was statistical significance at each time point in CsA group (P<0.05). The DQS group after 12 weeks of treatment was higher than that before and after 2 weeks of treatment (P<0.05). There was no significant difference between the combined group, DQS group and CsA group at each time point (P>0.05). The lipid layer thickness grading score: after 12 weeks of treatment, the combined group was higher than that before and after 2 and 4 weeks of treatment, and after 2 and 4 weeks of treatment were higher than before treatment (P<0.05). The CsA group was higher after 12 weeks than before and after 4 weeks, after 4 weeks was higher than after 2 weeks of treatment, and after 2 weeks of treatment was higher than before treatment (P<0.05). The DQS group after 12 weeks of treatment was higher than before and after 2 weeks of treatment (P<0.05). Conjunctival grade score: there were statistically significant differences between combined group and CsA group at each time point (P<0.05). The DQS group after 12 weeks of treatment was lower than that after 2 weeks of treatment (P<0.05). After 4 and 12 weeks of treatment, the combined group was lower than DQS group and CsA group (P<0.05). Corneal staining score: after 12 weeks of treatment, the score of the three groups was lower than before treatment, and after 2 and 4 weeks of treatment, and after 4 weeks of treatment, the score of the three groups was lower than before treatment and after 2 weeks of treatment (P<0.05). After 2 weeks of treatment, the combined group was lower than before treatment (P<0.05). At 2, 4 and 12 weeks after treatment, the corneal staining score in combined group was lower than that in DQS and CsA group (P <0.05). Conclusion Cyclosporine Eye Drops combined with Desquafoxol Sodium Eye Drops can significantly improve the objective signs and symptoms of patients with dry eye, continuously improve the time of tear film rupture, and have good clinical practicability.