术前醋酸泼尼松龙点眼对HBV携带者白内障术中疼痛及房水中炎性因子水平的影响

Effects of preoperative topical application of prednisolone acetate on intraoperative pain and inflammatory factors in aqueous humor in HBV carriers undergoing cataract surgery

目的探讨术前醋酸泼尼松龙干预对乙型肝炎病毒(HBV)携带者白内障术中疼痛及房水中炎性因子表达水平的影响。方法采用随机单盲对照研究设计,纳入2021年11月至2023年8月于首都医科大学附属北京同仁医院确诊为携带HBV的白内障患者36例。所有患者均拟行白内障超声乳化联合人工晶状体植入术。采用随机数字表法将患者分为醋酸泼尼松龙组和对照组,每组18例,于术前3 d分别使用0.1%醋酸泼尼松龙滴眼液联合0.5%左氧氟沙星滴眼液和0.3%玻璃酸钠滴眼液联合0.5%左氧氟沙星滴眼液点眼。在进行白内障手术时,采集房水样本,采用人细胞因子抗体阵列检测技术对房水中细胞因子进行检测。采用Wong-Baker量表和术中疼痛表现记录表评估患者术中疼痛程度。结果醋酸泼尼松龙组患者房水样本中炎性因子肿瘤坏死因子β、单核细胞趋化蛋白1、肿瘤坏死因子α、白细胞介素1受体拮抗因子表达低于对照组,差异均有统计学意义(t=-2.385、-2.286、-2.208、-2.134,均P<0.05)。醋酸泼尼松龙组中明显疼痛的比例为16.7%(1/18),明显低于对照组的61.1%(11/18),差异有统计学意义(χ^(2)=-2.697,P<0.05)。醋酸泼尼松龙组患者术中疼痛表现得分为1(1,2)分,低于对照组的2(1,2)分,差异有统计学意义(Z=-2.092,P<0.05)。结论术前使用醋酸泼尼松龙滴眼液进行抗炎干预能够降低患者房水中炎性因子水平并减轻HBV携带者白内障术中的疼痛。

Objective To investigate the effects of 0.1%prednisolone acetate eye drops on the intraoperative pain and expression levels of inflammatory factors in hepatitis B virus(HBV)carriers undergoing cataract surgery.Methods A randomized single-blind controlled study was adopted.Thirty-six cataract patients diagnosed as HBV carriers in Beijing Tongren Hospital Affiliated to Capital Medical University from November 2021 to August 2023 were enrolled.All patients were scheduled to underwent phacoemulsification combined with intraocular lens implantation.The patients were randomly divided into prednisolone acetate group and control group using the random number table method,with 18 cases in each group.The two groups used 0.1%prednisolone acetate eye drops combined with 0.5%levofloxacin eye drops and 0.3%sodium hyaluronate eye drops combined with 0.5%levofloxacin eye drops for 3 days before the operation according to grouping,respectively.During cataract surgery,aqueous humor samples were collected,and cytokines in the samples were detected using the human cytokine antibody array detection technology.The degree of intraoperative pain of patients was evaluated using the Wong-Baker Scale and the intraoperative pain manifestation record form.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital,Capital Medical University(No.TREXKY2017-018).Written informed consent was obtained from each subject.Results In the aqueous humor samples of patients in the prednisolone acetate group,the expressions of inflammatory factors such as tumor necrosis factor-β,monocyte chemoattractant protein-1,tumor necrosis factor-α,and interleukin-1 receptor antagonist were lower than those in the control group,and the differences were statistically significant(t=-2.385,-2.286,-2.208,-2.134;all at P<0.05).The proportion of patients with obvious pain in the prednisolone acetate group was 16.7%(1/18),which was significantly lower than 61.1%(11/18)in the control group(χ^(2)=-2.697,P<0.05).The intraoperative pain score of patients in the prednisolone acetate group was 1(1,2)points,which was lower than 2(1,2)points in the control group,and the difference was statistically significant(Z=-2.902,P<0.05).Conclusions Preoperative use of prednisolone acetate eye drops for anti-inflammatory intervention can reduce the expression of inflammatory factors in patients'aqueous humor and mitigate the intraoperative pain during cataract surgery in HBV carriers.