目的 分析杜氏肌营养不良症(Duchenne muscular dystrophy,DMD)患者长期服用激素对白内障、眼压的影响及白内障、高眼压发生的危险因素。方法 回顾性分析2018-08至2020-12就诊于解放军总医院第三医学中心具有详细眼科检查的158例DMD患者临床资料。根据长期(≥6个月)是否服用激素,将患者分为激素组(n=103例)与非激素组(n=31例),24例服用激素<6个月,没有纳入本次研究。分析白内障和高眼压的发生率,应用二元Logistic回归分析,探讨白内障、高眼压的发生分别与年龄、服药时间、服用激素种类及BMI、DP260、DP71的相关性。结果 非激素组中,眼压增高1例,未发现白内障;激素组中,发生白内障13例(12.6%),发生高眼压24例(23.3%),其中1例因白内障行手术治疗。激素组比非激素组更易发生白内障及高眼压(P<0.01)。激素组103例中,服用地夫可特患者(n=11)白内障发生率为27.3% (3/11)、高眼压发生率为27.3%(3/11);服用泼尼松患者(n=92)白内障发生率10.9%(10/92)、高眼压发生率22.8%(21/92)。logistic回归提示,白内障与服用激素种类和服药时间相关,而与年龄、BMI、DP260、DP71无显著相关。高眼压与年龄、服药时间、服用激素种类、BMI、DP260、DP71均无显著相关。结论 本组DMD患者长期服用激素后,有较高的白内障、高眼压发生率。服用激素种类与服药时间是引起白内障的独立危险因素,服用地夫可特更易诱发白内障。
Abstract
Objective To analyze the effects of long-term use of corticosteroids on high intraocular pressure and cataracts and related risk factors in patients with Duchenne muscular dystrophy (DMD). Methods The data on 158 DMD patients with detailed results of eye examinations and treated between August 2018 and December 2020 was retrospectively analyzed. According to whether corticosteroids were taken for a minimum of six months, the patients were divided into the corticosteroids group (n=103 cases) and corticosteroids free group (n=31 cases), so 24 cases that had taken corticosteroids for less than six months were not included in this study. The incidence of cataracts and high intraocular pressure in different groups was compared. Logistic regression analysis was used to study the correlations between cataracts and high intraocular pressure on one hand and age, duration of medication, types of corticosteroids, BMI, DP260 and DP71 on the other hand. Results In the corticosteroids free group, 1 case with intraocular pressure was reported, and no cataract was revealed. In the corticosteroids group, there were 13 cases (12.6%) with cataracts and 24 cases (23.3%) with high intraocular pressure, 1 case because of cataract was treated with surgery. Long-term use of corticosteroids was more likely to cause cataracts or high intraocular pressure (P<0.01). The incidence of cataracts and high intraocular pressure was 27.3% (3/11) and 27.3% (3/11) in the deflaxacort group (n=11), respectively, compared with 10.9% (10/92) and 22.8% (21/92) in the prednisone group. As indicated by logistic regression analysis, the incidence of cataracts was related to the type and duration corticosteroids. Moreover, there was no significant correlation between high intraocular pressure and age, duration of medication, types of hormones taken, BMI, DP260 or DP71. Conclusions DMD patients are more vulnerable to cataracts and high intraocular pressure after long-term use of corticosteroids. The types of corticosteroids taken and duration of medication are independent risk factors for cataracts. Besides, the longer corticosteroids are taken, the more likely deflazacort is to lead to cataracts.
关键词
杜氏肌营养不良症 /
白内障 /
高眼压
Key words
Duchenne muscular dystrophy /
cataract /
high intraocular pressure
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