结膜松弛症睑板腺功能的临床观察

A clinical study on the role of the meibomian gland in conjunctivochalasis

目的 探讨睑板腺功能障碍（MGD）与结膜松弛症（CCh）的关系,观察挤压睑板腺分泌排泄法对MGD的临床疗效.方法 前瞻性随机病例对照研究.选取CCh患者100例（200眼）,男45例,女55例,年龄为46～87岁,平均（72.6±5.5）岁.采用眼表面疾病指数（OSDI）积分法对患者进行眼部症状问卷调查评分；观察患者睑板腺开口；测定泪膜破裂时间（BUT）；对异常睑板腺分泌物行涂片染色；同时利用非接触红外线睑板腺照相系统进行睑板腺检查.对CCh伴有MGD患者随机分为睑板腺挤压治疗组（挤压组,24例）和抗生素眼液、人工泪液治疗组（对照组,22例）.治疗后1、2、4、8周进行随访观察,取第8周的数据进行统计学分析.对相关数据进行独立样本t检验或者配对t检验.结果 CCh伴有MGD者46例,占46％.不伴MGD患者的OSDI积分为21.6±5.9,伴MGD患者的OSDI积分为46.3±7.9,差异有统计学意义（t=17.172,P＜0.01）.MGD挤压治疗组治疗前的OSDI和睑板腺开口积分分别为45.8±8.9和2.1±0.3,治疗后分别为21.2±4.8和3.2±0.4,差异均有统计学意义（t=22.170、2.688,P＜0.05）.不伴MGD患者BUT值为（7.8±0.9）s,伴MGD患者的BUT值为（5.9±0.9）s,差异有统计学意义（t=6.189,P＜0.01）.挤压治疗组治疗前BUT值为（5.7±0.9）s,治疗后BUT值为（7.1±0.9）s,差异有统计学意义（t=10.110,P＜0.01）.对照组治疗前后除OSDI积分差异有统计学意义外（t=24.330,P＜0.01）,BUT及睑板腺开口积分差异无统计学意义.46例伴MGD患者的睑板腺分泌物涂片检查发现,26眼分泌物涂片除脂质外,还含有上皮细胞、正在凋亡的细胞和大量的细胞碎屑及少许炎症细胞,7例奶黄样分泌物涂片可见大量中性粒细胞和少量上皮细胞.结论 CCh多伴发MGD.睑板腺挤压治疗是一种有效的治疗MGD的方法,可以作为伴发MGD的CCh患者的重要的辅助治疗.

Objective To investigate the relationship between meibomian gland dysfunction （MGD） and conjunctivochalasis （CCh）,and to observe the therapeutic effect of meibomian gland pressing.Methods This was a prospective,randomized,case control study.Two hundred eyes of 100 patients with CCh were included in this study in which the ocular surface disease index （OSDI）,meibomian gland outlet score,smears of meibomian gland secretion,and tear break-up time （BUT）were observed and also used to evaluate the therapeutic effect of pressing treatment for MGD.CCh patients with MGD were randomly divided into two groups：24 patients （48 eyes） were treated with pressing treatment and 22 patients （44 eyes） were treated with artificial tears eye drops and antibiotic eye drops （the control group）.All patients were followed up at 1,2,4,and 8 weeks.The data from OSDI and BUT for the two groups at the 8-week follow-up were used to conduct with an independent samples t test or paired t test.Results Of the 200 eyes,92 eyes （46%） with MGD.While OSDI scores in CCh without MGD （21.6±5.9） were significantly lower than that in those with MGD （46.3± 7.9） （t=17.172,P〈0.01）,OSDI scores in eyes with pressing treatment （21.2±4.8） were significantly lower than that pre-treatment （45.8±8.9） （t=22.170,P〈0.01 ）.After pressing treatment,the meibomian gland outlet scores （2.1±0.3） were significantly lower compared with the pre-treatment scores （3.2±0.4）（t=2.688,P=0.025）.BUT in pressing-treated eyes significantly improved to be （7.1±0.9） seconds compared with （5.7±0.9） seconds of baseline （t=10.110,P〈0.05）.In the control group,there was a significant difference in OSDI （t=24.330,P〈0.01） rather than in BUT and meibomian gland outlet scores between pre- and post-treatment.In addition,lipid,epithelia,apoptosis cells,broken cells and inflammatory cells were observed in some smears of meibemian gland secretion.Conclusion MGD can accompany CCh and exacerbate its symptoms,whereas pressing the meibomian gland is an effective method for treating MGD and attenuating the related symptoms of CCh.