Ding Hui Jen, Denniston Alastair K, Rao Vijay K, Gordon Caroline
Department of Medicine, Putrajaya Hospital, Putrajaya, Malaysia, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, The Medical School, University of Birmingham.
Ophthalmology Department, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Centre for Translational Inflammation Research, College of Medical and Dental Sciences, The Medical School, University of Birmingham and.
Rheumatology (Oxford). 2016 Jun;55(6):957-67. doi: 10.1093/rheumatology/kev357. Epub 2015 Oct 1.
HCQ is widely used for the treatment of rheumatic diseases, particularly lupus and RA. It is generally well tolerated, but retinopathy is a concern. Retinopathy is rare, but is sight threatening, generally irreversible and may progress even after cessation of therapy. Damage may be subclinical. Although a number of risk factors have been proposed (such as duration of therapy and cumulative dose), the many exceptions (e.g. retinopathy on low-dose HCQ, or no retinopathy after a very large cumulative dose of HCQ) highlight our limited understanding of the disease process. Novel technologies such as optical coherence tomography (OCT), fundus autofluorescence (FAF) and multifocal electroretinogram (mfERG) may provide the earliest structural and functional evidence of toxicity in these stages. Along with the well-established technique of central visual field testing (10-2 visual fields), these modalities are increasingly being used as part of screening programmes. The ideal single test with high sensitivity and high specificity for HCQ retinopathy has still not been achieved. Screening for HCQ retinopathy remains an area of considerable debate, including issues of when, who and how to screen. Commonly accepted risk factors include receiving >6.5 mg/kg/day or a cumulative dose of >1000 g of HCQ, being on treatment for >5 years, having renal or liver dysfunction, having pre-existing retinopathy and being elderly. HCQ continues to be a valuable drug in treating rheumatic disease, but clinicians need to be aware of the associated risks and to have arrangements in place that would enable early detection of toxicity.
羟氯喹广泛用于治疗风湿性疾病，尤其是狼疮和类风湿关节炎。它通常耐受性良好，但视网膜病变是一个令人担忧的问题。视网膜病变虽罕见，但会威胁视力，一般不可逆转，甚至在停药后仍可能进展。损害可能是亚临床的。尽管已提出一些风险因素（如治疗持续时间和累积剂量），但众多例外情况（如低剂量羟氯喹导致的视网膜病变，或大剂量累积羟氯喹后未出现视网膜病变）凸显了我们对该疾病进程的了解有限。光学相干断层扫描（OCT）、眼底自发荧光（FAF）和多焦视网膜电图（mfERG）等新技术可能在这些阶段提供毒性的最早结构和功能证据。连同成熟的中心视野检测技术（10-2视野），这些方法越来越多地被用作筛查项目的一部分。尚未实现对羟氯喹视网膜病变具有高灵敏度和高特异性的理想单一检测方法。羟氯喹视网膜病变的筛查仍是一个存在大量争议的领域，包括何时、何人以及如何进行筛查等问题。公认的风险因素包括每日接受>6.5毫克/千克的剂量或羟氯喹累积剂量>1000克、治疗时间>5年、存在肾或肝功能障碍、已有视网膜病变以及年龄较大。羟氯喹在治疗风湿性疾病方面仍然是一种有价值的药物，但临床医生需要意识到相关风险，并做好安排以便能够早期发现毒性。
