睑板腺功能障碍患者眼表特征性变化及其与吸烟行为关系的临床研究

Clinical study of ocular surface changes in patients with meibomian gland dysfunction and its relationship with smoking behavior

目的探讨睑板腺功能障碍(MGD)患者眼表特征性变化与其吸烟行为的关系。方法横断面研究。收集2016年3月至11月由首都医科大学附属北京同仁医院、北京市眼科研究所组织陕西省西安市第一医院、中国医学科学院北京协和医院及暨南大学附属第一医院等23家多中心医疗单位眼科门诊连续观察的MGD患者923例和健康志愿者114例,分别命名为MGD组和对照组。其中,MGD组男性330例,女性593例;年龄18~88岁,平均年龄(42. 54±13. 62)岁。对照组男性23例,女性91例;年龄18~88岁,平均年龄(41. 96±17. 11)岁。所有对象均检查右眼眼表疾病指数(OSDI)填写吸烟评估量表,检测泪膜破裂时间(TBUT)、角结膜荧光素染色、SchirmerⅠ检查、睑板腺缺失率、泪膜脂质层厚度及睑板腺分泌物。其中,MGD组与对照组、吸烟组与非吸烟组患者眼表测量值的比较采用独立样本t检验;不同年龄MGD患者眼表指标的比较采用单因素方差分析;吸烟率构成比的比较采用卡方检验。结果 MGD组患者OSDI评分(33. 07±16. 50)高于对照组(20. 12±14. 04),具有统计学意义(t=9. 104,P <0. 05);TBUT值为(4. 31±2. 51) s低于对照组的(6. 06±3. 91) s,差异有统计学意义(t=-4. 654,P <0. 05);MGD组患者角结膜染色评分(0. 69±1. 18)高于对照组的(0. 50±1. 06),差异有统计学意义(t=1. 787,P <0. 05);MGD组患者SchirmerⅠ值(10. 10±7. 95) mm与对照组的(9. 63±8. 53)mm比较,无统计学意义(t=-0. 552,P> 0. 05);MGD组患者睑板腺缺失率(14. 35±12. 18)与对照组的(12. 31±11. 93)比较,差异无统计学意义(t=1. 697,P> 0. 05);MGD组患者睑缘异常评分(4. 47±3. 76)高于对照组的(5. 57±3. 66),差异有统计学意义(t=-2. 943,P <0. 05);MGD组患者睑板腺显像评分(1. 39±1. 95)及睑脂评分(9. 34±7. 56)均高于对照组的(5. 57±3. 66)及(13. 34±9. 35),差异有统计学意义(t=-4. 765,-4. 403;P <0. 05);MGD组患者脂质层厚度(62. 32±24. 88)与对照组的(64. 98±21. 19)比较,差异无统计学意义(t=-1. 094,P> 0. 05),MGD组患者不完全眨眼率(0. 56±0. 35)与对照组的(0. 66±0. 65)比较,差异无统计学意义(t=-1. 570,P> 0. 05)。18~29岁、30~39岁、40~49岁、50~59岁及60岁以上MGD患者OSDI检查结果随年龄增加而加重。OSDI、TBUT、SchirmerⅠ值及睑板腺缺失率的比较,差异均有统计学意义(F=2. 194,3. 866,15. 904,9. 030;P <0. 05)。MGD患者吸烟率为10. 40%,高于对照组的5. 26%,差异有统计学意义(χ2=4. 176,P <0. 05);MGD患者吸烟指数为(159. 36±26. 83)高于对照组的(73. 15±12. 16),差异有统计学意义(t=3. 906,P <0. 05)。MGD组内,男性吸烟率为91. 8%,高于女性的8. 2%,差异有统计学意义(χ^2=110. 04,P <0. 05)。吸烟患者的SchirmerⅠ值为(10. 22±8. 13)高于对照组的(8. 00±6. 10),差异有统计学意义(t=2. 99,P <0. 05);吸烟患者平均脂质层厚度为(63. 30±24. 86)高于对照组的(54. 22±17. 74),差异有统计学意义(t=3. 16,P <0. 05);吸烟患者睑缘异常评分为(4. 49±3. 66)低于对照组的(5. 86±4. 70),差异有统计学意义(t=-2. 51,P <0. 05);吸烟患者睑脂评分为(9. 61±7. 76)低于对照组的(11. 85±8. 91),差异有统计学意义(t=-2. 15,P <0. 05)。结论 MGD患者OSDI和角结膜染色评分提高,TBUT、睑缘异常、睑板腺显像及睑脂评分降低;而OSDI、TBUT、SchirmerⅠ值及睑板腺缺失率,患者眼表症状随其年龄增加而加重;MGD患者中吸烟率和吸烟指数高,且吸烟组中患者角结膜染色增高、睑缘异常评分增高、睑板腺显象评分增高,而脂质层厚度减小,吸烟行为是睑板腺功能障碍的危险因素。

