The Role of Systemic Immunomodulatory Treatment and Prognostic Factors on Chronic Ocular Complications in Stevens-Johnson Syndrome
The Role of Systemic Immunomodulatory Treatment and Prognostic Factors on Chronic Ocular Complications in Stevens-Johnson Syndrome
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DOI：
10.1016/j.ophtha.2014.08.013
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发表时间：
2015-02-01
期刊：
影响因子：
13.7
通讯作者：
Kim, Mee Kum
中科院分区：
文献类型：
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作者：
Kim, Dong Hyun;Yoon, Kyung Chul;Kim, Mee Kum
目的：比较Stevens-Johnson综合征（SJS）和中毒性表皮坏死松解症（TEN）患者早期全身免疫调节治疗的效果，探讨慢性眼部并发症的预后因素。设计：回顾性、比较性、多中心研究。研究对象：在韩国3所大学附属医院（首尔大学附属医院、全南大学附属医院和延世大学附属医院）中的1所医院接受诊断为SJS或TEN的43例患者，随访时间至少为6个月。方法：根据患者接受的全身免疫调节治疗分为5组：全身类固醇(S)、静脉注射免疫球蛋白（IVIG）、S + IVIG联合、全身脉冲类固醇（PS）和仅支持治疗(C)。比较5组患者末次随访时最佳矫正视力（BCVA）和慢性眼表并发症评分（COCS，范围0-15）。分析发病预后因素（年龄、性别、致病药物、初始视力、急性眼受累评分[范围0-3]、急性全身受累评分[范围0-16]、全身类固醇剂量、IVIG剂量、羊膜移植[AMT]），采用logistic回归或线性回归分析预测最终BCVA或COCS。主要观察指标：最终随访时最佳矫正视力和COCS。结果：患者平均年龄30.5 +/- 21.0岁，随访时间29.1 +/- 30.4个月。IVIG组、S + IVIG组和PS组的急性全身受累评分显著高于S组和C组（P < 0.001）。然而，即使经过统计校正，两组之间的最终BCVA和COCS也没有显著差异。高COCS（>= 8分）与女性（P = 0.012）和急性期AMT （P = 0.040）相关。急性眼部和全身受累评分高与较差的COCS相关（P < 0.001）， COCS与最终BCVA有良好的相关性（R-2 = 0.7101; P < 0.0001）。结论：系统性免疫调节治疗在SJS和TEN患者的最终视力和COCS方面没有治疗益处。女性性别和急性眼部及全身受累评分可能是预测慢性眼部并发症的预后因素。(C) 2015年由美国眼科学会发布。
Purpose: To compare the effect of early systemic immunomodulatory treatment and to identify prognostic factors of chronic ocular complications in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) patients.Design: Retrospective, comparative, multicenter study.Participants: Forty-three patients admitted to 1 of 3 University Hospitals (Seoul National University Hospital, Chonnam National University Hospital, and Yonsei University Hospital) with a diagnosis of SJS or TEN who were followed up for at least 6 months in Korea.Methods: Patients were divided into 5 groups according to systemic immunomodulatory treatment received: systemic steroids (S), intravenous immunoglobulin (IVIG), combined S plus IVIG, systemic pulse steroids (PS), and supportive care only (C). Best-corrected visual acuity (BCVA) and chronic ocular surface complications score (COCS; range, 0-15) at final follow-up were compared among the 5 groups. Prognostic factors at onset (age, gender, causative drugs, initial visual acuities, acute ocular involvement score [range, 0-3], acute systemic involvement score [range, 0-16], systemic steroid dose, IVIG dose, and amniotic membrane transplantation [AMT]) were analyzed to predict final BCVA or COCS using logistic regression or linear regression analysis.Main Outcome Measures: Best-corrected visual acuity and COCS at final follow-up.Results: The mean age and follow-up period of the patients was 30.5 +/- 21.0 years and 29.1 +/- 30.4 months, respectively. The acute systemic involvement score in the IVIG, S plus IVIG, and PS groups was significantly higher than that in the S and C groups (P < 0.001). However, final BCVA and COCS were not significantly different between groups, even after statistical adjustment. High COCS (>= 8 points) was associated with female gender (P = 0.012) and AMT at the acute stage (P = 0.040). High acute ocular and systemic involvement scores were associated with worse COCS (P < 0.001), and COCS showed good correlation with final BCVA (R-2 = 0.7101; P < 0.0001).Conclusions: There were no therapeutic benefits of systemic immunomodulatory treatments in final visual outcome and COCS in SJS and TEN patients. Female gender and acute ocular and systemic involvement scores may be prognostic factors predicting chronic ocular complications. (C) 2015 by the American Academy of Ophthalmology.