抗结核药对眼表功能的影响

Effect of Antituberculotic Drug on Ocular Surface Function

关键词:  抗结核药  Keratograph 5M  干眼  泪液炎症因子

Key words:  antituberculotic drug  keratograph 5M  dry eye  tear inflammatory factors

摘要:

目的 研究抗结核药物对眼表功能的影响。方法 采用前瞻性自身对照研究。对60例首次诊断为结核病的患者在进行抗结核治疗前及用药2个月后进行眼表疾病指数评分问卷（ocular surface disease index，OSDI）调查，进行泪膜破裂时间（tear break up time，TBUT）、非侵入式泪河高度（non-invasive tear meniscus height，NITMH）、非侵入式首次泪膜破裂时间[non-invasive break up time-frist，NITBUT（f）]、非侵入式平均泪膜破裂时间[non-invasive break up time-average，NITBUT（av）]、睑板腺完整度的检测，并收集泪液炎症因子白细胞介素-6（interleukin-6，IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）。比较用药前后各项干眼指标和泪液炎症因子的变化。结果 与用药前比较，用药2个月后OSDI评分升高，差异有统计学意义（P<0.05）；TBUT、NITBUT（f）、NITBUT（av）明显缩短，脂质层厚度减少，差异均有统计学意义（P<0.01）。NITMH及睑板腺完整度分级在用药前后无明显变化，差异无统计学意义。IL-6、TNF-α在用药2个月后浓度明显增加，差异均有统计学意义（P<0.01）。NITBUT（f）和NITBUT（av）与泪液炎症因子TNF-α之间均呈负相关（r=-0.510，P<0.01；r=-0.650，P<0.01），NITBUT（f）和NITBUT（av）与泪液炎症因子IL-6之间均呈负相关（r=-0.234，P<0.01；r=-0.386，P<0.01），TBUT与NITBUT（f）和NITBUT（av）呈正相关关系（r=0.885，P<0.05；r=0.996，P<0.05）。结论 口服抗结核药物可能造成眼表功能的损害，导致干眼的发生率上升。

Abstract:

OBJECTIVE To investigate the effect of antituberculotic drug on ocular surface function. METHODS This was a prospective case-control study. Sixty patients with tuberculosis who received antituberculotic treatment were investigated with dry eye questionnaire of ocular surface disease index(OSDI), tear break up time(TBUT), non-invasive tear meniscus height(NITMH), non-invasive break up time-frist[NITBUT(f)] and non-invasive break up time-average[NITBUT(av)] before and after 2 months antituberculosis treatment. IL-6 and TNF-α were also analyzed as tear inflammatory factors. The changes of dry eye index and tear inflammatory factors before and after treatment were compared. RESULTS Compared with before treatment, OSDI score was increased(P<0.05), TBUT, NITBUT(f), NITBUT(av) significantly shortened and lipid layer thickness were significantly decreased after 2 months antituberculotic treatment(P<0.01). There was no significant difference on NITMH and meibomian gland integrity grading between before and after treatment. Tear IL-6 and TNF-α significantly increased after 2 months treatment(P<0.01). There was a negative correlation between NITBUT(f), NITBUT(av) and tear TNF-a(r=-0.510, P<0.01; r=-0.650, P<0.01). There was a negative correlation between NITBUT(f), NITBUT(av) and tear IL-6(r=-0.234, P<0.01; r=-0.386, P<0.01). TBUT was positively correlated with NITBUT(f) and NITBUT(av) (r=0.885, P<0.05; r=0.996, P<0.05). CONCLUSION Oral antituberculotic drug may cause damage to ocular surface function, lead to increased of dry eyes.