438例睑缘炎患者的临床分析

Study on the clinical manifestation of 438 cases with blepharitis

目的 探讨睑缘炎的临床特征及治疗.方法 回顾性病例系列研究.对2009年1月至2012年7月间在北京市同仁医院眼科门诊临床诊断为睑缘炎的438例患者的一般情况、眼部症状和体征的分析,总结睑缘炎患者的临床特征.对患者进行临床程度分级,给予相应的治疗,并分析其疗效.主要指标包括睑缘情况、相关结膜及角膜病变及泪液质量.对不同程度睑缘炎的患者分布、并发角结膜病变的患者分布及并发干眼的患者分布进行x2检验.结果 共收集临床诊断为睑缘炎的患者共438例,435（99.3％）例为双眼发病.患者年龄为3～84岁,平均（40±18）岁.其中男性159例,占26.3％,女性279例,占63.7％.儿童患者（0～16岁）41例,占9.4％；成年患者（17～59岁）331例,占75.6％；老年患者（≥60岁）66例,占15.0％.睑缘炎患者中,轻度176例,占40.2％；中度174例,占39.7％；重度88例,占20.1％.重度患者中,成年患者明显高于儿童和老年患者,老年患者明显高于儿童患者（x2=34.575,P＜0.05）.不同性别患者之间睑缘炎程度差异无统计学意义（x2=32.877,P=0.192）.222例（50.7％）睑缘炎患者并发相关性角结膜病变,在轻度、中度、及重度的患者中,分别占8.5％、75.3％及86.4％.中、重度患者并发角结膜病变者多于轻度患者,其差异有统计学意义（x2=362.785,P＜0.05）.成年患者并发角结膜病变明显高于儿童患者和老年患者,老年患者明显高于儿童患者（x2 =362.785,P＜0.05）.303例（69.2％）患者伴有泪液异常,其中轻度睑缘炎伴有泪液异常的比例为10.0％,中度为39.3％,重度为69.2％.患者治疗效果分析：平均随访时间为8个月.按照睑缘炎不同分级程度给予1个疗程治疗后,333例（76.0％）患者达到临床痊愈,其余患者都有明显好转.结论 睑缘炎主要发生于成年人,常会引起干眼及相关性角结膜病变.临床医师须对其重视,并根据临床体征进行诊断和分级给予治疗,其中对睑缘的治疗是关键.

Objective To summarize the clinical characteristics and the therapy effect of blepharitis patients in clinic.Methods Retrospective case series study.Four hundred and thirty-eight patients were diagnosed clinically as blepharitis in Beijing Tongren Hospital from Jan 2009 to Jul 2012.Analyzed the general states of health,case history,and the clinical manifestation,to summarize the clinical characteristics of blepharitis.The patients were clinically degree indexing and treated appropriately.After 1-2 courses of the treatment,the effect was analyzed.main outcome measures：manifestation of lid margin,corneal,conjunctiva,and the results of tear tests.Result Four hundred and thirty-eight patients were recorded,from 3 to 84 years old,and the average was 40 ± 18 years old.435 （99.3％）cases were suffered with double eyes.159（26.3％） cases were males,and 279 （63.7％） cases were females.Children group had 41 cases （9.4％）,which from 0 to 16 years old.Adult group （17-59 years） included 331cases,which were 75.6％ in the study.66 cases were in aged group （≥60 years）,being 15.0％ in all cases.176 cases （40.2％） were on mild stage,174 cases （39.7％） on middle stage,and 88 cases （20.1％） were on serious stage.Aged group were significantly more than children group （x2 =34.575,P ＜ 0.05）.No significant difference between male and female （x2 =32.877,P =0.192）.In 222 cases （50.7％） blepharitis patients complicated with correlation of keratoconjunctivitis lesions,respectively 8.5％,75.3％ and 86.4％ in the mild,moderate,and severe patients.Adult group cases were significantly more than Children and aged group （x2 =362.785,P ＜ 0.05）.Aged group were significantly more than Children group （x2 =362.785,P ＜0.05）.303 cases（69.2％）were with tear abnormal.The moderate and serious patients were more suffered with tear abnormal than mild patients （x2 =64.438,P =0.000）.Patients were followed up for 1.5 to 27 months,mean 8 months.According to different extent of blepharitis,patients were given 1 courses of treatment.333 cases were clinical recovery,and the other cases were improved obviously.Conclusions Blepharitis occurs mainly in adults.It always complicate with dry eye and keratoconjunctival lesions.It is needed pay attention to by Ophthalmologist.The diagnosis and grade is based on typical clinical symptoms.The treatment according different grades should focus on the correct handling of the palpebral margin.