非侵入式眼表综合分析仪在干眼诊断中的应用

The application of non invasive ocular surface analyzer in the diagnosis of dry eye disease

目的探讨应用非侵入式眼表综合分析仪对干眼症的临床诊断价值。方法临床病例回顾性研究。选择2015年4-8月就诊于开封眼病医院的46例（46只眼）可疑干眼患者，应用非侵入式眼表综合分析仪测量首次泪膜破裂时间（rift noninvasive tear film break-up time, NITBUTf）、平均泪膜破裂时间（average noninvasive tear film break-up time, NITBUTav）、泪河高度（tear meniscus height，TMH）、睑板腺缺失评分、脂质层分析评分。再运用传统方法做泪液分泌实验Ⅰ（schirmer Ⅰ test，SIT）和泪膜破裂时间（tear film break-up time, BUT）检查。应用配对t检验及Pearson相关分析干眼相关指标与非侵入式眼表综合分析仪检测结果间的关系，用McNemar检验分析2种方法对泪膜异常检出率的差异。结果BUT与NITBUTf、NITBUTav的比较差异无统计学意义（r=0．764、P=0．000，r=0．906、P=0．000），sIt与NITBUTav呈正相关（r=0．439、P=0．000），TMH与sIt、BUT均呈正相关（r=0．652、P=0．000，r=0．587、P=0．000）。睑板腺缺失评分与BUT呈负相关（r=-0．633、P=0．000），与SITSN关性分析无统计学意义（r=0．165、P=0．143）。脂质层分析评分与BUT呈负相关（r=-0．541、P=0．000），与sIt相关性分析无统计学意义（r=0．225、P=0．067）。46例受检者应用非侵入式眼表综合分析仪发现泪膜异常者42例，正常4例，检出率为91．30％（42／46），用传统方法发现泪膜异常者36例，正常10例，检出率为78．26％（36／46），2种方法对干眼检出率的差异有统计学意义（P=0．031）。结论非侵入式眼表综合分析仪能同时对泪膜的不同层次进行间接、可靠的分析，明显提高干眼的诊断检出率，具有一定的临床应用价值。

Objective To investigate and evaluate clinical application of non invasive ocular sur- face analyzer in the diagnosis of dry eye disease. Methods The NITBUTf, NITBUTav, TMH, Meibo- mian gland loss score and Lipid layer analysis score of 46 eyes of 46 patients with suspected dry eyes were measured by non invasive ocular surface analyzer in Kaifeng eye hospital from April 2015 to August 2015. Then sit and BUT were examined by using traditional methods. The correla- tion between Keratograph analyzer-related examinations and conventional dry eye-related examinations were assessed by using Pearson correlation analysis and MeNemar test was used to analyze the dif- ferences between the 2 methods of detection rate of abnormal tear film. Results There was no sig- nificant difference between BUT and NITBUTf and NITBUTav, but they were all positive （r =0.764, P =0.000; r =0.906, P =0.000）, Sit was positively correlated with NITBUTav （r =0.439, P =0.000）, TMH was positively correlated with sit and BUT （r =0.652, P =0.000; r =0.587, P =0.000）. Meibo- mian gland loss score and Lipid layer analysis score were negatively correlated with BUT （r =-0.633, P =0.000; r =-0.541, P =0.000）, had no correlation with sit （r =0.165, P =0.143; r = 0.225, P =0.067）. Forty-two cases of abnormal tear were found by the non invasive ocular surfaceanalyzer, normal in 4 cases, the detection rate was 91.30% （42/46）, 36 cases of abnormal tear were found by the traditional method, normal in 10 cases, the detection rate was 78.26% （36/46）, the dif- ference of dry eye detection rate was statistically significant between the 2 methods （P =0.031）. Conclusions Noninvasive ocular surface analyzer can reliably and indirectly analyze the different lev- els of the tear film at the same time, obviously improve the diagnostic rate of dry eye, and has cer- tain clinical application value.