88例血液病患者的眼科临床特征分析

王国艳; 李莹; 于鑫悦; 张鸿瑫; 杨青华

doi:10.3969/j.issn.2095-5227.2022.10.014

摘要:

背景血液病容易继发眼部病变，不同类型血液病患者眼科主诉及眼科临床特征有差异。

目的分析血液病患者眼科临床特征，为血液病继发眼病的诊断和治疗提供依据。

方法回顾性病例资料分析。选取2018年8月 - 2021年9月在解放军总医院第一医学中心眼科门诊会诊的不同类型的88例血液病患者临床资料，根据血液科诊断分组，统计各组的病例数，分析比较各组患者的性别、年龄、眼科主诉、最佳矫正视力、眼底改变等资料的差异。

结果 88例血液病患者中，男59例，女29例，年龄4 ~ 64(31.81 ± 13.31)岁。其中急性白血病(acute leukemia，AL) 59例、再生障碍性贫血(aplastic anemia，AA) 8例、骨髓增生异常综合征(myelodysplastic syndromes，MDS) 5例及造血干细胞移植(hematopoietic stem cell transplantation，HSCT)后16例。四组患者年龄、性别比差异无统计学意义(P＞0.05)。26例患者有眼科主诉，占29.55%，眼科主诉主要为视力下降。眼科检查中阳性发现以眼底病变为主，共48例，占54.54%，在AL、AA、MDS和HSCT后中的患病率分别为44.07%、87.5%、100%、62.5%(P＞0.05)；眼底病变多为双眼受累，分别占61.54%、85.71%、100%、90%，组间差异无统计学意义(P＞0.05)。不同血液病患者眼底改变方面，AL、AA及MDS眼底改变呈对称性特征性改变，其特征表现为眼底多形态、多层次出血；HSCT后眼底病变在上述基础上更为复杂，有典型的奶酪夹番茄酱样改变。

结论血液病患者继发眼底病变的比例高，眼底病变导致视力下降。血液病患者眼底改变多呈双眼对称的特征性改变，其中HSCT后患者眼底改变更为复杂，且其视力相对其他血液病患者更差，临床工作中应更加重视。

Abstract:

Background Hematologic diseases are prone to cause secondary ocular lesions, and the chief complaints and ophthalmic manifestations in patients with distinct hematologic diseases are various.

Objective To analyze the clinical features of ophthalmology in patients with different hematologic diseases, so as to provide reference for the diagnosis and treatment of secondary hematologic diseases.

Methods Clinical data about 88 cases with various hematological diseases who were recruited from the Department of Ophthalmology, the First Medical Center of Chinese PLA General Hospital from August 2018 to September 2021 were retrospectively analyzed. According to hematologic diseases, the number of cases in each group were counted. The age, gender, chief complaint of ophthalmology, best corrected visual acuity and fundus change of patients with different hematologic diseases were analyzed and compared.

Results Of the 88 cases, there were 59 males and 29 females with average age of 31.81 ± 13.31 years old, ranged from 4 to 64 years. Among them, there were 59 cases of acute leukemia (AL), 8 cases of aplastic anemia (AA), 5 cases of myelodysplastic syndrome (MDS) and 16 cases undergoing hematopoietic stem cell transplantation (HSCT). There was no significant difference in age and sex ratio among the four groups (P＞0.05). There were 26 patients with ophthalmic complaints, accounting for 29.55%, and the main complaints were visual loss. Fundus lesions were the main positive findings in ophthalmic examination, accounting for 54.54% (48 cases), and the prevalence in AL, AA, MDS and after HSCT were 44.07%, 87.5%, 100% and 62.5%, respectively (P＞0.05). Fundus lesions mostly involved in both eyes, accounted for 61.54%, 85.71%, 100% and 90% respectively, without significant difference between groups (P＞0.05). The fundus changes in patients with different hematologic diseases showed symmetrical characteristic changes in AL, AA and MDS, which were characterized by multi-morphology and multi-level hemorrhage, the fundus lesions in undergoing HSCT group tended to be more complex on the basis of the above changes (with typical cheese and ketchup retinopathy).

Conclusion The proportion of secondary ocular fundus diseases in patients with hematopathy is high, and ocular fundus diseases lead to decreased vision. The fundus changes in patients with hematologic diseases is characterized by binocular symmetry. The fundus changes in patients undergoing HSCT is more complex, and their visual acuity is worse than that of patients with other hematologic diseases, which should be paid more attention in clinical work.

88例血液病患者的眼科临床特征分析

Ophthalmic manifestations of 88 patients with hematological diseases