血清雌激素水平升高对接受体外受精治疗的女性干眼症的影响。

Effects of elevated serum estrogen on dry eye in women undergoing in vitro fertilisation.

机构信息

School of Optometry and Vision Science, UNSW Sydney, Australia.

St.George's Hospital and School of Women's & Children's Health UNSW Sydney, Australia; IVF Australia, Southern Sydney, Australia.

出版信息

Ocul Surf. 2023 Jul;29:511-520. doi: 10.1016/j.jtos.2023.06.015. Epub 2023 Jul 6.

DOI:10.1016/j.jtos.2023.06.015

PMID:37422153

Abstract

PURPOSE

Sex hormones impact inflammatory and immune-mediated diseases. During IVF (in vitro fertilisation) treatment, circulating estrogen levels increase dramatically (10-50x) alongside changes in other hormones. This study examined changes in dry eye with IVF and its relationship with sex hormones.

METHODS

A two visit study was conducted on first day of menstruation when estrogen levels are lowest (baseline visit), and on day 9-11 (peak estrogen visit (PO)) of IVF. Symptoms of dry eye and ocular pain and signs of dry eye were examined. Serum hormone levels were assessed using mass spectrometry and immunoassay. Changes in signs and symptoms and associations were explored. Hierarchical multiple regression analysis assessed factors contributing to signs and symptoms.

RESULTS

40 women (36.2 ± 4.0 years) completed the study. Baseline and PO oestradiol (E2) levels were 28.9 pg/ml (20) (median (IQR)); 1360 pg/ml (1276) respectively. Ocular pain and dry eye symptoms worsened (p = 0.02 and p < 0.01) and tear break up and tear secretion values decreased (p = 0.005 and 0.01) at PO. Higher E2 and lower luteinizing hormone (LH) were associated with worsening of dry eye symptoms (ρ = 0.34 p = 0.03, ρ = -0.49 p = 0.001). Reduction in LH and increase in progesterone (P4) were associated with increased ocular pain (ρ = 0.45, p = 0.004 and ρ = 0.39, p = 0.01). Dry eye symptoms were predicted by LH and tear break up (p = 0.02; R = 0.18).

CONCLUSIONS

IVF treatment resulted in significantly increased ocular symptoms and tear film alterations although these changes were not clinically significant. Dry eye signs and symptoms were poorly predicted by hormone levels.

摘要

目的

性激素会影响炎症和免疫介导性疾病。在体外受精（IVF）治疗过程中，循环雌激素水平会显著升高（增加 10-50 倍），同时其他激素也会发生变化。本研究旨在探讨 IVF 过程中干眼症的变化及其与性激素的关系。

方法

进行了一项两访研究，分别在月经第一天（雌激素水平最低时）即基础访视和 IVF 第 9-11 天（雌激素峰值访视（PO））进行。检查干眼症的症状和眼部疼痛以及干眼症的体征。使用质谱法和免疫测定法评估血清激素水平。探讨了体征和症状的变化及其相关性。分层多元回归分析评估了导致体征和症状的因素。

结果

40 名女性（36.2±4.0 岁）完成了研究。基础访视和 PO 雌二醇（E2）水平分别为 28.9pg/ml（20）（中位数（IQR））；1360pg/ml（1276）。PO 时眼部疼痛和干眼症症状恶化（p=0.02 和 p<0.01），泪膜破裂时间和泪液分泌值降低（p=0.005 和 0.01）。E2 水平升高和黄体生成素（LH）水平降低与干眼症症状恶化相关（ρ=0.34，p=0.03；ρ=-0.49，p=0.001）。LH 降低和孕酮（P4）升高与眼部疼痛增加相关（ρ=0.45，p=0.004 和 ρ=0.39，p=0.01）。泪膜破裂时间和 LH 可预测干眼症症状（p=0.02；R=0.18）。