Objective The aim of this study was to investigate the relationship between ocular surface characteristic changes and smoking behavior of patients with MGD.Methods Cross-sectional study.From March to November 2016,23 multi-center medical institutions including Beijing Tongren Hospital affiliated to Capital Medical University,First Eye Hospital of Shaanxi Province,Peking Union Medical College Hospital of Chinese Academy of Medical Sciences,and First Hospital Affiliated to Jinan University.923 cases of MGD patients and114 cases of healthy volunteers were included.Among of them,they were divided into the MGD group and the control group.In MGD group,there were 330 males and 591 females.The age range was from 18 to 88;average age was(42.54±13.62).In the control group,there were 23 males and 91 females;average age(41.96±17.11).All subjects checked Ocular surface disease index(OSDI),Fill smoking evaluation amount table,Tear film rupture time(TBUT),corneal and conjunctival fluorescein staining,Schirmer I,meibomian gland loss rate,tear film lipid layer thickness and Meibomian gland secretions of the right eye.The comparison of the ocular surface measurements of patients in the MGD group with the control group,the smoking group and the non-smoker group was performed using the independent sample t test;The comparison of the ocular surface indicators of patients with different ages of the MGD group was analyzed by one-way analysis of variance.The comparison of the smoking rate composition ratio was performed using the chi-square test.Results The OSDI score of patients in the MGD group(33.07±16.50)was higher than that in the control group(20.12±14.04),which was statistically significant(t=9.104,P<0.05);the TBUT values(4.31±2.51)was lower than that of the control group(6.06±3.91),and the difference was statistically significant(t=4.654,P<0.05).The corneal and conjunctival staining score of patients in the MGD group(0.69±1.18)was higher than that in the control group(0.50±1.06),and the difference was statistically significant(t=1.787,P<0.05).The Schirmer I value(10.10±7.95)mm of the patients in the MGD group was not statistically significant compared with the control group(9.63±8.53)mm(t=-0.552,P>0.05);The rate of meibomian gland loss in patients with MGD(14.35±12.18)was similar to that in the control group.(12.31±11.93)There was no significant difference in comparison(t=1.969,P>0.05);the score of abnormal eyelid margin of the patients in the MGD group(4.47±3.76)was higher than that in the control group(5.57±3.66);the difference was statistically significant(t=-2.943,P<0.05).The scores of meibomian gland imaging(1.39±1.95)and Meibum score(9.34±7.56)of the patients in the MGD group were higher than those of the control group(5.57±3.66)and(13.34±9.35);the difference was statistically significant(t=-4.765,-4.403;P<0.05).The thickness of the lipid layer in the MGD group(62.32±24.88)and the control group(64.98±21.19);the difference was not statistically significant(t=-1.094,P>0.05).The incomplete blink rate of patients in the MGD group(0.556±0.35)and The comparison of the control group(0.66±0.65)was not statistically significant(t=-1.570,P>0.05).The OSDI results of patients with MGD who are 18 to 29 years old,30 to 39 years old,40 to 49 years old,50 to 59 years old,and 60 years old or older increase with age.The comparisons between the values of OSDI,TBUT,Schirmer I and the rate of meibomian gland loss were statistically significant(F=2.194,3.866,15.904,9.030;P<0.05).The smoking rate of MGD patients was 10.40%,higher than that of the control group(5.26%);the difference was statistically significant(χ^2=4.176,P<0.05).The smoking index of MGD patients(159.36±26.83)was higher than that of the control group(73.15±12.16);the difference was statistically significant(t=3.906,P<0.05).In the MGD group,the male smoking rate(91.8%)was higher than that of female(8.2%);the difference has statistical significance(χ2=110.04,P<0.05).The value of SchirmerⅠof smoking patients(10.22±8.13)was higher than that of the control group(8.00±6.10),and the difference was statistically significant(t=2.99,P<0.05).The average lipid layer thickness of the smoking patients(63.30±24.86)was higher than that of the control group(54.22±17.77),and the difference was statistically significant(t=3.16,P<0.05).Tthe abnormal score of the eyelid margin of smoking patients(4.49±3.66)was lower than that of the control group(5.86±4.70),and the difference was statistically significant(t=-2.51,P<0.05).The smoker’s eyelid fat score(9.61±7.76)was lower than that of the control group(11.85±8.91),and the difference was statistically significant(t=-2.15,P<0.05).Conclusions OSDI and corneal and conjunctival staining scores were increased in patients with MGD;and TBUT,blepharoplasty,meibomian gland imaging,and blephalipid scores were reduced;while OSDI,TBUT,SchirmerⅠ,and meibomian gland loss rates,ocular surface symptoms of patients with increasing age aggravate;The smoking rate and smoking index were high in patients with Mg D,the corneal and conjunctival staining,the eyelid margin abnormality score and the meibomian gland imaging score increased in the smoking group,and the lipid layer thickness decreased.Smoking behavior was meibomian gland dysfunction risk factors.