泪液渗透压与干眼严重程度的关联性研究

Correlation between tear osmolarity and the dry eye severity

背景于眼的发病率逐渐增加，但目前尚无统一的诊断标准。近年的研究提示，泪液渗透压增高可导致眼表不适症状，2007年国际干眼工作小组（DEWS）将泪液渗透压作为伴随症状写入干眼定义中，因此研究泪液渗透压与干眼的关系有重要的临床意义。目的依据DEWS干眼严重程度分级标准，分析泪液渗透压与干眼严重程度的相关性。方法采用描述性研究方法，收集在河南省眼科研究所经传统诊断方法诊断为干眼的患眼54例54眼，询问患者的眼部症状，裂隙灯显微镜下观察眼前节表现，同时行Schirmer试验Ⅰ（sⅠt）、泪膜破裂时间（BUT）试验、泪膜影像学检查、角膜荧光素染色以及泪液渗透压试验，参照和结合DEWS的标准对干眼表现进行评分，将干眼症状评分与泪液渗透压进行相关分析。结果男性发病与女性发病的比例为1：2。泪液渗透压与sⅠt、BUT均呈明显负相关（r=-0．456、-0．699，P〈0．01），与泪膜影像学检查值、角膜荧光素染色评分、结膜充血评分、干眼严重程度评分均呈显著正相关（r=0．545、0．686、0．691、0．803，P〈0．01），与年龄、性别相关（β1=141．138，P=0．000；β2=1．845，P=0．049）。结论泪液渗透压检测可客观地反映干眼的严重程度，结合临床症状和体征可作为干眼严重程度分级的标准。

Background There still is no a uniform diagnostic criteria for increasing population of dry eye. Studies showed that high tear osmotic pressure is one of causes of a variety of ocular surface discomfort, and the change of tear osmolality has been included in the definition of dry eye syndrome by Dry Eye World Study Group （DEWS） in 2007. It is very clinically significant to study the relationship of tear osmolality with dry eye. Objective This clinical trial was to study the correlation between tear osmolarity and dry eye severity based on Preferred Practice Pattern（PPP） of DEWS. Methods A descriptive study was performed. Fifty-four eyes of 54 patients with dry eye disease were asked to complete an evaluation of dry eye signs and symptoms questionnaire based on PPP. The ocular anterior segment was examined under the slit lamp biomicroscope. Cornealfluorescein staining,tear-film breakup time （BUT） ,Schirmer test IⅠ （S Ⅰt）without anesthesia were performed,and tear sample was collected for tear imageology and tear osmolarity admeasurement. The correlation between dry eye score with tear osmolarity was evaluated using Pearson linear correlation analysis. Written informed consent ..as obtained prior to any relevant medical procedure. Results The ratio of male and female patients was 1 ： 2 in this study. The negative correlations were found between tear osmolarity with S Ⅰ t or BUT （r =-0. 456,-0. 699, P〈0.01 ） , and significantly positive correlations were found between tear osmolarity with tear imaging examination,corneal fluorescein staining,eonjunctival hyperemia or dry eye symptom score（ r= 0. 545,0. 686,0. 691,0. 803, P〈0. 01 ）. Conclusions As a diagnostic method, tear osmolarity can objectively reflects dry eye severity. It can be a biomarker in dry eye severity grade when combined with clinical symptom.