阻塞型睑板腺功能障碍患者睑板腺的形态学观察

Morphological evalution of obstructive meibomian gland dysfunction by noninvasive Keratograph

背景阻塞型睑板腺功能障碍（OMGD）是睑板腺功能障碍的常见类型，目前认为OMGD是由于睑板腺导管的阻塞和/或睑脂分泌异常导致，因此睑板腺形态学的改变具有重要的临床意义。目的运用Keratograph 5M眼表综合分析仪观察OMGD患者睑板腺的形态学改变并对其进行分析。方法采用前瞻性病例观察研究方法。纳入2015年1—6月在天津医科大学眼科医院确诊的OMGD患者60例60眼，同时选择60名健康体检者作为正常对照组。分别对2个组受检者进行眼表疾病指数（OSDI）问卷调查、泪膜破裂时间（BUT）、Keratograph 5M眼表综合分析仪观察睑板腺缺失情况、睑板腺开口评分及睑脂评分。根据OSDI评分分为轻度OMGD组（12.0〈OSDI≤22.0）23例、中度OMGD组（22.0〈OSDI≤32.0）21例和重度OMGD组（32.0〈OSDI≤100.0）16例。分别对3个组患者的睑板腺状况进行评估与分析。结果OMGD组OSDI评分、睑板腺缺失评分及睑脂评分均高于正常对照组，与正常对照组比较，差异均有统计学意义（Z＝－9.425、－7.781、－8.954，均P〈0.05）。OMGD组和正常对照组BUT分别为（6.10±1.91）s和（10.67±2.11）s，睑板腺开口评分分别为1.35±0.90和0.88±0.64，差异均有统计学意义（t＝－12.418、3.276，均P〈0.05）。轻度OMGD组、中度OMGD组和重度OMGD组间OSDI、睑板腺缺失评分及睑脂评分比较，差异均有统计学意义（H＝52.121、37.180、13.642，均P〈0.05），BUT、睑板腺开口评分差异均有统计学意义（F＝58.191、8.474，均P〈0.05）。OSDI与睑板腺缺失评分、睑脂评分及睑板腺开口评分之间均呈正相关（r＝0.708，P＝0.000；r＝0.759，P＝0.000；r＝0.270，P＝0.003）。BUT与睑板腺缺失评分、睑脂评分及睑板腺开口评分之间呈负相关（r＝－0.692，P＝0.000；r＝－0.691，P＝0.000；r＝－0.192，P＝0.036）。结论Keratograph 5M眼表综合分析仪可以快速、精确地对睑板腺进行形态学观察。OMGD患者在眼表及睑板腺等方面与正常人存在差异。

Background Obstructive meibomian gland dysfunction （OMGD） is due to the meibomian gland duct obstruction and/or meibum abnormal secretion.Meibomian gland morphological change is important to clinical observation.Objective This study aimed to image the meibomian gland structures and the morphological changes in eyes with OMGD using a non-contact infrared meibography system （Keratograph 5M）.Methods A case-control study was performed in Tianjin Medical University Eye Hospital from January to June in 2015.Sixty OMGD patients and 60 age-matched healthy controls were recruited.Ocular Surface Disease Index （OSDI） questionnaire was employed for the assess of ocular surface symptoms, and slit-lamp examination was performed for the observation of lid margin and meibomian gland orifices.Meibomian gland secretion scores and Keratograph 5M examination the morphological changes of the meibomian glands.According to OSDI questionnaire, the patients of OMGD were classified into mild group （12.0〈OSDI≤22.0）（23 eyes）, moderate group （22.0〈OSDI≤32.0）（21 eyes） and severe group （32.0〈OSDI≤100.0）（16 eyes）. Partial or complete loss of the meibomian glands （meibomian dropout） was scored from grade 0 （no loss） through out grade 3 （lost area was 〉2/3 of the total meibomian gland area）. Written informed consent was obtained from all subjects before the examination.ResultsThe OSDI, meibomian gland orifices, meibomian gland secretion scores and meibomian gland dropout scores were significantly higher, and BUT was dramatically shorter in the OMGD group than those in the normal group, showing significant differences between the two groups （Z=-9.425, -8.954, -7.781, all at P〈0.05）. The BUT was （6.10±1.91）s and （10.67±2.11）s, and meibomian gland dropout scores were 1.35±0.90 and 0.88±0.64 in the OMGD group and normal control group, showing significant differences between the two groups （t=3.276, -12.418, both at P〈0.05）. OSDI, meibomian gland secretion scores and meibomian gland dropout scores were significantly in three intergroups （H=52.121, 13.642, 37.180, all at P〈0.05）. BUT, meibomian gland orifices were significantly different among the mild, moderate and severe OMGD （F=58.191, 8.474, both at P〈0.05）. OSDI showed a significantly high positive correlation with meibomian gland orifices, meibomian gland secretion scores and meibomian gland dropout scores （r=0.708, P=0.000; r=0.759, P=0.000; r=0.270, P=0.003）. BUT showed negative correlation with meibomian parameters （r=-0.692, P=0.000; r=-0.691, P=0.000; r=-0.192, P=0.036）.Conclusions Keratograph 5M provides an effective noninvasive method in assessing the image of the meibomian gland structures and meibomian gland dropout.There are differences in the ocular surface and meibomian glands between the OMGD patients and normal persons.