脂质层厚度和泪液半月板高度测量用于蒸发型干眼亚型的鉴别诊断。
Lipid layer thickness and tear meniscus height measurements for the differential diagnosis of evaporative dry eye subtypes.
作者信息
Sang Xuan, Li Yan, Yang Liu, Liu Jia-Hui, Wang Xiao-Ran, Li Chao-Yang, Liu Ying, Wang Chen-Jie, He Xiong-Jun, Wang Shou-Bi, Wang Zhi-Chong
机构信息
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China.
Department of Ophthalmology, Zhujiang Hospital of Southern Medical University, Guangzhou 510060, Guangdong Province, China.
出版信息
Int J Ophthalmol. 2018 Sep 18;11(9):1496-1502. doi: 10.18240/ijo.2018.09.11. eCollection 2018.
AIM
To explore a new diagnostic index for differentiating the evaporative dry eye (EDE) subtypes by analysis of their respective clinical characteristics.
METHODS
A cross-sectional study of 139 patients (139 eyes) with EDE who were enrolled and classified as obstructive meibomian gland dysfunction (MGD) (=81) and non-obstructive MGD (=58) EDE. All patients completed a Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire and were evaluated for average lipid layer thickness (LLT), tear meniscus height measurements (TMH), tear break-up time (TBUT), ocular surface staining score, Schirmer I test (SIT), lid margin abnormalities, and meibomian gland function and morphology.
RESULTS
Age, average LLT, TMH, scores of lid margin abnormalities, meibum quality, meibomian gland loss (MGL) (all ≤0.001), and TBUT (=0.03) were all significantly different between obstructive MGD EDE patients and non-obstructive MGD EDE patients. Average LLT in obstructive MGD EDE was correlated with meibomian expressibility (=-0.541, ≤0.001), lid margin abnormalities were marginally not significant (=0.197, =0.077), and TMH was correlated with MGL (total MGL: =0.552, ≤0.001; upper MGL: =0.438, ≤0.001; lower MGL: =0.407, ≤0.001). Average LLT in non-obstructive MGD EDE, was correlated with meibomian expressibility and Oxford staining (=-0.396, =0.002; =-0.461, ≤0.001). The efficiency of combining average LLT and TMH was optimal, with a sensitivity of 80.2% and a specificity of 74.1%. Obstructive MGD EDE patients had an average LLT≥69 nm and TMH≥0.25 mm, while non-obstructive MGD EDE patients had an average LLT<69 nm and TMH<0.25 mm.
CONCLUSION
Obstructive MGD EDE and non-obstructive MGD EDE have significantly different clinical characteristics. Combining average LLT and TMH measurements enhanced their reliability for differentiating these two subtypes and provided guidance for offering more precise treatments for EDE subtypes.
目的
通过分析蒸发型干眼（EDE）各亚型的临床特征，探索一种新的诊断指标以区分这些亚型。
方法
对139例EDE患者（139只眼）进行横断面研究，这些患者被纳入并分为阻塞性睑板腺功能障碍（MGD）（=81）和非阻塞性MGD（=58）EDE。所有患者均完成干眼标准患者评估（SPEED）问卷，并接受平均脂质层厚度（LLT）、泪河高度测量（TMH）、泪膜破裂时间（TBUT）、眼表染色评分、Schirmer I试验（SIT）、睑缘异常以及睑板腺功能和形态的评估。
结果
阻塞性MGD EDE患者与非阻塞性MGD EDE患者在年龄、平均LLT、TMH、睑缘异常评分、睑脂质量、睑板腺缺失（MGL）（所有P≤0.001）以及TBUT（P = 0.03）方面均存在显著差异。阻塞性MGD EDE患者的平均LLT与睑板腺可挤压性相关（r = -0.541，P≤0.001），睑缘异常差异无统计学意义（r = 0.197，P = 0.077），TMH与MGL相关（总MGL：r = 0.552，P≤0.001；上睑MGL：r = 0.438，P≤≤0.001；下睑MGL：r = 0.407，P≤0.001）。非阻塞性MGD EDE患者的平均LLT与睑板腺可挤压性及牛津染色相关（r = -0.396，P = 0.002；r = -0.461，P≤0.001）。联合平均LLT和TMH的诊断效能最佳，敏感性为80.2%，特异性为74.1%。阻塞性MGD EDE患者的平均LLT≥69 nm且TMH≥0.25 mm，而非阻塞性MGD EDE患者的平均LLT<69 nm且TMH<0.25 mm。
结论
阻塞性MGD EDE和非阻塞性MGD EDE具有显著不同的临床特征。联合平均LLT和TMH测量可提高区分这两种亚型的可靠性，并为EDE亚型提供更精准治疗的指导。
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