综述
ENGLISH ABSTRACT
眼部移植物抗宿主病治疗进展
孙素花
洪晶 [综述]
作者及单位信息
·
DOI: 10.3760/cma.j.cn115989-20210922-00525
Progress in the treatment of ocular graft-versus-host disease
Sun Suhua
Hong Jing
Authors Info & Affiliations
Sun Suhua
Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
Sun Suhua is working at the Department of Otorhinolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, China
Hong Jing
Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
·
DOI: 10.3760/cma.j.cn115989-20210922-00525
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摘要

异基因造血干细胞移植是治疗血液系统良恶性肿瘤的有效疗法,但移植物抗宿主病的发生会影响全身各脏器和组织,使患者身体受到重大的损伤,不仅严重影响患者的生活质量,还可能增加移植后患者的死亡率。眼部移植物抗宿主病是眼部排斥反应的表现,60%~90%的慢性移植物抗宿主病患者伴发眼部移植物抗宿主病,可表现为干眼、结膜炎、角膜炎等症状,严重者导致患者视力丧失。目前临床上尚无统一的眼部移植物抗宿主病治疗标准,常用的治疗方法包括人工泪液、自体血清滴眼液、糖皮质激素类药物、免疫抑制剂的局部应用以及泪小点栓塞和治疗用角膜接触镜的佩戴。本文就眼部移植物抗宿主病的治疗进展进行综述。

异基因造血干细胞移植;眼部移植物抗宿主病;治疗
ABSTRACT

Allogeneic hematopoietic stem cell transplantation is an effective therapy for the treatment of hematological benign and malignant tumors, but the occurrence of graft-versus-host disease (GVHD) will affect the whole organs and tissues, causing serious damages to the patient's body.This not only seriously affects the life quality of patients, but also increases the mortality of patients after transplantation.Ocular GVHD is a manifestation of ocular rejection, and 60%-90% of patients with chronic GVHD are accompanied by ocular GVHD, the manifestations of which are dry eye, conjunctivitis, keratitis, and so on.Severe ocular GVHD can cause vision loss.But there is no unified treatment standard at present.The commonly used treatments include artificial tears, autologous serum eye drops, topical glucocorticoid, topical immunosuppressive agents, punctal occlusion, and contact lens wearing.The treatment progress of ocular GVHD was reviewed in this article.

Hematopoietic stem cell transplantation, allogeneic;Graft versus host disease, ocular;Therapy
Hong Jing, Email: mocdef.aabnis4691gnijgnoh
引用本文

孙素花,洪晶. 眼部移植物抗宿主病治疗进展[J]. 中华实验眼科杂志,2022,40(03):280-283.

DOI:10.3760/cma.j.cn115989-20210922-00525

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异基因造血干细胞移植是治疗血液系统良恶性肿瘤的有效疗法,但移植物抗宿主病(graft-versus-host disease,GVHD)的发生极大限制了该疗法的应用 [ 1 ]。近年来,随着外周血干细胞移植应用的增多,GVHD的发病率也相应地升高 [ 2 ]。根据2021年NIH公布的诊断及分级标准 [ 3 ],可将GVHD分为急性和慢性2类,其中,60%~90%的慢性GVHD患者可伴发眼部GVHD [ 4 ]。眼部GVHD可累及眼表的各个结构,以角膜、结膜和眼睑常见,表现为干眼或干燥性角结膜炎、结膜充血、球结膜水肿、角膜糜烂,严重者可出现角膜溃疡,甚至穿孔。其中,干眼发生率最高,为40%~76%,其主要原因是泪腺中淋巴细胞浸润和CD34 +基质成纤维细胞增多,导致腺泡和导管纤维化 [ 4 , 5 ],而睑板腺功能障碍可进一步加重干眼症状,表现为眼部刺激感、异物感、烧灼感、溢泪、畏光、疼痛、红肿、视物模糊等 [ 5 , 6 ]。结膜炎症可导致瘢痕形成,破坏眼表正常解剖结构,引起睑内翻、睑外翻、倒睫、睑板腺萎缩、睑裂闭合不全等,严重影响异基因造血干细胞移植后患者的生活质量 [ 7 , 8 , 9 ]。目前,系统性应用类固醇激素或联合钙调磷酸酶抑制剂/免疫抑制剂(如环孢霉素、他克莫司)是临床上治疗GVHD的常用方法。但系统性用药很难在眼部达到有效药物浓度,因此眼部GVHD的局部治疗必不可少。眼部GVHD的局部治疗主要包括人工泪液、眼用润滑剂、局部免疫抑制剂、自体血清滴眼液、泪小点栓塞等,对于比较严重的病例,还可以行睑缘缝合术、羊膜移植等手术治疗,但尚无统一的治疗标准。无论眼部GVHD治疗的手段如何不同,都可以归结为润滑眼表和控制炎症2个原则,其治疗目的均是缓解症状、保护眼表、避免永久性损坏的发生 [ 10 ]。本文就眼部GVHD的治疗进展进行综述。
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洪晶,Email: mocdef.aabnis4691gnijgnoh
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