早期羟氯喹视网膜病变神经节细胞复合体厚度的临床研究

Clinical Study on the Ganglion Cell Complex Thickness in Early Hydroxychloroquine Retinopathy

摘要: 目的：本研究旨在评估长期服用羟氯喹(HCQ)患者视网膜内层视网膜神经节细胞层(ganglion cell complex, GCC)厚度变化，为早期检测HCQ视网膜毒性提供结构学指标。方法：本研究收集了2023~2025年期间在青岛大学附属医院风湿免疫科就诊的羟氯喹使用患者，分为低危组(服药年限1至5年)和高危组(服药年限 ≥ 5年)。同时随机收集健康对照组。所有受试者接受SD-OCT检查，分别测量黄斑区域内界膜至内丛状层(ILM-IPL)和内界膜至外界膜(ILM-BM)厚度，以及视网膜神经节细胞复合体(GCC)厚度，进行组间统计学差异比较。结果：研究结果显示，低危组和高危组的黄斑区神经节细胞复合体厚度均较健康对照组有所减薄，且高危组的厚度变化明显较低危组。黄斑内圈颞侧和内圈上侧的神经节细胞层厚度差异具有统计学意义(P < 0.05)。此外，低危组和高危组的神经节细胞层厚度相较对照组有所减少，且随着用药年限增加，厚度逐渐减薄。结论：本研究提示，长期使用HCQ的患者在视网膜神经节细胞层存在区域性厚度变化，这可能是HCQ视网膜毒性早期的结构学表现。

Abstract: Purpose: This study aims to evaluate the changes in the ganglion cell complex (GCC) thickness in the inner retina of patients with long-term hydroxychloroquine (HCQ) use, providing structural indicators for the early detection of HCQ retinal toxicity. Methods: Patients who used HCQ and visited the Rheumatology and Immunology Department of Qingdao University Affiliated Hospital between 2023 and 2025 were enrolled, divided into low-risk group (1~5 years of HCQ use) and high-risk group (≥5 years of HCQ use). Healthy controls were randomly selected. All participants underwent SD-OCT to measure the thickness of the macula, including the inner limiting membrane to inner plexiform layer (ILM-IPL), inner limiting membrane to Bruch’s membrane (ILM-BM), and GCC thickness. Statistical analysis was performed to compare differences between groups. Results: The results showed that both the low-risk and high-risk groups had thinner GCC layers in the macula compared to the healthy control group, with a more significant reduction in thickness observed in the high-risk group. Statistical differences were found in the ganglion cell layer thickness at the temporal side of the inner macula and the superior side of the inner macula (P < 0.05). Additionally, the GCC thickness in both the low-risk and high-risk groups was reduced compared to the control group, and thickness decreased progressively with the duration of HCQ use. Conclusion: This study suggests that long-term HCQ use leads to regional thickness changes in the ganglion cell layer of the retina, which may represent an early structural manifestation of HCQ retinal toxicity.