Effect of intrastromal injection of amphotericin B combined with local eye drops on fungal keratitis
安琳 1连慧芳 1韦秋红 1蔡晶晶 1杨赪雯 1张荣1
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作者信息
1. 保定市第一中心医院眼一科,保定 071000
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摘要
目的 探究基质内注射两性霉素B联合局部点眼治疗真菌性角膜炎(fungal keratitis,FK)的效果及对角膜组织中核苷酸结合寡聚化结构域样受体蛋白3(nucleotide binding oligomerization domain like receptor protein 3,NLRP3)炎症小体、白细胞介素-1β(interleukin-1β,IL-1β)水平的影响.方法 将收治的69例(69眼)真菌性角膜炎患者按照随机数字表法分为对照组(n=34)和观察组(n=35),对照组给予局部点眼治疗,观察组在对照组治疗的基础上联合基质内注射两性霉素B治疗,2组均连续治疗1个月,比较2组患者的临床疗效、症状及体征改善情况、视力、角膜组织中NLRP3炎症小体和IL-1β水平,统计不良反应的发生情况.结果 观察组的临床总有效率(91.43%)较对照组(70.59%)显著提高(P<0.05);观察组异物感、畏光、前房积脓消失时间及角膜溃疡愈合时间均短于对照组(P<0.05);治疗前,2组患者视力比较差异无统计学意义(P>0.05),治疗后,2组患者视力均提高,且观察组高于对照组(P<0.05);治疗前,2组患者NLRP3信使核糖核酸(messenger ribonucleic acid,mRNA)、IL-1β水平比较差异无统计学意义(P>0.05),治疗后,2组患者上述指标均下降,且观察组低于对照组(P<0.05);2组患者不良反应总发生率比较差异无统计学意义(P>0.05).结论 FK患者应用基质内注射两性霉素B联合局部点眼治疗,疗效显著,可有效改善患者的临床症状及体征,提高视力,降低角膜组织中NLRP3炎症小体、IL-1β水平.
Abstract
Objective To investigate the effect of intrastromal injection of amphotericin B combined with local eye drops in the treatment of fungal keratitis(FK),and the influence on nucleotide binding oligomerization domain-like receptor protein 3(NLRP3)inflammasome and interleukin-1β(IL-1β)levels in corneal tissues.Methods A total of 69 patients(69 affected eyes)with FK who were admitted to the hospital were randomly divided into control group(n=34)and observation group(n=35).The control group was treated with local eye drops while the observation group was treated with intrastromal injection of amphotericin B combined with local eye drops.The both groups received 1 month of continuous treatment.The clinical effect,improvement of symptoms and signs,visual acuity,NLRP3 inflammasome and IL-1β levels in corneal tissues were compared between the 2 groups.The incidence rates of adverse reactions were calculated.Results The total clinical response rate in the observation group was significantly higher than that in the control group(91.43%vs.70.59%)(P<0.05).The disappearance time of foreign body sensation,photophobia and hypopyon,and corneal ulcer healing time in the observation group were shorter than those in the control group(P<0.05).After treatment,the visual acuity of the 2 groups was improved,and the observation group had higher visual acuity than the control group(P<0.05).After treatment,the NLRP3 mRNA and IL-1β levels in the 2 groups decreased,and the levels in observation group were lower than those in the control group(P<0.05).There was no statistically significant difference in the total incidence of adverse reactions between the 2 groups(P>0.05).Conclusion Intrastromal injection of amphotericin B combined with local eye drops is effective in the treatment of FK,which can effectively improve clinical symptoms and signs,improve visual acuity,and lower the levels of NLRP3 inflammasome and IL-1β in corneal tissues,with high safety.
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