四种前列腺素类药物的降眼压疗效和耐受性对比研究

目的探讨四种前列腺素类药物治疗原发性开角型青光眼(primary open-angle glaucoma,POAG)的疗效和耐受性差异。方法采用随机平行试验,64例(128眼)POAG患者随机分成4组,分别使用贝美前列素(贝美前列素组)、拉坦前列素(拉坦前列素组)、曲伏前列素(曲伏前列素组)和他氟前列素(他氟前列素组)滴眼液治疗,观察并比较4组患者用药前和用药后1个月、3个月和6个月的眼压、眼部检查和眼表疾病指数(ocular surface disease index,OSDI)评分。结果贝美前列素组用药前眼压为(26.1±6.2)mmHg(1 kPa=7.5 mmHg),用药后1个月、3个月和6个月眼压分别为(17.1±3.4)mmHg、(15.6±4.2)mmHg、(15.5±2.9)mmHg,与用药前比较,差异均有统计学意义(t=17.408、13.016、12.352,均为P<0.001)。拉坦前列素组用药前眼压为(24.7±2.4)mmHg,用药后1个月、3个月和6个月眼压分别为(16.3±3.0)mmHg、(17.0±3.8)mmHg、(17.4±2.6)mmHg,与用药前比较,差异均有统计学意义(t=12.238、13.365、16.140,均为P<0.001)。曲伏前列素组用药前眼压为(24.4±1.9)mmHg,用药后1个月、3个月和6个月眼压分别为(16.3±2.0)mmHg、(17.4±1.3)mmHg、(14.9±1.1)mmHg,与用药前比较,差异均有统计学意义(t=12.109、14.451、11.732,均为P<0.001)。他氟前列素组用药前眼压为(25.2±2.3)mmHg,用药后1个月、3个月和6个月眼压分别为(17.2±3.1)mmHg、(17.0±2.1)mmHg、(18.1±2.4)mmHg,与用药前比较,差异均有统计学意义(t=10.540、16.129、14.006,均为P<0.001)。拉坦前列素组患者睫毛增长和虹膜变色的发生率最高,4组患者的结膜充血和角膜炎的发生率相似。用药6个月后患者的OSDI评分贝美前列素组(21.8±11.1)分、拉坦前列素组(32.1±24.1)分、曲伏前列素组(10.7±5.7)分、他氟前列素组(25.6±6.3)分,曲伏前列素组患者的OSDI评分显著低于其他3组,差异均有统计学意义(均为P<0.05)。结论四种前列腺素类药物均能显著降低POAG患者眼压,曲伏前列素耐受性较好,拉坦前列素的耐受性最差。

Efficacy and tolerance of four prostaglandins in reducing intraocular pressure

Objective　To evaluate the differences of efficacy and tolerance of 4 prostaglandins in patients with primary open-angle glaucoma (POAG).Methods　A randomized parallel experiment was conducted in 64 patients with POAG,and these patients were respectively treated with bimatoprost (bimatoprost group),latanoprost (latanoprost group),travoprost (travoprost group),and tafluprost (tafluprost group).Then,the intraocular pressure (IOP),ocular examination and ocular surface disease index (OSDI) score were detected and compared of the 4 groups before treatment,and after treatment for 1 month,3 months and 6 months.Results　For patients in group of bimatoprost,the IOP was (26.1±6.2)mmHg (1 kPa=7.5 mmHg) before treatment,and the IOP was (17.1±3.4)mmHg,(15.6±4.2)mmHg,(15.5±2.9) mmHg after treatment for 1 month,3 months and 6 months,respectively,and the difference was statistically significant compared with that before treatment (t=17.408,13.016,12.352,all P＜0.001).For patients in the latanoprost group,the IOP was (24.7±2.4)mmHg before treatment,and the IOP was (16.3±3.0) mmHg,(17.0±3.8)mmHg,(17.4±2.6)mmHg after treatment for 1 month,3 months and 6 months,respectively,and the difference was statistically significant compared with that before treatment (t=12.238,13.365,16.140,all P＜0.001).For patients in the travoprost group,the IOP was (24.4±1.9)mmHg before treatment,and the IOP was (16.3±2.0)mmHg,(17.4±1.3)mmHg,(14.9±1.1)mmHg after treatment for 1 month,3 months and 6 months respectively,and the difference was statistically significant compared with that before treatment (t=12.109,14.451,11.732,all P＜0.001).For patients in the tafluprost group,the IOP was (25.2±2.3)mmHg before treatment,and the IOP was (17.2±3.1)mmHg,(17.0±2.1)mmHg and (18.1±2.4)mmHg after treatment for 1 month,3 months and 6 months,respectively,and the difference was statistically significant compared with that before treatment (t=10.540,16.129,14.006,all P＜0.001).The incidence of eyelash growth and iris discoloration were highest in the latanoprost group,and the incidence of conjunctival congestion and keratitis was similar in the four groups.After 6 months of treatment,the OSDI was 21.8±11.1,32.1±24.1,10.7±5.7 and 25.6±6.3 for patients in the bimatoprost group,latanoprost group,travoprost group and tafluprost group,and the OSDI for patients in travoprost group was significantly lower than that in the other three groups,and the difference was statistically significant (all P<0.05).Conclusion　All the four prostaglandins can significantly reduce IOP in POAG patients,and the tolerance of travoprost is the best and that of latanoprost is the worst among the four prostaglandins.