绝经后干眼症妇女泪液与血清雌激素质量浓度的分析

The analysis of estradiol content in tear and serum of postmenopausal women

目的测定绝经后干眼症妇女泪液与血清中雌二醇的质量浓度,探讨与干眼症发病的关系。方法取绝经后干眼症32例,正常对照30例,均检测右眼。用化学发光法测定绝经后干眼症患者泪液和血清中的雌二醇的质量浓度,所得数据用非参数检验的Mann-Whitney检验和Spearman秩相关分析。采用印迹细胞学法取得被测定者的球结膜上皮细胞,用扫描电镜观察眼表的超微结构变化。结果绝经后干眼症组泪液和血清的雌二醇质量浓度较正常对照组差异均有统计学意义(P=0.001)。正常对照组泪液与血清中的雌二醇质量浓度呈正相关。绝经后干眼症组泪液与血清中的雌二醇质量浓度无明显相关。绝经后干眼症患者眼表出现明显的病理变化。结论绝经后干眼症患者泪液中雌二醇质量浓度较正常对照组明显降低。血清和泪液中的雌二醇质量浓度在绝经前存在正相关性,而绝经后二者无相关性。

Objective That decline of estradiol in serum of postmenopausal women can result in dry eye has been accepted at present. However, the change of estradiol in tear of postmenopausal women has been not reported ever. This study was to discuss the relationship between dry eye syndrome and estradiol in tears and serum of postmenopausal women. Methods Total 62 eyes of 62 women were collected in this trial. The aim of this trial was informed orally and the informed consent was obtained from all the subjects. The 32 right eyes were from menopausal women for more one year and 30 right eyes were from premenopause women. The dry eye was diagnosed based on the abnormalities of tear break-up time （BUT） , Schirmer I test, corneal fluorescence and subjective symptom of patients. The periphery blood specimen was collected from all the subjects, and tear specimen was obtained and quantified using filter paper. Estradiol contents in tears and serum were determined by chemiluminescence method. The bulbar eonjunctiva was obtained by impression cytology,and the mierostructure of eonjunetiva was observed under the scanning electron microscopy. Results In comparison to the premenopause group,the content of estradiol in tears and serum in menopause group was significantly reduced（73.50 ± 24.47 vs 17.43 ±10.92） （ U = -6. 396,P = 0. 001 ）. In the premenopause group, the estradiol content between tear and serum showed the positive correlation （ r = 0. 838, P = 0. 001 ）. However, no statistical correlation was found in estradiol content between tears and serum in menopause group（ r = 0. 127 ,P = 0. 487 ）. The maicrostructure changes were seen in the dry eyes of postmenopausal women,and decrease of goblet ceil and loosen of intercellular junction were found under the electron microscope. Conclusion The content of estradiol in tears in menopause group is significantly lower than that in the premenopause group. Estradiol content in tears and serum of the postmenopausal women showes insignificant correlation. This result indicates that the topical substitute therapy with estradiol is possible in dry eye.