泪液分泌增加作为麦氏腺缺失的代偿反应：一项多中心横断面研究。
Increased Tear Fluid Production as a Compensatory Response to Meibomian Gland Loss: A Multicenter Cross-sectional Study.
机构信息
Lid and Meibomian Gland Working Group, Japan; Department of Ophthalmology, Itoh Clinic, Saitama, Japan; Department of Ophthalmology, University of Tokyo, Tokyo, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
Lid and Meibomian Gland Working Group, Japan; Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
出版信息
Ophthalmology. 2015 May;122(5):925-33. doi: 10.1016/j.ophtha.2014.12.018. Epub 2015 Jan 24.
PURPOSE
To compare tear film parameters as well as meibomian gland morphologic features and function among patients with meibomian gland dysfunction (MGD), those with non-Sjögren syndrome aqueous-deficient dry eye (non-SS ADDE), those with non-SS ADDE and MGD, and normal subjects.
DESIGN
Multicenter, cross-sectional, observational case series.
PARTICIPANTS
Forty-one eyes of 41 patients (all women; mean age ± standard deviation, 62.1±9.9 years) with non-SS ADDE, 70 eyes of 70 patients (all women; 66.0±8.7 years) with MGD, 17 eyes of 17 patients (all women; 72.4±7.8 years) with non-SS ADDE and MGD, and 70 eyes of 70 normal control subjects (all women; 65.0±7.1 years).
METHODS
Ocular symptoms were scored from 0 to 14 and lid margin abnormalities from 0 to 4 according to their respective number. Meibomian gland changes were scored from 0 to 6 (meiboscore) on the basis of noncontact meibography findings, and meibum was graded from 0 to 3 depending on its volume and quality. Conjunctival and corneal epithelial damage were scored from 0 to 9 (fluorescein score). Tear film break-up time (TBUT) was measured as an index of tear film stability, and tear fluid production was evaluated with Schirmer's test.
MAIN OUTCOME MEASURES
Ocular symptom score, lid margin abnormality score, meiboscore, meibum grade, fluorescein score, TBUT, and Schirmer's test value.
RESULTS
The ocular symptom score did not differ significantly between the MGD and non-SS ADDE groups (P = 0.762). The lid margin abnormality score, meiboscore, and meibum grade were significantly higher in the MGD group than in the non-SS ADDE group (P = 0.0012, P < 0.0001, and P < 0.0001, respectively). The fluorescein score, TBUT, and Schirmer's test value were significantly worse in the non-SS ADDE group than in the MGD group (P < 0.0001, P = 0.0061, and P < 0.0001, respectively). The meiboscore correlated significantly with Schirmer's test value only in the MGD group (ρ = 0.508, P = 8.3×10(-6)).
CONCLUSIONS
An increase in tear fluid production likely compensates for loss of meibomian glands in individuals with MGD.
目的
比较睑板腺功能障碍（MGD）患者、非干燥综合征性水样缺乏性干眼症（非 SS ADDE）患者、MGD 合并非 SS ADDE 患者与正常对照者的泪膜参数以及睑板腺形态学特征和功能。
设计
多中心、横断面、观察性病例系列研究。
参与者
41 例患者（均为女性；平均年龄 ± 标准差，62.1±9.9 岁）的 41 只眼患有非 SS ADDE、70 例患者（均为女性；66.0±8.7 岁）的 70 只眼患有 MGD、17 例患者（均为女性；72.4±7.8 岁）的 17 只眼患有非 SS ADDE 合并 MGD 和 70 例正常对照者（均为女性；65.0±7.1 岁）的 70 只眼。
方法
根据各自的数量，眼表症状评分范围为 0 至 14 分，眼睑缘异常评分为 0 至 4 分。非接触式睑板腺照相法检查睑板腺变化，评分范围为 0 至 6（睑板腺评分），根据睑板腺分泌物的量和质量将睑脂分级为 0 至 3 级。根据角膜荧光素染色评分（FLS）评估结膜和角膜上皮损伤，评分为 0 至 9 分。泪膜破裂时间（TBUT）作为泪膜稳定性的指标进行测量，Schirmer 测试评估泪液产生情况。
主要观察指标
眼表症状评分、眼睑缘异常评分、睑板腺评分、睑脂分级、FLS、TBUT 和 Schirmer 测试值。
结果
MGD 组和非 SS ADDE 组的眼表症状评分无显著差异（P = 0.762）。MGD 组的眼睑缘异常评分、睑板腺评分和睑脂分级均显著高于非 SS ADDE 组（P = 0.0012、P<0.0001 和 P<0.0001）。非 SS ADDE 组的 FLS、TBUT 和 Schirmer 测试值均显著差于 MGD 组（P<0.0001、P = 0.0061 和 P<0.0001）。MGD 组的睑板腺评分与 Schirmer 测试值呈显著正相关（ρ=0.508，P = 8.3×10(-6))。
结论
MGD 患者泪液产生增加可能弥补了睑板腺的丧失。
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