眼表综合分析仪在评价干燥综合征干眼中的临床意义

Clinical significance of auxiliary examinations in evaluating dry eye induced by Sjgren Syndrome

目的探讨干燥综合征患者主观症状上的Mc Monnie问卷评分、眼科检查和免疫学相关检查等辅助检查在评价干燥综合征干眼中的临床意义。方法干燥综合征干眼患者共102例204眼,其中83人有效完成Mc Monnie问卷调查以评估主观症状;101人完成眼表综合分析仪等眼科相关检查,94人完成免疫球蛋白Ig G、Ig A、Ig M、补体C3、补体C4和C反应蛋白的检查,78人完成抗核抗体、抗α胞衬蛋白抗体、抗ENA抗体-SSA和抗ENA抗体-SSB的检查。采用t检验和卡方检验比较相关数据之间的联系。结果主观问卷评分与角膜荧光素染色结果(P=0.019)、脂质层颜色(P=0.027)有相关性。年龄与睑板腺数量有相关性(P=0.022)。双眼脂质层颜色(P=0.015)、角膜荧光素染色(P=0.025)和泪河高度(P=0.039)均与血清中Ig G水平存在相关性。血清中Ig A水平和BUT结果有相关性(P=0.022)。结论泪膜脂质层、睑板腺、角膜的结构和功能的状态与患者的眼部症状关系密切,血清中免疫球蛋白水平与其眼科客观检查的指标有明显关联,可作为干燥综合征干眼的整体病情和泪膜角膜损伤程度的重要评估手段。

Objective To assess the clinic significance of the auxiliary examinations in dry eye associated with Sjgren Syndrome through the analysis of the Mc Monnies questionnaire and auxiliary examinations about the ocular and immune status. Methods In this study,102 patients（ 204 eyes） with dry eye associated with Sjgren Syndrome were collected. Among all the patients,83 patients were assessed with the Mc Monnie questionnaire,101 patients completed the ophthalmologic examinations,94 completed the examinations of Ig A,Ig G,Ig M,C3,C4 and CRP,and 78 completed the examinations of ANA,anti-α-fodrin antibody,anti-SSA antibody and anti-SSB antibody. T-test and Chi-square test were used to analyze the association in the related data. Results The assessment in the Mc Monnie questionnaire was positively correlated with the corneal fluorescein stain（ P = 0. 019） and the color of the lipid layer（ P = 0. 027）. The age was associated with the amount of meibomian gland（ P = 0. 022）. Ig G in serum was related with the color of the lipid layer（ P = 0. 015）,corneal fluorescein staining（ P = 0. 025） and tear meniscus height（ P = 0. 039）. BU Twas also correlated with the Ig A in serum（ P = 0. 022）. Conclusion The structure and function of the lipid layer in the tear film,meibomian gland and cornea are closely related to patients’ ocular symptoms. In addition,the blood serum immunoglobulin levels are associated with the objective ophthalmologic examinations. These examinations all above can be applied to the clinical assessment of the systemic condition of dry eye induced by Sjgren Syndrome and the injury severity of tear film and cornea.