办公室干眼泪膜脂质层形态分析

Tear film lipid layer pattern in office dry eye

目的 应用Keeler泪膜镜评估办公室干眼泪膜脂质层形态的变化,并分析泪膜脂质层与其他干眼检测方法之间的相关性.方法 横断面研究.本研究共纳入61例办公室工作人员（干眼患者33例,正常者28例）.所有受检者采用随机数字表法选择一眼按照以下顺序进行检查：干眼症状问卷表（OSDI）、泪新月容量、泪膜脂质层形态、非侵入性泪膜破裂时间、荧光素泪膜破裂时间、角膜荧光素染色以及Schirmer I试验.独立样本t检验或Mann-Whitney U 检验用于比较2组间参数,Spearman 相关用于分析脂质层厚度等级与其他参数的相关性.结果 办公室干眼组脂质层[2（1～3）]较正常组[3（3～4）]薄（U=250,P＜0.01）.在诊断办公室干眼时,脂质层厚度等级的最优诊断敏感性（0.545）和特异性（0.857）截断值为2级.脂质层厚度等级与非侵入性泪膜破裂时间和总泪新月容量呈正相关（r=0.485、0.349,P＜0.05）,而与症状及其他检测方法不相关.结论 Keeler泪膜镜可以有效评估办公室干眼泪膜脂质层厚度.泪膜脂质层厚度与泪新月容量、泪膜稳定性相关.

Objective To evaluate the tear film lipid layer pattern in office dry eye （ODE） with a Keeler tearscope and to determine its relationship to clinical tests.Methods Cross-sectional study.Thirty-three ODE patients and 28 control subjects participated in this study.Subjects were evaluated with the Ocular Surface Disease Index （OSDI）,which was followed by measurements of the total tear meniscus volume （TTMV）,tear film lipid layer thickness （TFLLT） grading,non-invasive tear breakup time （NITBUT）,fluorescein tear breakup time （FTBUT）,corneal fluorescein staining （CFS） and Schirmer I test （SIT）.All the measurements were performed on one eye selected at random for each subject.A paired t test or Mann-Whitney U test was used to compare the difference in each variable between the two groups.Spearman＇s rank correlation was used to indicate the relationship between TFLLT and other variables in the ODE group.Results TFLLT grading was significantly lower in the ODE group [2（1～3）] compared to the control group [3（3～4）] （U=250,P＜0.01）.High sensitivity and specificity of TFLLT grading （0.545 and 0.857,respectively） were found in the diagnosis of ODE,the cut-off value of which was grade 2.TFLLT grading was correlated with TTMV （r=0.349,P＜0.05） and NITBUT （r=0.485,P＜0.05）,while it was not correlated with the OSDI score,FTBUT,CFS or SIT.Conclusion A Keeler tearscope may effectively evaluate tear film lipid layer in ODE.Tear film lipid layer can also reflect the tear meniscus volume and tear film stability in ODE.