北京大学学报(医学版) ›› 2017, Vol. 49 ›› Issue (5): 794-797. doi: 10.3969/j.issn.1671-167X.2017.05.009

• 论著 • 上一篇    下一篇

原发肾病综合征患儿糖皮质激素治疗致眼科不良反应临床特点分析

赵芸*, 苏白鸽, 肖慧捷, 张宏文, 刘晓宇, 王芳, 丁洁   

  1. 北京大学第一院儿科,北京 100034
  • 收稿日期:2017-05-22 出版日期:2017-10-18 发布日期:2017-10-18
  • 作者简介:回顾性分析患儿的住院病史资料,对记录不详尽的病例,通过电话随访补充记录相关随访内容。每例患儿均详细记录发病年龄、性别、体重、身高、血压及使用糖皮质激素药品名称、用药剂量和用药时间。所有患儿均进行裂隙灯显微镜眼前段检查、眼底检查,散瞳检查晶状体和周边视网膜,测量眼压(CANON TX-20,非接触眼压计),对部分患儿行视野检查。记录发生眼科不良反应的疾病种类、时间及监测数值。

Clinical characteristics of glucocorticoid-induced eye adverse reactions in children with primary nephrotic syndrome

ZHAO Yun*, SU Bai-ge, XIAO Hui-jie, ZHANG Hong-wen, LIU Xiao-yu, WANG Fang, DING Jie   

  1. Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
  • Received:2017-05-22 Online:2017-10-18 Published:2017-10-18

摘要: 目的 分析原发性肾病综合征患儿糖皮质激素治疗致眼科不良反应的临床特点。方法 回顾性分析2014年6月至2016年6月间71例因原发性肾病综合征使用糖皮质激素治疗而引发高眼压、青光眼、白内障患儿的临床资料。结果 同期共收治1 580例原发性肾病综合征患儿,71例发生眼科不良反应,发生率为4.5%,男性41例、女性30例,平均起病年龄8(2,16)岁,其中66例高眼压,2例青光眼,2例高眼压合并白内障,1例青光眼合并白内障。用药至发病平均时间为157(6,420) d,不同性别、用药种类、用药方式、是否行甲泼尼龙冲击治疗组间,眼压差异无统计学意义(P>0.05);患儿年龄、体重指数、血压、累积剂量、日平均剂量、累积用药时间与糖皮质激素导致的眼压升高无明显相关性(P>0.05)。经治疗后眼压均控制到正常。结论 原发性肾病综合征患儿使用糖皮质激素后易出现眼部并发症,高眼压的发生与患儿的糖皮质激素易感性密切相关,需定期密切监测眼压情况。

关键词: 肾病综合征, 糖皮质激素类, 高眼压, 白内障, 青光眼, 儿童

Abstract: Objective: To investigate the clinical features and side effects, with regard to glucocorticoid-induced ocular hypertension, glaucoma or cataract in children with primary nephrotic syndrome. Methods: Clinical data were collected and analyzed from 71 cases of primary nephrotic syndrome with glucocorticoid-induced ocular hypertension, glaucoma or cataract from Jun. 2014 to Jun. 2016. These children were hospitalized in Peking University First Hospital. Results: Totally 1 580 children with primary nephrotic syndrome were collected, glucocorticoid-induced complications in eyes were found in 71 cases, and the incidence was 4.5%. There were 66 cases with ocular hypertension, 2 cases with glucocorticoid glaucoma, 2 cases with glucocorticoid glaucoma combined with cataract, 1 case with high intraocular pressure combined with cataract. There were 41 boys and 30 girls with eye-related side effects caused by glucocorticoid. The average age of onset of glucocorticoid-induced eye adverse reactions in children with primary nephrotic syndrome in our research were 8 (2, 16) years. The average duration or interval time from glucocorticoid medication use to eye adverse effects was 157 (6, 420) days. No statistical significance was found in intraocular pressure between different genders, types of glucocorticoid, different route of glucocorticoid and whether methylprednisolone pulse treatment (P>0.05). There was no significant correlation between age, body mass index, blood pressure, cumulative dosage, duration time of glucocorticoid, mean daily dosage and glucocorticoid-induced ocular hypertension (P>0.05). The ocular hypertension was controlled after treatment. Conclusion: Children with nephrotic syndrome after treatment of glucocorticoid are susceptible to ocular complications, and the occurrence of ocular hypertension is closely related to glucocorticoid susceptibility of the nephrotic children. Regular eye monitor is indispensable for the children suffering from primary nephrotic syndrome.

Key words: Nephrotic syndrome, Glucocorticoids, Oular hypertension, Cataract, Glaucoma, Child

中图分类号: 

  • R726.9
[1] 胡亚美, 江载芳. 诸福棠实用儿科学[M]. 8版. 北京: 人民卫生出版社, 2015: 1729, 1783.
[2] Rüfer F, Uthoff D. Symptoms and therapy for steroid glaucoma [J]. Klin Monbl Augenheilkd, 2013, 230(7): 692-696.
[3] Dibas A, Yorio T. Glucocorticoid therapy and ocular hypertension [J]. Eur J Pharmacol, 2016(787): 57-71.
[4] 中华医学会儿科学分会肾脏病学组. 小儿肾小球疾病的临床分类、诊断及治疗[J]. 中华儿科杂志, 2001, 39(12): 746-749.
[5] 李凤鸣. 中华眼科学[M]. 北京: 人民卫生出版社, 2006: 1473, 1583, 1772.
[6] Zode GS, Sharma AB, Lin X, et al. Ocular-specific ER stress reduction rescues glaucoma in murine glucocorticoid-induced glaucoma [J]. J Clin Invest, 2014, 124(5): 1956-1965.
[7] Skuta GL, Morgan RK. Corticosteroid induced glaucoma [M]//Ritch R, Shields MR, Krupin T. The glaucoma. St. Louis: Mostly, 1996: 1177-1188.
[8] Bermudez JY,Webber HC,Brown B,et al. A comparison of gene expression profiles between glucocorticoid responder and non-responder bovine trabecular meshwork cells using RNA sequencing [J/OL]. PLoS One, 2017, 12(1): e0169671.
[9] Wang XQ, Duan ZX, He XG, et al. Clinical relevance of the glucocorticoid receptor gene polymorphisms in glucocorticoid-induced ocular hypertension and primary open angle glaucoma [J]. Int J Ophthalmol, 2015, 1(18): 169-173.
[10] 王玲, 陈慧, 谢青, 等. 103例糖皮质激素性青光眼的研究[J]. 现代预防医学, 2011, 38(21): 4562-4564.
[11] Jeppesen P, Krag S. Steroid treatment and risk of glaucoma [J]. Ugeskr Laeger, 2015, 177(34): 1620-1623.
[12] Jain A, Wordinger RJ, Yorio T, et al. Role of the alternatively spliced glucocorticoid receptor isoform GRβ in steroid responsiveness and glaucoma [J]. J Ocul Pharmacol Ther, 2014, 30 (2-3): 121-127.
[13] Da Silva JA, Jacobs JW, Kirwan JR, et al. Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data [J]. Ann Rheum Dis, 2006, 65(3): 285-293.
[14] 苗静, 徐虹, 沈茜, 等. 原发肾病综合征患儿糖皮质激素治疗致眼科不良反应分析[J]. 临床儿科杂志, 2013, 31(4): 335-338.
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