系统性红斑狼疮患者眼表损害和角膜知觉减退及其相关性研究

Study of ocular surface abnormality,corneal hypoesthesia and their relationship in systemic lupus erythematosus

目的探讨系统性红斑狼疮(SLE)眼表损害和角膜知觉减退以及其相关性研究。方法采用病例对照研究。观察组为70例(140眼)SLE患者,对照组为62例(124眼)健康体检人群。为了解眼表损害的情况,对两组中每个患者的两眼首先进行泪膜破裂时间测量(tear film break up time,BUT)、基础泪液分泌试验(Schirmer's I test,sIt)、角膜荧光素染色,然后根据上述3项指标的数据判定干燥性角结膜炎(keratoconjunctivitis sicca,KCS),记录KCS的发生率。测量角膜中央处的知觉。询问合并KCS的SLE患者是否有干眼症状,记录干眼症状的发生率。结果与对照组比较,观察组的SIt值低(t=5.49,P<0.01),BUT值低(t=6.54,P<0.01),角膜荧光素着染阳性率增加(χ2=82.563,P<0.001),KCS发生率高(χ2=16.381,P<0.001)。观察组角膜知觉减退(t=4.492,P<0.001);SLE患者的角膜知觉与SIt、BUT、角膜荧光素染色阳性率有一定的相关关系。合并KCS的SLE患者有干眼症状主诉的角膜知觉高于无干眼症状主诉的,差异有统计学意义(t=3.426,P<0.01)。结论 SLE患者的角膜知觉明显减退,易发生眼表损害。眼表损害严重的KCS患者无眼干不适主诉可能是因为其角膜知觉低下。

Objective To investigate ocular surface abnormality, corneal hypoesthesia to study the relationship between corneal hypesthesia and ocular surface abnormality in systemic lupus erythematosus （SLE）. Methods A case-controlled study was adopted. Seventy SLE subjects （140 eyes） and 62 nonrheumatic diseases subjects （124 eyes） were recruited. To understand the situation of ocular surface abnormality, with Schirmer＇s Ⅰ test （sit）, tear film Break Up Time （BUT）, corneal fluorescein staining were used to examine all the subjects. Then according to the judgment of keratoconjunctivitis sieea （KCS） of the three indicators of data, and the incidence of KCS was recorded. Central corneal sensation （CCS） were measured. The patients with KCS SLE were asked whether they had dry eye symptoms, and the incidence of dry eye symptoms was recorded. Results Compared with control subjects, the observation group was for low values of sit （t=5.49, P〈0.01）, low BUT value （t=6.54, P〈0.01）, corneal fluorescein staining positive rate increased （x^2=82. 563, P〈0. 001）, the high incidence of KCS （x^2= 16. 381, P〈0. 001）. The observation group corneal hypoaffectivity （t=4. 492, P〈0. 001） ; SLE corneal perception and Sit, BUT, corneal fluorescein staining there is a certain correlation between the positive rate. Combined with KCS in SLE patients with dry eye symptoms of corneal sensitivity was higher than that of dry eye symptoms, the difference has statistical significance （t=3. 426, P〈0.01）. Conclusion Obvious decrease in patients with SLE corneal perception is prone to ocular surface damage. Ocular surface damage of severe KCS patients without dry eye complaints is probably because of its low corneal perception.