Cheng Kai-Chun, Tu Hung-Pin, Lin Tsung-Hsien, Cheng Kai-Hung
Department of Ophthalmology, Kaohsiung Medical University Hospital.
Department of Ophthalmology, Kaohsiung Municipal Siaogang Hospital.
Acta Cardiol Sin. 2023 May;39(3):435-448. doi: 10.6515/ACS.202305_39(3).20221005A.
In addition to cardiotoxicity, ocular toxicity induced by chemotherapeutic agents is not uncommon.
This study aimed to explore the association between ocular adverse events and major adverse cardiovascular events (composite endpoint) caused by chemotherapy, and whether specific ocular events could be potential predictors of some specific components of the composite endpoint.
A total of 5378 newly diagnosed patients (age > 18 y/o) with any malignancy or metastatic solid tumors who received chemotherapy from January 1997 to December 2010 were enrolled from the Taiwan National Health Insurance Research Database. Patients who developed new incident ocular diseases were classified as the study group, and those who did not develop incident ocular diseases as the control group.
After propensity score matching, there was a significant increase in the incidence of stroke in the ocular diseases group compared to the no ocular diseases group (13.4% vs. 4.5%, p < 0.0001). Tear film insufficiency, keratopathy, glaucoma, and lens disorders were associated with a significantly higher risk of stroke. A longer duration of methotrexate and a longer duration with higher total amount of tamoxifen were associated with both incident ocular diseases and incident stroke. Cox proportional hazards regression showed that the only independent risk factor for stroke was incident ocular diseases [Adjusted relative risk (95% confidence interval): 2.96 (1.66-5.26), p = 0.0002]. In addition, incident ocular disease was the most significant risk factor compared with other traditional cardiovascular risk factors.
Incident ocular diseases related to chemotherapy were associated with a significantly higher risk of stroke.
除心脏毒性外，化疗药物引起的眼部毒性并不少见。
本研究旨在探讨化疗引起的眼部不良事件与主要不良心血管事件（复合终点）之间的关联，以及特定的眼部事件是否可能是复合终点某些特定组成部分的潜在预测因素。
从台湾国民健康保险研究数据库中纳入了1997年1月至2010年12月期间接受化疗的5378例新诊断的（年龄>18岁）患有任何恶性肿瘤或转移性实体瘤的患者。出现新发眼部疾病的患者被分类为研究组，未出现新发眼部疾病的患者为对照组。
倾向评分匹配后，眼部疾病组中风的发生率与无眼部疾病组相比显著增加（13.4%对4.5%，p<0.0001）。泪膜功能不全、角膜病变、青光眼和晶状体疾病与中风风险显著升高相关。甲氨蝶呤使用时间较长和他莫昔芬总量较高且使用时间较长与眼部疾病和中风的发生均相关。Cox比例风险回归显示，中风的唯一独立危险因素是眼部疾病的发生[调整后的相对风险（95%置信区间）：2.96（1.66 - 5.26），p = 0.0002]。此外，与其他传统心血管危险因素相比，眼部疾病的发生是最显著的危险因素。
与化疗相关的眼部疾病与中风风险显著升高相关。
