异基因造血干细胞移植术后眼表病变的相关因素：一项回顾性研究。
Correlative factors of ocular surface lesions after allogeneic hematopoietic stem cell transplantation: A retrospective study.
作者信息
Zhuang Xin-Yu, Sun Zheng-Tai, Xu Yue, Ren Ya-Ru, Chen Ying-Jie, Chen Feng, Ma Xiao, Tang Xiao-Wen, Zhang Xiao-Feng
机构信息
Department of Ophthalmology, First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China.
出版信息
Front Oncol. 2022 Nov 21;12:1040679. doi: 10.3389/fonc.2022.1040679. eCollection 2022.
BACKGROUND
Ocular graft-versus-host disease (oGVHD) is one of the complications after allogeneic hematopoietic stem cell transplantation (HSCT), which impairs the quality of life and may indicate poor prognosis. In this retrospective study, the aim was to investigate the characteristics of ocular surface after HSCT, and analyze the risk factors related to the severity of ocular surface lesions.
METHODS
248 post-HSCT patients were enrolled in this retrospective study. Subjects were divided into no lesion group, mild lesion group and severe lesion group, according to the severity of ocular surface lesions. The correlations between grades of ocular surface lesions and gender, age, primary disease, donor source, human leukocyte antigen (HLA) type, kinship, donor-recipient relationship, blood type, source of stem cell and systemic GVHD were analyzed.
RESULTS
The median scores of corneal epitheliopathy, lid margin lesions and meibomian gland loss were 3, 6 and 2 points, respectively. The grade of corneal epitheliopathy was related to donor source (P<0.001), kinship (P=0.033), HLA-matching (P<0.001), and systemic GVHD (P=0.007), especially oral GVHD (P<0.001) and liver GVHD (P=0.002). The grade of lid margin lesions was related to donor source (P=0.019), HLA-matching (P=0.006), and systemic GVHD (P=0.013), especially skin GVHD (P=0.019) and oral GVHD (P=0.019). The grade of meibomian gland loss was related to age (P=0.035) and gastrointestinal GVHD (P=0.007). The grade of corneal epitheliopathy after HSCT was related to the lid margin lesion score (P<0.001).
CONCLUSIONS
The occurrence and development of ocular GVHD are mostly accompanied by the history of systemic GVHD. While in few cases, ocular surface lesions related to GVHD can be observed prior to the rejection of other tissues and organs. Severe corneal epitheliopathy occurs in patients with severe lid margin lesions in ocular GVHD. The lesions of corneal epithelium and lid margin are milder in HLA partially matching transplantation.
背景
眼部移植物抗宿主病（oGVHD）是异基因造血干细胞移植（HSCT）后的并发症之一，会损害生活质量，且可能预示预后不良。在这项回顾性研究中，目的是调查HSCT后眼表的特征，并分析与眼表病变严重程度相关的危险因素。
方法
248例HSCT后患者纳入这项回顾性研究。根据眼表病变的严重程度，将受试者分为无病变组、轻度病变组和重度病变组。分析眼表病变分级与性别、年龄、原发病、供体来源、人类白细胞抗原（HLA）类型、亲缘关系、供受者关系、血型、干细胞来源和系统性GVHD之间的相关性。
结果
角膜上皮病变、睑缘病变和睑板腺缺失的中位数评分分别为3分、6分和2分。角膜上皮病变的分级与供体来源（P<0.001）、亲缘关系（P=0.033）、HLA匹配（P<0.001）和系统性GVHD（P=0.007）有关，尤其是口腔GVHD（P<0.001）和肝脏GVHD（P=0.002）。睑缘病变的分级与供体来源（P=0.019）、HLA匹配（P=0.006）和系统性GVHD（P=0.013）有关，尤其是皮肤GVHD（P=0.019）和口腔GVHD（P=0.019）。睑板腺缺失的分级与年龄（P=0.035）和胃肠道GVHD（P=0.007）有关。HSCT后角膜上皮病变的分级与睑缘病变评分有关（P<0.001）。
结论
眼部GVHD的发生和发展大多伴有系统性GVHD病史。而在少数情况下，与GVHD相关的眼表病变可在其他组织和器官发生排斥之前被观察到。眼部GVHD中，严重睑缘病变的患者会出现严重的角膜上皮病变。在HLA部分匹配移植中，角膜上皮和睑缘的病变较轻。
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