眼睑刷上皮病变与干眼相关性的初步观察

Preliminary observation the correlation between lid-wiper epitheliopathy and dry eye

目的 探讨眼睑刷上皮病变（LWE）在不同人群中的患病率和影响因素及其与干眼的相关性。方法 为患病率研究。选择2006年9月至2007年3月于北京大学第一医院眼科就诊的141例（141只眼）患者，根据有无干眼症状及常规干眼检查（泪膜破裂时间、Schirmer I试验及角膜荧光素染色）结果将患者分为3组：A组60例（60只眼，无干眼症状且常规干眼检查阴性）、B组51例（51只眼，有干眼症状且常规干眼检查阴性）及C组30例（30只眼，干眼组）。再根据是否配戴角膜接触镜，将A组分为A1（不戴镜，30例，30只眼）和A2（戴镜，30例，30只眼）亚组，将B组分为B1（不戴镜，21例，21只眼）和B2（戴镜，30例，30只眼）亚组。行荧光素钠和丽丝胺绿染色，观察眼睑刷的病变情况，依病变程度将其分为0～3级。B组中23例（23只眼）LWE患者和C组30例（30只眼）患者行结膜印迹细胞学检查并分级。各组间年龄比较采用t检验和方差分析；各组的LWE患病率及染色分级比较均采用卡方检验；结膜印迹细胞学检测结果比较采用秩和肌形检验。结果 A、B及C组中LWE患病率分别为18．3％（11例）、86．3％（44例）及100．O％（30例）；其中A1亚组、A2亚组分别为13．3％（4例）和23．3％（7例），B1亚组、B2亚组分别为81．O％（17例）和90．O％（27例）。A、B及C组3组间比较差异有统计学意义（X^2=78．256，P〈0．01）。戴镜组（A2亚组和B2亚组）分别较不戴镜组（A1亚组和B1亚组）的LWE患病率高，但二者间比较差异无统计学意义（X^2=1．002，P=0．253；X^2=0．854，P=0．301）。B组中LWE患者印迹细胞染色结果分别为：0级17例（74．O％），1级6例（26．O％），无2级和3级；C组的印迹细胞染色结果分别为：无0级，1级12例（40．O％），2级15例（50．0％），3级3例（10．O％），两样本间比较差异有统计学意义（M-W=36．0，P〈0．01）。所观察的141例患者中，有LWE者85例，无LWE者56例。有LWE的患者中，单纯荧光素钠染色阳性16例（18．8％）、单纯丽丝胺绿染色阳性12例（14．1％）、两者均阳性57例（67．1％）。结论 在有干眼症状但常规干眼检查阴性的人群中LWE患病率很高。LWE可能是干眼的早期表现之一。

Objective To investigate the prevalence of lid-wiper epitheliopathy （LWE） and risk factors in dry eye patients. Methods One hundred forty-one patients （ 141 eyes） were recruited in Peking University First Hospital from September 2006 to March 2007. These patients were divided into three groups based on the dry eye symptoms and the results of break up time, Schirmer I test and corneal fluorescein staining. Group A ： 60 patients （60 eyes） with no dry eye symptoms and normal results of BUT, Schirmer I test and corneal fluorescein staining. Group B： 51 patients （51 eyes） with dry eye symptoms and normal results of BUT, Schirmer I test and corneal fluorescein staining. Group C： 30 patients （30 eyes） with dry eye. The patients in group A and group B were further divided into two subgroups based on wearing contact lens. Subgroup Al ：30 patients （30 eyes） with no contact lens wearers; Subgroup A2：30 patients （30 eyes） with contact lens wearers. Subgroup B1 ：21 patients （21 eyes） with no contact lens wearers; Subgroup B2： 30 patients （30 eyes） with contact lens wearers. Lid-wiper staining was graded in all patients following the instillation of fluorescein and lissamine green dyes. Impression cytology （IC） was made up in the patients in group C and the patients with LWE in group B. Results The prevalence of LWE was 18.3% （11 patients）, 86.3% （44 patients） and 100.0% （30 patients） in group A, B, C respectively. The prevalence of LWE was 13.3% （4 patients） , 23.3% （7 patients） , 81.0% （ 17 patients） and 90. 0% （27 cases） in subgroup A1, A2, B1 and B2. There was a significant statistical difference in the prevalence of LWE among groups A, B and C （X^2 = 78. 256, P 〈 0. 01 ）. There were no statistical difference in the prevalence of LWE between subgroup A2 and subgroup Al （ X^2 = 1. 002, P =0. 253 ）, subgroup B2 and subgroup Bl （ X^2 = 0. 854, P = 0. 301 ）. In group B, IC was graded as mark zero in 74. 0% of patients with LWE, as mark one in 26.0% of patients with LWE. In group C, IC was graded as mark one in 40. 0% of patients, as mark two in 50. 0% of patients, and as mark three in 10. 0% of patients. There was a significant statistical difference in grade of IC between group B and C （M-W=36. 0, P 〈0. 01 ）. The result of the corneal fluorescein staining was positive in 18.8% of patients with LWE. The result of lissamine green staining was positive in 14. 1% of patients with LWE. However, the result of both fluorescein and lissamine green staining was 67. 1% in patients with LWE. Conclusions The prevalence of LWE is higher in patients with dry eye symptoms and normal results of BUT, Schirmer I test and corneal fluorescein staining. LWE may be an early manifestation of the dry eye.