水液缺乏型干眼症患者下泪新月高度临床对比分析

Clinical analysis of lower tear meniscus height in aqueous tear deficiency dry eye patients

目的比较水液缺乏型干眼症(aqueous tear deficiency,ATD)患者与非ATD人群的下泪新月高度(lower tear meniscus height,LTMH),并分析LTMH用于ATD诊断的可行性。方法选取2013年5月至9月于我院眼科门诊确诊的ATD患者40例(40眼)作为ATD组,另选取39例(39眼)非ATD人群作为对照组,分别用眼前节光学相干断层扫描仪获取被检者自然瞬目后的下泪新月图像并测量LTMH。通过绘制诊断试验特征曲线并计算线下面积,计算并选择LTMH的"异常"临界值,同时得出相应的敏感性(ATD患者中LTMH值呈阳性的比率)与特异性(非ATD人群中LTMH值呈阴性的比率)值,以此确定LTMH是否可作为诊断ATD的有效指标。结果 ATD组的LTMH为(141.1±22.4)μm,对照组为(193.9±22.3)μm,2者差异有统计学意义(t=10.495,P<0.01)。当LTMH选择"异常"临界值为0.168 mm时,其对于ATD的诊断敏感性为92.3%,特异性为92.5%。结论ATD患者的泪新月明显小于非ATD人群,LTMH对于ATD有良好的诊断准确性,因此用作ATD的诊断指标具有可行性。

Objective To compare the lower tear meniscus height （LTMH） between aqueous tear deficiency （ATD） dry eye patients and non-ATD subjects, and ana- lyze its potential in the diagnosis of ATD. Methods Forty eyes of 40 ATD patients coUected between May to September 2013 constituted ATD group, which were compared with control group consisted of 39 eyes from 39 non-ATD subjects. Lower tear meniscus was imaged by anterior segment optical coherence tomography （AS-OCT） immediately after normal blink, and LTMH was measured. For LTMH used for diagnosing ATD, receiver operating characteristic （ROC） curve was plotted and area under the ROC curve （AUC） was calculated. When the cut-off value of LTMH for ＇ abnormal＇ was figured out, sensitivity （ the ratio of patients with ATD who were positive for the variable） and specifmity （the ratio of non-ATD subjects who were negative for the variable） were al- so calculated. Results LTMH in ATD group was （ 141. 1 ± 22.4 ） μm, and which in control group was （ 193.9 ± 22.3 ） μm. LTMH was significantly smaller in ATD group than control group （ t = 10. 495, P 〈 0. 01 ）. LTMH showed 92. 3% of sensitivity and 92. 5% of specificity for diagnosing ATD when the cut-off value for ＇ abnormal＇ was 0. 168 mm. Conclusion The tear meniscus is smaller in patients with ATD compared with non-ATD subjects. LTMH shows good diagnostic accuracy for ATD and which has potential in the diagnosis of ATD.