干眼患者泪膜及睑板腺功能分析

Assessment of tear film and meibomian gland function in dry eye patients

目的探讨干眼患者泪膜功能及睑板腺功能随年龄和性别的变化趋势。方法本研究采用回顾性系列病例研究。选取154例（308眼）来我院就诊的干眼患者为研究对象，其中男76例（152眼），女78例（156眼），通过Oeulus角膜地形图眼表综合分析仪，测量每位患者双眼的首次泪膜破裂时间、平均泪膜破裂时间、首次泪膜破裂区域等数据，研究其随年龄及性别变化的规律；同时观察睑板腺形态，统计腺管根数及睑板腺缺失面积，通过睑板腺缺失面积评分系统研究其随年龄及性别变化的规律。结果干眼患者睑板腺缺失面积评分与年龄存在正相关关系（r=0．715，P〈0．05），其中男性r=0．821，P〈0．05，女性r=0．663，P〈0．05；腺管缺失根数百分比与年龄存在正相关关系（r=0．620，P〈0．05），其中男性r=0．629，P〈0．05，女性r=0．631，P〈0．05。睑板腺缺失面积评分在50-59岁组，男性为（9．47±1．00）分，明显高于女性的（7．53±2．21）分，差异具有统计学意义（P〈0．05）；在≥60岁组，男性为（10．69±1．20）分，明显高于女性的（9．87±1．70）分，差异具有统计学意义（P〈0．05）。泪膜破裂时间与年龄存在负相关关系，其中首次泪膜破裂时间为r=-0．49，P〈0．01，平均泪膜破裂时间为r=-0．54，P〈0．01；除〈30岁组以外，其他各年龄组中平均泪膜破裂时间均大于首次泪膜破裂时间，且差异均具有统计学意义（均为P〈0．05）。泪膜的首次破裂区域集中在角膜鼻下方，占所有分区中的31％。结论干眼患者在睑板腺的缺失面积及腺管缺失根数方面具有随年龄增长而逐渐加重的趋势，在泪膜破裂时间方面具有随年龄增长而逐渐下降的趋势，各年龄组干眼患者泪膜首次破裂区域集中在角膜鼻下方位置，这对干眼患者的诊断及治疗有一定指导价值。

Objective To investigate the change of tear film function and meibo- mian gland function along with the age and gender in dry eye patients. Methods This was a retrospective case study. 154 dry eye patients （308 eyes） in our hospital were se- lected as the research objects,including 75 male（ 152 eyes） and 78 female（ 156 eyes）. The first and average tear break-up time ,first break-up area in each eyes of all patients were evaluated using the Oculus Keratograph--comprehensive analysis of ocular sur- face, at the same time the meibomian gland morphology and the lack of number and ar- ea of the gland were observed. These changes along with age and sex were observed through the meiboscore and percent of missing number of the meibomian gland. Re- sults In dry eye patients, there were positive correlations between meiboscore and age（r= 0.715,P〈0.05） ,males（r = 0. 821,P 〈0.05） ,females（r =0. 653,P 〈0.05） ; There were also positive correlations between the percent of missing number of meibo- mian gland and age （ r = 0.520,P 〈 0.05 ）, males （ r = 0.629,P 〈 0.05 ）, females （ r = 0. 531, P 〈 0.05 ）. In the 50 - 59 years old group, meiboscore was significantly higher in men （9.47 ± 1.00） than that in women （7.53 ± 2.21 ） （P 〈 0. 05 ） ; In the ≥ 60 years old group,meiboscore was significantly higher in men（ 10. 69 ± 1.20） than that in women （ 9.87 ± 1.70） （P 〈 0.05 ）. There were negative correlations between age and tear break- up time,which included first tear break-up time（r = -0.49 ,P 〈0.05 ） and average tear break-up time（r = -0.54,P 〈0.05）. Except in the 〈 30 years old group,the average tear break-up time was greater than the firt tear break-up time in other age group （ all P 〈 0.05 ）. The first break-up area was inferonasal quadrant of the cornea in each age group,3 1% in the total ratio. Conclusion The lack of meibomian gland area and the missing of meibomian gland number are gradually increased with the age, and tear break-up time is gradually declined with age. The most frequently area of first tear break-up is in inferonasal quadrant of the cornea.