综合治疗不同类型干眼症的临床疗效对比

Effects of combined therapy for dry eye with different types

目的比较不同类型干眼症综合治疗的疗效及相关临床检查结果。方法选取我院1999年3月至2010年9月门诊确诊干眼症患者64例(128眼),其中泪液蒸发过强型19例(A组)、泪液分泌不足型11例(B组)、混合型34例(C组),均给予相关临床检查,包括泪膜破裂时间(break-up time,BUT)、泪液分泌试验、睑板腺功能障碍评分等。所有患者均采用人工泪液滴眼、口服维生素A、热敷及按摩睑板腺等综合治疗,将各组间疗效进行对比分析。结果 A组、B组、C组的治愈率和有效率分别为55.3%和94.7%、0和77.3%、35.3%和91.2%,总治愈率35.2%,总有效率89.8%;B组与A组、C组治愈率比较,差异均有统计学意义(χ2=17.7、16.8,均为P<0.05);B组与A组、C组有效率比较,差异均无统计学意义(χ2=2.8、3.7,均为P>0.05)。A组、C组BUT治疗前后的改善程度与B组比较,差异均有统计学意义(t=2.07、2.90,均为P<0.05)。A组、C组泪液分泌试验结果改善程度与B组比较,差异均无统计学意义(t=0.18、0.85,均为P>0.05)。睑板腺功能障碍评分与初诊时BUT呈负相关(r=-0.367,P<0.01),与泪液分泌试验无相关性(r=0.211,P>0.05)。结论不同类型干眼症的相关临床检查结果存在差异,综合治疗轻、中度干眼症有效。

Objective To compare the therapeutic effects of treating mild and moderate dry eye by combined methods,and analyze its related clinical examination results.Methods Sixty-four patients（128 eyes） diagnosed as dry eye in our hospital from March 1999 to September 2010,including over-evaporation type（19 cases,group A）,decreased tear production type（11 cases,group B） and mixed type（34 cases,group C）,were treated by dropping artificial tears liquid,taking orally vitamin A,hot compress and meibomian gland massage,the therapeutic effects in each group were compared.Meanwhile,the clinical examinations were performed,including break-up time（BUT）,Schirmer test and meibomian gland dysfunction scoring,the results were analyzed.Results The cure rates and effective rates of group A,B and C were 55.3% and 94.7%,0 and 77.3%,35.3% and 91.2%,the total cure rate and effective rate were 35.2% and 89.8%;There were statistical differences in cure rate between group B and group A,C（χ2=17.7,16.8,both P0.05）,no statistical difference in effective rate between group B and group A,C（χ2=2.8,3.7,both P0.05）.There were statistical differences in improved degree of BUT between group B and group A,C（t=2.07,2.90,both P0.05）,no statistical difference in improved degree of Schirmer test between group B and group A,C（t=0.18,0.85,both P0.05）.The score of meibomian glands dysfunction was negative correlated with BUT without treatment（r=-0.367,P0.01）,but not correlated with Schirmer test（r=0.211,P0.05）.Conclusion The clinical examination results in different types of dry eye have difference,and combined therapy for mild and moderate dry eye is effective.