眼睑刷上皮病变与干眼检查指标相关性分析

Clinical analysis of the correlation between lid-wiper epitheliopathy and dry eye examination

目的观察并分析眼睑刷上皮病变(lid-wiper epitheliopathy,LWE)患者的干眼相关检查结果与LWE严重程度的相关性强度,初步探讨LWE的发病原因。方法对2015年1月至2017年9月于北京积水潭医院眼科就诊的有干眼症状的LWE患者共200例(200眼)行眼睑刷部位染色、角结膜染色、OCULUS keratograph 5M眼表综合分析仪检查和结膜印迹细胞学检查。分析各项指标与LWE评分之间的相关性。结果 200例(200眼)LWE患者中轻度者33例(33眼),中度者128例(128眼),重度者39例(39眼),LWE染色评分为(1.58±0.49)分。LWE染色评分与泪河高度、脂质层厚度、睑板腺缺失程度之间存在较弱相关性(|r|≤0.4,P<0.05);与患者年龄、首次泪膜破裂时间之间存在中度相关氉性(0.4<|r|≤0.6,P<0.05),与平均泪膜破裂时间、角结膜染色评分、结膜印迹细胞学分级存在强相关性(0.6<|r|≤0.8,P<0.05)。LWE患者中有53例53眼出现瞬目异常情况,占总人数的26.5%。结论 LWE的病因与眼睑刷区域和眼表的摩擦异常有关,其中泪膜稳定性下降、黏蛋白异常、角结膜表面不光滑是主要影响因素。

Objective To explore the etiology of lid-wiper epitheliopathy （LWE） by observing and analyzing the correlation between the dry eye examination results and the degree of severity of LWE.Methods Totally 200 patients （200 eyes） with LWE were selected from ophthalmology department of Beijing Ji Shui Tan Hospital from January 2015 to September 2017.The lid-wiper staining,keratoconjunctival staining,OCULUS keratograph 5M examination and conjunctival impression cytology were performed.The correlation between each index and LWE scores was analyzed.Results There were 33 patients （33 eyes） of mild lesions,128 patients （128 eyes） of moderate lesions,39 patients （39 eyes） of severe lesions,and the average staining score was （1.58±0.49）points.There was a weakly significant correlation between LWE scores and tear meniscus height,lipid layer thickness,and absence of meibomian glands （｜r｜≤0.4,P〈0.05）;there was a moderate degree of significant correlation between LWE scores and age,first NIKBUT（0.4〈｜r｜≤0.6,P〈0.05）,and there was extremely significant correlation between LWE scores and average NIKBUT,keratoconjunctival staining scores and conjunctival impression cytology grading（0.6〈｜r｜≤0.8,P〈0.05）.There were 53 eyes （26.5%） patients with blink abnormalities.Conclusion The cause of LWE is related to the abnormal friction between the lid-wiper area and the ocular surface.The decrease of the tear film stability,the abnormality of mucin,and the non-smooth surface of the keratoconjunctiva are the main factors.