角膜共聚焦显微镜检查辅助治疗干眼症的临床研究

Clinical study on corneal confocal microscope assisted treatment of xerophthalmia

目的探讨角膜共聚焦显微镜检查辅助治疗干眼症的临床效果。方法收集2015年1月至2016年1月在江苏省常熟市第二人民医院眼科就诊的120例（240只眼）干眼症患者的临床资料。按照数字表法将患者随机分为对照组和观察组，对照组和观察组各60例（120只眼）患者。对照组患者在治疗前行常规检查，根据常规检查结果使用具体的药物和方法进行调整和治疗。观察组患者在治疗前行常规检查和角膜共聚焦显微镜检查，结合二者的检查结果进行治疗，治疗中所用的药物和方法均与对照组相同。治疗前和治疗半年后，分别对两组患者进行眼表疾病指数（OSDI）评分，评分结果以均数±标准差（面±s）描述，并采用t检验进行比较。治疗半年后，分别对两组患者行泪膜破裂时间试验（BUT）、Schirmer泪液分泌试验及荧光素染色检查，数据结果以中位数和四分位数描述，并采用wilcoxon秩和检验进行比较。在治疗前和治疗半年后，分别对两组患者进行于跟严重程度评级。两组患者干眼严重程度的改善情况以例数和百分数（％）表示，并采用疋。检验进行比较。结果对照组患者治疗前和治疗半年后的OSDI平均评分结果分别为（31．26±5．63）分和（12．63±2．36）分。观察组患者治疗前和治疗半年后的OSDI平均评分结果分别为（34．28±4．23）分和（6．78±3．26）分。将两组患者治疗前的评分结果进行比较，差异无统计学意义（t=-1．77，P〉0．05），但对照组患者治疗半年后的OSDI评分高于观察组，差异有统计学意义（t=15．93，P〈0．05）。治疗半年后．观察组患者的Schirmer泪液分泌试验的检测结果为16．78（9．21，24．35）mm／5min，明显高于对照组的5．41（1．02，11．21）mm／5min，差异有统计学意义（W=31．23，P〈0．05）。观察组患者的BUT为8．37（6．12，10．05）s，长于对照组的5．42（3．21，7．15）s，差异有统计学意义（W=10．15，P〈0．05）。观察组患者的荧光素染色分值为0．01（0．00，0．02）分，少于对照组的2．15（1．21，5．67）分，差异有统计学意义（W=8．67，P〈0．05）。治疗半年后，对两组患者的干眼严重程度重新评级。结果，观察组患者总的改善率为71．67％．优于对照组的58．33％，两组间的差异有统计学意义（X2=4．56，P〈0．05）。结论角膜共聚焦显微镜检查辅助治疗干眼症的临床效果优于依据常规干眼症的检查结果开展干眼症治疗的临床效果。

Objective To study the clinical effect of corneal confocal microscope assisted treatment of xerophthalmia. Methods The clinical data of 120 cases （240 eyes） with xerophthalmia who were in the department of Ophthalmology in Changshu No.2 people＇s Hospital in Jiangsu Province were collected from January 2015 to January 2016. According to the digital table method, the patients were randomly divided into control group and observation group. There were （ 120 eyes ） 60 cases in the control group and 60 cases （120 eyes） in the observation group. Patients in the control group were treated with routine examination before treatment, and the specific drugs and therapeutic methods were adjusted and treated according to the routine examination results. Patients in the observation group were treated with routine examination and corneal confocal microscopy examination, and the therapeutic methods were treated according those two examinations. The drugs and therapeutic methods used in the treatment were the same as that in the control group. Before and after half a year＇s treatment, grading patients of two groups with ocular surface disease index （OSDI） score sheet, the score results were presented as mean ＋ standard deviation （X±s）. Average score results were compared by t-test. After half a year＇s treatment, patients of two groups were underwent the test of tear break-up time （ BUT）, Schirmer and fluorescein staining. The results were presented as the median and quartile, and compared within the wilcoxon rank test. Before and after half a year＇s treatment, patients of two groups were rated with dry eye severity degree. The results were presented as number and percentage, and compared by X2 test. Results The OSDI score results of patients in control group and observation group before treatment were compared, the difference was not statistically significant （t =- 1.77, P〉0.05）. But after half a year＇s treatment, Comparing these two score results, the difference was statistically significant （t = 15.93, P〈0.05）. After half a year＇s treatment, the secretion of Schirmer test in patients in observation group was 16.78 （9.21, 24.35） mm/5 rain, which was higher than that in control group 5.41 （1.02, 11.21） mm/5min, and the difference was statistically significant （w= 31.23, P〈0.05）. BUT of patients in observation group 8.37 （6. 12, 10.05） s was longer than that in control group 5.42 （3.21, 7.15） s, the difference was statistically significant （w= 10.15, P〈0.05）. What＇s more the fiuorescein staining score in patients in observation group 0.01 （0, 0.02） was less than that in control group 2.15 （ 1.21, 5.67） , and the difference was statistically significant （ w = 8.67, P 〈 0.05 ）. After half a year＇ s treatment, patients of two groups were rated with dry eye severity degree again. The improved rate of patients in observation group was 71.67%, which was better than that in control group（ 58.33%）, and there were statistically significant differences between the two groups （X2= 4.56, P〈0.05）. Conclusion The clinical effect of corneal confocal microscope assisted treatment of xerophthalmia is better than that of routine examination results based treatment of xerophthalmia.