Yildiz Elvin H, Erdurmus Mesut, Hammersmith Kristin M, Rapuano Christopher J, Laibson Peter R, Cohen Elisabeth J
Wills Eye Institute, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Cornea. 2009 Sep;28(8):846-50. doi: 10.1097/ICO.0b013e318197eedc.
To compare the incidence and characteristics of graft rejection in keratoconus patients with and without self-reported atopy.
From November 2007 to February 2008, 75 consecutive keratoconus patients who had undergone penetrating keratoplasty completed a questionnaire regarding personal history of atopy. The questionnaires were reviewed without knowledge of history of graft rejection. The patients were divided into three groups: nonatopic (group 1), mild atopic (group 2), and severe atopic (group 3). Charts were retrospectively reviewed with regard to the incidence and characteristics of graft rejection episodes for each patient.
There were 13 patients in group 1, 36 patients in group 2, and 26 patients in group 3. The incidence of graft rejection (rejection episodes per 100 person-years) in groups 1, 2, and 3 was 7.3, 15.8, and 13.4, respectively. Although the mild and severe atopic groups had roughly twice the rate of rejection of the nonatopic group, there was no statistically significant difference among the groups (P = 0.25). The mean age of 37.1 +/- 8.9 years at the time of surgery was significantly lower (P = 0.004) and the rate of bilateral penetrating keratoplasty was significantly higher (40/55 eyes 73%) (P = 0.01) in group 2 than in the two other groups. The majority of first graft rejection episodes were mild or moderate in atopic patients (69% in group 2 and 94% in group 3) and severe (50%) in nonatopic patients; however, no significant difference was found among the groups (P = 0.13).
Atopic conditions may increase the incidence of graft rejection in keratoconus patients, and the characteristics of graft rejection in atopic patients may differ from those in nonatopics because of the immune alteration, but differences in this study were not statistically significant.
比较有和没有自我报告特应性的圆锥角膜患者移植排斥反应的发生率及特征。
2007年11月至2008年2月，75例连续接受穿透性角膜移植术的圆锥角膜患者完成了一份关于特应性个人史的问卷。在不知道移植排斥反应病史的情况下对问卷进行审查。患者被分为三组：非特应性组（第1组）、轻度特应性组（第2组）和重度特应性组（第3组）。对每位患者移植排斥反应发作的发生率和特征进行回顾性图表审查。
第1组有13例患者，第2组有36例患者，第3组有26例患者。第1、2、3组移植排斥反应的发生率（每100人年的排斥反应发作次数）分别为7.3、15.8和13.4。虽然轻度和重度特应性组的排斥反应发生率约为非特应性组的两倍，但各组之间无统计学显著差异（P = 0.25）。第2组手术时的平均年龄为37.1±8.9岁，显著低于其他两组（P = 0.004），且双侧穿透性角膜移植术的比例显著更高（55只眼中40只，73%）（P = 0.01）。特应性患者首次移植排斥反应发作大多为轻度或中度（第2组为69%，第3组为94%），非特应性患者为重度（50%）；然而，各组之间未发现显著差异（P = 0.13）。
特应性状况可能增加圆锥角膜患者移植排斥反应的发生率，由于免疫改变，特应性患者移植排斥反应的特征可能与非特应性患者不同，但本研究中的差异无统计学显著性。
