에탐부톨 안독성의 조기진단을 위한 시기능 검사의 연구
Visual Function Test for Early Detection of Ethambutol-Induced Ocular Toxicity
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초록
목적: 에탐부톨 안독성의 조기진단에 유용한 시기능 검사를 알아보고자 한다. 대상과 방법: 에탐부톨 복용예정인 결핵환자 10명(20안)을 대상으로 시력, 시야, 색각, 안저, 대비감도 및 빛간섭단층촬영검사를 복용전부터 복용 후 5달까지 1달 간격으로, 시유발전위검사를 2달 간격으로 실시하여 복용 전의 검사결과와 비교하였다. 또한, 각각의 눈에서 복용 전 검사의 평균값으로부터 2표준편차(SD) 이상의 변화가 있는 경우를 에탐부톨 안독성에 의한 변화로 생각하고 그 유무를전향적으로 조사하였다. 결과: 빛간섭단층촬영검사에서 에탐부톨 복용 4개월 후부터 전체 환자의 평균 망막신경섬유층 두께의 증가가 나타났고(p＜0.05), 시유발전위검사에서 복용 2, 4개월 후에 평균 P100 잠복기의 지연이 나타났다(p＜0.05). 그러나 각 눈에서 2 SD 이상의 변화는 빛간섭단층촬영검사에서는 관찰되지 않았고 시유발전위검사에서는 총 6안에서 나타났다. 관찰기간 내 시력, 색각, 안저, 대비감도 및 시야의 변화는 없었다. 결론: 시유발전위검사는 에탐부톨 안독성을 조기에 반영하는 것으로 보이며, 에탐부톨 복용 환자, 특히 고위험군에서 안독성의 조기진단에 도움이 될 것으로 생각한다.
Abstract
Purpose: The purpose of the present study was to investigate various visual function tests for early detection of ethambutol-induced ocular toxicity. Methods: A prospective study of 20 eyes of 10 patients being treated with ethambutol was conducted. Visual acuity, visual field, color vision, fundus examination, contrast sensitivity, optical coherence tomography (OCT), and pattern-visual evoked potential (VEP) were assessed. Examinations were performed prior to therapy and every month for 5 months after treatment. VEP was performed every other month. The mean values of each parameter at each month were compared with the baseline examination and a p-value of <0.05 was considered significant. In addition, a greater than 2 standard deviation (SD) change in each parameter from the mean values at baseline was considered as an ocular toxicity induced change in each individual eye. Results: On OCT, a significant increase of the average retinal nerve fiber layer thickness was detected after 4 months of therapy. VEP showed an increased mean latency of the P100 wave after 2 and 4 months of therapy. However, a greater than 2 SD change from the mean values of the baseline was not observed on OCT, while 30% (6/20) of the eyes showed more than a 2 SD increase in VEP latency. Visual acuity, color vision, fundus, contrast sensitivity, and visual field were not affected in any patients. Conclusions: The authors of the present study consider VEP as a sensitive test to detect early toxicity of ethambutol. VEP can be helpful in identifying subclinical ocular toxicity, especially in the high-risk patients.
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