羟氯喹长期使用者的视网膜毒性风险。
Risk of Retinal Toxicity in Longterm Users of Hydroxychloroquine.
机构信息
From the Division of Rheumatology, Department of Internal Medicine, and Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea.
J.W. Kim, MD, Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine; Y.Y. Kim, MD, PhD, Department of Ophthalmology, Catholic University of Daegu School of Medicine; H. Lee, MD, Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine; S.H. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine; S.K. Kim, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine; J.Y. Choe, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine.
出版信息
J Rheumatol. 2017 Nov;44(11):1674-1679. doi: 10.3899/jrheum.170158. Epub 2017 Sep 1.
OBJECTIVE
Several studies have reported risk factors for hydroxychloroquine (HCQ) retinal toxicity, but data are limited for patients of Asian ancestry. The aim of this study was to investigate the rate of and factors for HCQ retinal toxicity in the Korean population.
METHODS
There were 123 patients enrolled in this study who were using or had used HCQ. Retinal toxicity was detected using spectral domain optical coherence tomography, fundus autofluorescence, multifocal electroretinography, and automated visual field testing. Binary logistic regression analysis was performed to identify factors associated with HCQ retinal toxicity.
RESULTS
Mean duration of HCQ use and mean HCQ dose in study participants was 10.1 years and 6.4 mg/kg, respectively. We found 17 patients (13.8%) with HCQ retinal toxicity among 123 patients. Patients with retinal toxicity took HCQ ranging from 6.7-21.9 years and daily dosage ranging from 4.9-9.1 mg/kg. Only 1 patient had retinal toxicity among patients with daily dose < 5.0 mg/kg. These factors increased the risk of HCQ retinal toxicity: longer duration of HCQ use [adjusted OR (aOR) = 4.71, 95% CI 2.18-10.15 for duration of HCQ use in 5-yr increments], higher daily HCQ dose (aOR = 3.34, 95% CI 1.03-10.80 for daily HCQ dose in 100-mg increments), and the presence of kidney disease (aOR = 8.56, 95% CI 1.15-64.00).
CONCLUSION
HCQ retinal toxicity is associated with duration of HCQ use, daily HCQ dose, and presence of kidney disease. Proper dosing of maximum 5 mg/kg and regular screening according to risk factors are important in HCQ use.
目的
多项研究报道了羟氯喹（HCQ）视网膜毒性的相关风险因素，但针对亚洲人群的数据有限。本研究旨在调查韩国人群中 HCQ 视网膜毒性的发生率及相关因素。
方法
本研究共纳入 123 例使用或曾使用 HCQ 的患者。采用频域光学相干断层扫描、眼底自发荧光、多焦视网膜电图和自动视野检查来检测视网膜毒性。采用二项逻辑回归分析来识别与 HCQ 视网膜毒性相关的因素。
结果
研究参与者中 HCQ 的平均使用时间和平均剂量分别为 10.1 年和 6.4mg/kg。我们在 123 例患者中发现了 17 例（13.8%）HCQ 视网膜毒性患者。视网膜毒性患者的 HCQ 使用时间范围为 6.7-21.9 年，每日剂量范围为 4.9-9.1mg/kg。仅 1 例每日剂量<5.0mg/kg 的患者出现了视网膜毒性。这些因素增加了 HCQ 视网膜毒性的风险：HCQ 使用时间更长[调整后的比值比（aOR）=4.71，95%置信区间（CI）为 2.18-10.15，每增加 5 年 HCQ 使用时间]、每日 HCQ 剂量更高（aOR=3.34，95%CI 为 1.03-10.80，每增加 100mg 每日 HCQ 剂量）和存在肾脏疾病（aOR=8.56，95%CI 为 1.15-64.00）。
结论
HCQ 视网膜毒性与 HCQ 使用时间、每日 HCQ 剂量和肾脏疾病有关。在 HCQ 用药中，应合理控制剂量（最大 5mg/kg），并根据风险因素进行定期筛查。
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