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中华实验和临床感染病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 48 -54. doi: 10.3877/cma.j.issn.1674-1358.2023.01.008

论著

慢性丙型肝炎患者干眼临床特征
王胜男1, 孙挥宇1,(), 接英2, 谢雯3, 毛菲菲1, 李丹1, 鲁丹1, 刘夕瑶1   
  1. 1. 100015 北京,首都医科大学附属北京地坛医院眼科 感染病科国家临床重点专科
    2. 100730 北京,首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科研究所北京市眼视光与视觉科学重点实验室
    3. 100015 北京,首都医科大学附属北京地坛医院肝病中心 感染病科国家临床重点专科
  • 收稿日期:2022-04-27 出版日期:2023-02-15
  • 通信作者: 孙挥宇
  • 基金资助:
    北京市医院管理中心项目(No. DFL20191802); REAL-C:源自亚洲肝病联合会的真实世界的HCV病例(No. 733564)

Clinical characteristics of dry eye in patients with chronic hepatitis C

Shengnan Wang1, Huiyu Sun1,(), Ying Jie2, Wen Xie3, Feifei Mao1, Dan Li1, Dan Lu1, Xiyao Liu1   

  1. 1. Department of Ophthalmology, National Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
    2. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
    3. Center of Liver Diseases, National Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2022-04-27 Published:2023-02-15
  • Corresponding author: Huiyu Sun
引用本文:

王胜男, 孙挥宇, 接英, 谢雯, 毛菲菲, 李丹, 鲁丹, 刘夕瑶. 慢性丙型肝炎患者干眼临床特征[J/OL]. 中华实验和临床感染病杂志(电子版), 2023, 17(01): 48-54.

Shengnan Wang, Huiyu Sun, Ying Jie, Wen Xie, Feifei Mao, Dan Li, Dan Lu, Xiyao Liu. Clinical characteristics of dry eye in patients with chronic hepatitis C[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2023, 17(01): 48-54.

目的

分析慢性丙型肝炎(CHC)患者干眼的临床特征。

方法

收集2021年2月至2022年1月于首都医科大学附属北京地坛医院肝病科确诊并于眼科筛查的CHC患者共69例(138只眼),年龄23~75岁,平均(45.39 ± 12.88)岁。收集患者病史、血小板计数(PLT)、丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)检测值,并计算AST/PLT比值指数(APRI)。对患者行干眼相关检查,即国际标准眼表疾病指数(OSDI)干眼问卷调查、泪液分泌(Schirmer Ⅰ)试验及干眼眼表分析仪检查[(平均非接触式泪膜破裂时间(NIBUTav)和泪河高度测定(TMH)]。患者OSDI得分0~12分为无症状组(36例)和OSDI≥ 13分为有症状组(33例)。依据数据类型采用独立样本t检验、秩合检验及Pearson χ2检验进行统计学处理。

结果

无症状组患者Schirmer Ⅰ为12.5(8.25,17.75)mm/5 min,NIBUTav为12.1(6.35,20.65)s,TMH为0.26(0.19,0.34)mm;有症状组患者Schirmer Ⅰ为11(6,19.25)mm/5 min,NIBUTav为7.95(4.78,13.32)s,TMH为0.24(0.20,0.28)mm。27例患者诊断为干眼,以NIBUT结果异常为主要表现,两组患者NIBUT差异有统计学意义(Z = -3.77、P < 0.001),Schirmer Ⅰ差异无统计学意义(Z =-1.15、P = 0.25),TMH差异无统计学意义(Z =-0.96、P = 0.34)。无症状组患者丙型肝炎病毒(HCV)感染病程为7(3.25,12)年,有症状组患者为11(7,16)年,差异有统计学意义(Z =-2.40、P = 0.02)。无症状组和有症状组患者ALT水平分别为79(45.75,128.75)U/L和77.00(42.5,117.5)U/L,差异无统计学意义(Z =-0.14、P = 0.89)。无症状组患者APRI为0.62(0.34,0.88),有症状组患者为0.78(0.61,1.03),差异有统计学意义(Z =-0.20、P = 0.04)。

结论

CHC患者干眼的发病率较高,该类患者应定期进行干眼相关检查,以改善患者的眼表状态。

Objective

To investigate the prevalence of dry eye in patients with chronic hepatitis C (CHC).

Methods

Total of 69 patients (138 eyes) with CHC, who were 23 to 75 years old, with the average of (45.39 ± 12.88) years old, diagnosed in Department of Hepatology of Beijing Ditan Hospital, Capital Medical University from February 2021 to January 2022 were collected. Medical history, levels of platelet count (PLT), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) of the patients were collected and the AST/PLT ratio index (APRI) was calculated. All patients received the international standard ocular surface disease index (OSDI) dry eye questionnaire, and the observation indexes included Schirmer Ⅰ test, noninvasive breakup time average (NIBUTav), tear meniscus height (TMH). According to the OSDI score, patients with 0-12 score were divided into asymptomatic group (36 cases), and with the score ≥ 13 were considered as symptomatic group (33 cases). Statistical treatment was performed by independent sample t-test, rank combination test and Pearson χ2 test according data type.

Results

Schirmer Ⅰ of patients in asymptomatic group was 12.5 (8.25, 17.75) mm/5 min, NIBUTav was 12.1 (6.35, 20.65) s, TMH was 0.26 (0.19, 0.34) mm; For patients in symptomatic group, Schirmer Ⅰwas 11 (6, 19.25) mm/5 min, NIBUTav was 7.95 (4.78, 13.32) s, TMH was 0.24 (0.20, 0.28) mm. Total of 27 cases were diagnosed as dry eyes, with abnormal results of NIBUT as the main manifestation. There was significant difference in NIBUT between the two groups (Z = -3.77, P < 0.01). But there were no significant difference in Schirmer Ⅰ (Z =-1.15, P = 0.25) and TMH (Z =-0.96, P = 0.34). The course of hepatitis C virus (HCV) infection was 7 (3.25, 12) years in asymptomatic group and 11 (7, 16) years in symptomatic group, with significant difference (Z =-2.40, P = 0.02). ALT levels of patients in asymptomatic group and symptomatic groups were 79 (45.75, 128.75) U/L and 77.00 (42.5, 117.5) U/L, respectively, with significant difference (Z =-0.14, P = 0.89). APRI of patients in asymptomatic group and symptomatic groups were 0.62 (0.34, 0.88) and 0.78 (0.61, 1.03), with significant difference (Z = -0.20, P = 0.04).

Conclusions

The incidence rate of dry eye is high in CHC patients. CHC patients should be regularly examined for dry eye to improve their ocular surface status.

表1 两组慢性丙型病毒性肝炎患者的基本资料
表2 两组患者丙型病毒性肝炎病程及相关指标[M(P25,P75)]
表3 无症状组和有症状组患者干眼诊断
表4 无症状组和有症状组患者干眼指标[M(P25,P75)]
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