Lai Eric W, Tai Ying-Hsuan, Wu Hsiang-Ling, Dai Ying-Xiu, Chen Tzeng-Ji, Cherng Yih-Giun, Lai Shih-Chung
University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
J Clin Med. 2023 Apr 29;12(9):3203. doi: 10.3390/jcm12093203.
Autoimmune thyroid diseases (ATDs) are potentially connected to lacrimal gland dysfunction and ocular surface disruption. This study aimed to evaluate the relationships between ATD, dry eye disease (DED), and corneal surface damage. In a matched nationwide cohort study, we used Taiwan's National Health Insurance research database to compare the incidences of DED and corneal surface damage between subjects with and without ATD. Multivariable Cox proportional hazards regression models were used to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for the ophthalmological outcomes. A total of 50,251 matched pairs with 748,961 person-years of follow-up were included for analysis. The incidence of DED was 16.37 and 8.36 per 1000 person-years in the ATD and non-ATD groups, respectively. ATDs were significantly associated with increased DED (aHR: 1.81, 95% CI: 1.73-1.89, < 0.0001). This association was generally consistent across the subgroups of age, sex, different comorbidity levels, and use of systemic corticosteroids or not. Furthermore, patients with ATD had a higher risk of corneal surface damage compared with non-ATD subjects (aHR: 1.31, 95% CI: 1.19-1.44, < 0.0001), including recurrent corneal erosions (aHR: 2.00, 95% CI: 1.66-2.41, < 0.0001) and corneal scars (aHR: 1.26, 95% CI: 1.01-1.59, = 0.0432). Other independent factors for corneal surface damage were age, sex, diabetes mellitus, Charlson Comorbidity Index scores, and use of systemic corticosteroids. Our results suggested that ATDs were associated with higher risks of DED and corneal surface damage. Considering the high prevalence of ATD, prophylactic and therapeutic strategies should be further developed to prevent irreversible vision loss in this susceptible population.
自身免疫性甲状腺疾病（ATD）可能与泪腺功能障碍和眼表破坏有关。本研究旨在评估ATD、干眼症（DED）和角膜表面损伤之间的关系。在一项全国性匹配队列研究中，我们利用台湾国民健康保险研究数据库，比较了患有和未患有ATD的受试者中DED和角膜表面损伤的发生率。采用多变量Cox比例风险回归模型来估计眼科结局的调整风险比（aHR）和95%置信区间（CI）。总共纳入了50251对匹配对象，随访时间达748961人年进行分析。ATD组和非ATD组中DED的发生率分别为每1000人年16.37例和8.36例。ATD与DED发生率增加显著相关（aHR：1.8l，95%CI：1.73 - 1.89，P < 0.0001）。这种关联在年龄、性别、不同合并症水平以及是否使用全身性皮质类固醇的亚组中总体上是一致的。此外，与非ATD受试者相比，ATD患者发生角膜表面损伤的风险更高（aHR：1.31，95%CI：1.19 - 1.44），包括复发性角膜糜烂（aHR：2.00，95%CI：1.66 - 2.41）和角膜瘢痕（aHR：1.26，95%CI：1.01 - 1.59，P = 0.0432）。角膜表面损伤的其他独立因素包括年龄、性别、糖尿病、查尔森合并症指数评分以及是否使用全身性皮质类固醇。我们的结果表明，ATD与DED和角膜表面损伤的较高风险相关。鉴于ATD的高患病率，应进一步制定预防和治疗策略，以防止这一易感人群出现不可逆的视力丧失。
