抗炎治疗睑板腺功能障碍的临床研究

Clinical research of anti-inflammatory therapy in patients with meibomian gland dysfunction

目的探讨抗炎治疗在睑板腺功能障碍患者中的作用,比较抗炎药物1g·L-1氟米龙滴眼液和双氯芬酸钠滴眼液的抗炎作用。方法将48例(96眼)在我院门诊诊断为睑板腺功能障碍患者,随机分为3组(每组各16例32眼),对照组单纯使用人工泪液+抗生素滴眼液+睑板腺局部物理治疗,激素治疗组和非甾体抗炎药物治疗组则在对照组治疗的基础上分别加用1g·L-1氟米龙滴眼液、双氯芬酸钠滴眼液治疗1个月,分别在治疗前、治疗后1周、1个月进行症状评分、视力、裂隙灯检查(睑缘评分等)、泪膜破裂时间检测、角膜荧光素染色检查、泪液分泌试验检查以及眼压检测;并做对比分析。结果 (1)治疗前采用完全随机设计的单因素方差分析进行两两比较,各组间差异均无统计学意义(均为P>0.05);(2)3组症状评分、泪膜破裂时间、角膜荧光素染色评分、泪液分泌试验、睑缘评分治疗前与治疗后1周、1个月分别行配对t检验,差异均有统计学意义(均为P<0.05),提示3种治疗均有效;(3)治疗后1周及1个月:抗炎药物组(激素治疗组和非甾体抗炎药物治疗组)与对照组相比:症状评分和睑缘评分差异均有统计学意义(均为P<0.05),且以上各项指标均值抗炎药物治疗组优于对照组;激素治疗组与非甾体抗炎药物治疗组相比:症状评分、泪膜破裂时间和睑缘评分差异均有统计学意义(均为P<0.05),且以上各项指标均值前者优于后者。结论抗炎治疗对睑板腺功能障碍有效,皮质类固醇激素可以显著改善睑板腺功能障碍患者的症状和体征,抗炎效果优于非甾体抗炎药物。

Objective To discuss the effect of anti-inflammatory therapy in patients with meibomian gland dysfunction,and compare the difference effect of 1 g·L-1 fluorometholone eye drops and diclofenac sodium eye drops.Methods Forty-eight patients（96 eyes） diagnosed as meibomian gland dysfunction in our hospital were randomly divided into 3 groups,32 eyes in each group.The control group only used the antibiotic eye drops＋artificial tears＋local physical of meibomian gland therapy,the glucocorticoid treatment group and non-steroidal anti-inflammatory drug treatment group added 1 g·L-1 fluorometholone eye drops and 1 g·L-1 diclofenac sodium eye drops for 1 month,respectively.The symptom score,visual acuity,slit lamp examination（palpebral and conjunctival hyperemia score degree of observation,etc.）,break-up time test,fluorescein staining,Schirmer Ⅰ test and intraocular pressure were investigated and compared before treatment and 1 week,1 month after treatment.Results Before treatment,the data was compared by completely random design ANOVA among three groups,there was no statistical difference（all P0.05）.There were statistical difference in symptom score,tear film breakup time,corneal staining score,Schirmer Ⅰ test,lid margin score before treatment and 1 week,1 month after treatment among three groups by paired t tests（all P0.05）,suggested that three kinds of treatment were effective.Break-up time and eyelid scores at 1 week,1 month after treatment in anti-inflammatory drug group（glucocorticoid treatment group and non-steroidal anti-inflammatory drug group） were better than that in control group,there were statistical differences（all P0.05）,and there were statistical differences in above indicators between glucocorticoid treatment group and non-steroidal anti-inflammatory drug group（all P0.05）,glucocorticoid treatment group were superior to non-steroidal anti-inflammatory drug group.Conclusion The anti-inflammatory treatment is effective for meibomian gland dysfunction.The glucocorticoid can significantly improve the symptoms and signs for patients with meibomian gland dysfunction,and its effect is superior to non-steroidal anti-inflammatory drug.