Mian Shahzad I, De la Parra-Colín Paola, De Melo-Franco Rafael, Johnson Christopher, Barrientos-Gutierrez Tonatiuh
Department of Ophthalmology and Visual Sciences, Division of Cornea and External Disease, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan.
Department of Ophthalmology and Visual Sciences, Division of Cornea and External Disease, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, Department of Ophthalmology, Cornea and Ocular Surface Clinic, Centro Médico La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Trans Am Ophthalmol Soc. 2015 Sep;113:T11.
To determine if chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (HSCT) is associated with stable or progressive dry eye disease and to determine the true incidence in patients with no prior history of dry eye disease.
A nonconcurrent cohort study at a single institution with 136 patients who had no previous history of dry eye disease before HSCT. Survival analysis was used to estimate dry eye disease incidence. The incidence rate was calculated using life tables as the number of observed dry eye disease cases divided by the person-time at risk accumulated by the cohort. Transition probabilities were calculated from time of transplant to time of diagnosis, and then to last recorded visit.
Incidence rate was 0.8 cases of dry eye disease per person-year, and half of the population at risk developed dry eye disease during the first 10 months post transplant. Time to develop dry eye disease was 2.5 months for mild dry eye disease, 9.6 months for moderate dry eye disease, and 13.2 months for severe dry eye disease. In terms of cumulative incidence, 73% of subjects developed dry eye disease (50% mild, 16% moderate, and 7% severe) at the time of diagnosis.
Our findings suggest that dry eye disease associated with cGVHD is an extremely frequent event and shows a wide spectrum of severity, with a mild form presenting early and a moderate to severe form presenting later after HSCT. These findings need to be studied further to elucidate if these are two different pathophysiological entities or just different expressions of the same pathology.
确定异基因造血干细胞移植（HSCT）后慢性移植物抗宿主病（cGVHD）是否与干眼症的稳定或进展相关，并确定既往无干眼症病史患者的真实发病率。
在单一机构进行的一项非同期队列研究，纳入136例HSCT前无干眼症病史的患者。采用生存分析估计干眼症发病率。发病率通过生命表计算，即观察到的干眼症病例数除以队列累积的风险人时。计算从移植时间到诊断时间，再到最后一次记录访视的转移概率。
发病率为每人年0.8例干眼症，半数有风险的人群在移植后前10个月发生干眼症。轻度干眼症发病时间为2.5个月，中度为9.6个月，重度为13.2个月。就累积发病率而言，73%的受试者在诊断时发生干眼症（50%为轻度，16%为中度，7%为重度）。
我们的研究结果表明，与cGVHD相关的干眼症是一种极其常见的事件，且严重程度范围广泛，轻度形式在HSCT后早期出现，中度至重度形式在后期出现。这些发现需要进一步研究，以阐明这是两种不同的病理生理实体，还是同一病理的不同表现。
