新型非侵入性眼表综合分析仪在干眼评估中的应用价值

Clinical value evaluation of a new noninvasive ocular analyzer for the assessment of dry eye

背景 干眼的发病率逐渐升高,但目前干眼的早期诊断尚有一定的困难,如何正确地诊断和治疗干眼是研究的热点.新型非侵入性眼表综合分析仪对干眼的分析研究具有重要的临床意义. 目的 探讨Keratograph 5M非侵入性眼表综合分析仪对干眼的临床诊疗价值. 方法 采用观察性研究方法,纳入2013年10-12月在天津医科大学眼科医院门诊就诊的拟行屈光手术的近视患者88例88眼,其中男32例,女56例;年龄18 ～51岁.对患者进行干眼相关检查,包括传统的泪膜破裂时间（TBUT）检测、角膜荧光素染色评分、Schirmer试验Ⅰ（SⅠ t）;用Keratograph 5M非侵入性眼表综合分析仪对患眼进行非侵入性泪膜破裂时间（NITBUT）检测和结膜充血程度分级,采用Spearman秩相关分析评价干眼相关指标与Keratograph 5M非侵入性眼表综合分析仪检测结果间的关系. 结果 不同性别间的年龄差异无统计学意义（P=0.34）.Keratograph 5M非侵入性眼表综合分析仪分析系统在88例受检者中检出正常者15例,可疑干眼44例,检出率为50.0％;检出干眼29例,检出率为33.0％,而采用《中国干眼临床诊疗专家共识》的标准检出正常者39例,干眼49例,干眼的检出率为55.7％.首次NITBUT （NITBUTf）所测的时间短于覆盖整个角膜的平均NITBUT（NITB UTav）,差异有统计学意义（P=0.00）,但二者间呈显著正相关（rs=0.62,P=0.00）.干眼分级与NITBUTf及NITBUTav均呈显著负相关（rs=-0.60、-0.89,均P=0.00）,与结膜充血程度分级呈正相关（rs=0.24,P=0.02）.结膜充血程度分级与NITBUTav呈负相关（rs=-0.24,P=0.02）,但与NITBUTf、TBUT、SⅠt值、角膜荧光素染色评分均无明显相关性（rs=-0.13,P=0.22;rs=0.16,P=0.14;rs=-0.16;P=0.13;rs=-0.08;P=0.44）.TBUT与NITBUTf间差异无统计学意义（P=0.71）,二者呈正相关性（rs=0.23,P=0.03）;但TBUT与NITBUTav无明显相关（rs=0.18,P=0.09）;S Ⅰ t结果与NITBUTf及NITBUTav均无明显相关性（rs =0.20,P=0.07;rs=0.05,P=0.66）. 结论 Keratograph 5M非侵入性眼表综合分析仪测得的NITBUTav值对评估眼表情况意义更大,对球结膜充血的检测可作为临床判断眼表健康与否的参考指标之一.

Background The incidence of dry eye is growing.However,the early diagnosis of dry eye is still difficult up to now.Keratograph 5M analyzer,a novel noninvasive ocular surface analyzer for dry eye may offer important parameters.Objective This study was to evaluate the clinical value of Keratograph 5M analyzer for clinical diagnosis of dry eye.Methods An observational study was proceeded with 88 cases who accepted myopia diagnosis in Tianjin Medical University Eye Hospital from October to December 2013.A series of conventional dry eye-related examinations were performed on the patients,including tear film break-up time （TBUT）,corneal fluorescein staining scoring,Schirmer Ⅰ test （S Ⅰ t）,and then Keratograph 5M analyzer-related examinations were subsequently carried out,including noninvasive tear film break-up time （NITBUT） and conjunctival hyperemia scoring.The correlations between conventional dry eye-related examinations and Keratograph 5M analyzer-related examinations were assessed by using Spearman rank correlation analysis.Results A total of 88 patients were recruited with male 32 and female 56.No significant difference in age was found between different genders （P =O.34）.In 88 patients,Keratograph 5M analyzer showed the non-dry eyes in 15 patients,suspicious 44 patients （50.0%） and dry eyes in 29 patients （33.0%）.However,the non-dry eyes were checked out in 39 patients and dry eyes were in 49 （55.7%） based on China Dry Eye Clinical Diagnosis and Treatment Consensus.The first NITBUT （NITBUTf） was less than the average NITBUT （NITBUTav） （P =0.00）,and a positive correlation was seen between them （rs =0.62,P =0.00）.Dry eye grade was significantly correlated with NITBUTf or NITBUTav or conjunctival hyperemia scoring （rs =-0.60,P =0.00 ; r,=-0.89,P =0.00 ; rs =0.24,P =0.02）.A negative correlation was found between the conjunctival hyperemia scoring and NITBUTav （rs =-0.24,P =0.02）.However,no significant correlation was seen between conjunctival hyperemia scoring and NITBUTf,TBUT,S Ⅰ t or corneal fluorescein staining scoring （rs=-0.13,P=0.22;rs=0.16,P=0.14;rs =-0.16,P=0.13;rs=-0.08,P=0.44）.No significant difference was found between TBUT and NITBUTf （P =0.71）.And TBUT was correlated with NITBUTf （rs =0.23,P =0.03）,but not NITBUTav （rs =0.18,P =0.09）.In addition,no significant correlations were seen between S Ⅰ t and NITBUTf or NITBUTav （rs=0.20,P=0.07;rs=0.05,P=0.66）.Conclusions NITBUTav has an important significance in assessing overall ocular surface conditions.The conjunctival hyperemia score is one of refrent indicators to judge ocular surface status.