羊膜覆盖术联合药物治疗眼部移植物抗宿主病的临床疗效比较

Comparison of clinical efficacy of amniotic membrane covering combined with drugs in the treatment of ocular graft-versus-host disease

目的比较羊膜覆盖术联合药物治疗眼部移植物抗宿主病(GVHD)的临床疗效。方法采用前瞻性病例对照研究,收集苏州大学附属第四医院确诊为眼部GVHD的患者,观察组和对照组各30眼。观察组接受羊膜覆盖术联合药物治疗,对照组仅接受单纯药物治疗,比较两组患者的治疗效果、平均视力和平均疗程,ELISA方法检测两组患者治疗前后泪液中IL-1β、IL-6、TNF-α表达水平,评估两种治疗方案的疗效差异。结果观察组轻/中度、重度GVHD患者的有效率分别为93.75%、92.85%,对照组分别为80.00%、73.33%,差异具有统计学意义(P<0.05);观察组的平均视力为(0.66±0.04),优于对照组(0.42±0.03)(P<0.05);观察组治疗疗程平均为(22.4±1.8)d,短于对照组(33.2±2.4)d(P<0.05)。治疗后观察组泪液中炎症因子IL-1β、IL-6、TNF-α的表达水平明显低于对照组(P<0.01)。结论羊膜覆盖术联合药物治疗是治疗眼部GVHD的有效方法,可减轻炎症反应,缩短疗程,提高治疗效率,相较于单纯药物治疗具有明显优势。

Objective To compare the clinical efficacy of amniotic membrane covering combined with drugs in the treatment of ocular graftversus-host disease(GVHD).Methods A prospective case-control study was conducted to collect patients diagnosed with ocular GVHD in the Fourth Affiliated Hospital of Soochow University.There were 30 eyes in both the observation group and the control group.The observation group were treated with amniotic membrane covering combined with drug therapy,while those in the control group were treated with simple drug therapy.The therapeutic effect,average visual acuity and average course of treatment were compared between the two groups.The expression levels of IL-1β,IL-6,and TNF-αin tear fluid before and after treatment were detected using the ELISA method to evaluate the differences in efficacy between the two treatment regimens.Results The effective rates for mild/moderate and severe GVHD patients in the observation group were 93.75%and 92.85%,respectively,while those in the control group were 80.00%and 73.33%,respectively,with statistically significant differences(P<0.05).The average visual acuity of the observation group was(0.66±0.04),which was better than that of the control group(0.42±0.03)(P<0.05).The average course of treatment in the observation group was(22.4±1.8)d,which was shorter than that in the control group(33.2±2.4)d(P<0.05).After treatment,the expression levels of inflammatory factors IL-1β,IL-6 and TNF-αin tears of the observation group were significantly lower than those of the control group(P<0.01).Conclusion Amniotic membrane coverage combined with drug therapy is an effective method for the treatment of ocular GVHD.It can reduce the inflammatory reaction,shorten the course of treatment,and improve the treatment efficiency,which is significantly better than simple drug therapy.