[Clinical characteristics and correlative factors of dry eye disease associated with graft-versus-host disease].

Objective: To investigate the clinical features of dry eye disease in patients with graft-versus-host disease (GVHD) and to identify the correlative factors that contribute to its severity. Methods: It was a retrospective case series study. A total of 62 patients with dry eye disease caused by GVHD after allogeneic hematopoietic stem cell transplantation (HSCT) were recruited from the First Affiliated Hospital of Soochow University between 2012 and 2020. The study population comprised 38 males (61%) and 24 females (39%), with an average age of (35.29±11.75) years. Only the right eye of each patient was evaluated. The patients were divided into two groups based on the severity of corneal epitheliopathy: a mild group (15 eyes) and a severe group (47 eyes). Demographic information, including gender, age, primary disease, type of allogeneic HSCT, donor-to-recipient information, source of hematopoietic stem cells, systemic GVHD, and the time from HSCT to the first visit, was collected. Ophthalmologic assessments, including the Schirmer Ⅰ test, tear breakup time, corneal epithelial staining, and eye margin assessment, were performed during the first visit to the ophthalmology department and compared between the two groups. Results: The average time from HSCT to the first visit to the ophthalmology department among the 62 patients was (20.26±13.09) months. The median corneal fluorescein staining score was 4.5 points. In the mild group, the main characteristic of corneal staining was scattered punctate staining in the peripheral region in 80% of cases, while in the severe group, corneal staining fused into clumps in both the peripheral region (64%) and the pupillary zone (28%). Results of the Schirmer Ⅰ test were significantly lower in the severe group compared to the mild group (P<0.05). The median total eyelid margin score in the severe group was higher than that in the mild group [9 (7, 12) points vs. 6 (5, 8) points] (P<0.05). The median eyelid congestion score in the severe group was, also higher than that in the mild group [2 (1, 3) points vs. 1 (0, 2) points] (P<0.05). The compatibility between the blood types of the donor and recipient was found to be statistically significant (P<0.05). There was no significant difference in gender, age, family relationship, human leukocyte antigen matching, gender consistency, source of hematopoietic stem cells, or the occurrence of systemic GVHD between the two groups (P>0.05). Conclusions: Patients in the mild group had scattered punctate corneal staining in the peripheral region, while those in the severe group showed fusion of corneal staining into clumps in both the peripheral and pupillary zones. The severity of dry eye disease caused by GVHD was strongly correlated with eyelid margin lesions. A higher degree of eyelid margin lesions indicated more severe dry eye disease caused by GVHD. Additionally, compatibility between the blood types of the donor and recipient may play a role in the development of GVHD-associated dry eye.目的： 探讨移植物抗宿主病（GVHD）干眼的临床特征及其严重程度的相关因素。 方法： 回顾性病例系列研究。收集2012至2020年于苏州大学附属第一医院眼科角膜病门诊就诊的62例异基因造血干细胞移植术（HSCT）术后GVHD干眼患者的资料，均取右眼进行分析。其中男性38例，女性24例；年龄为（35.29±11.75）岁。按角膜上皮病变严重程度分为轻度组（15例）和重度组（47例），统计并比较2个组患者原发疾病信息及眼部评估资料。原发疾病信息包括性别、年龄、原发疾病、HSCT移植配型方式、与供体人类白细胞抗原（HLA）配型的一致性、与供体的血缘关系、与供体的性别和血型的一致性、造血干细胞来源、HSCT至初次器官免疫排斥的时间、出现免疫排斥的器官、HSCT至眼科初诊的时间等。眼部评估包括眼科初诊时基础泪液分泌试验结果、泪膜破裂时间、角膜荧光素染色评分、睑缘情况评分。 结果： 62例患者中HSCT至眼科初诊的时间为（20.26±13.09）个月。角膜荧光素染色评分的中位数为4.5分，轻度组主要表现为中周部角膜上皮散在点状染色（80%），重度组主要表现为中周部（64%）和瞳孔区（28%）角膜上皮染色融合成片。2个组间比较，基础泪液分泌试验结果重度组低于轻度组（P<0.05）。重度组的睑缘情况总分为9（7，12）分，高于轻度组的6（5，8）分（P<0.05）。重度组的睑缘充血评分为2（1，3）分，高于轻度组的1（0，2）分（P<0.05）。2个组间供体和受体血型关系的比较具有统计学意义（P<0.05），性别、年龄、HLA配型、血缘关系、供体和受体性别是否匹配、造血干细胞来源等差异无统计学意义（P>0.05）。 结论： GVHD干眼轻度病变主要表现为中周部角膜上皮散在点状染色，严重者表现为中周部和瞳孔区角膜上皮染色融合成片。严重程度与睑缘病变密切相关，较高的睑缘病变评分提示患者可出现重度病变。供体和受体血型是否相合是GVHD干眼进展的一个相关因素。.