睫毛蠕形螨感染与睑板腺功能障碍的关系

Relationship between ocular eyelid Demodex infection and meibomian gland dysfunction

目的探讨睫毛蠕形螨感染与睑板腺功能障碍(meibomian gland dysfunction,MGD)发生的相关性,并分析睫毛蠕形螨感染对MGD患者眼表症状跟体征的影响。方法前瞻性队列研究。选取2018年7月-2019年3月在广州市第一人民医院眼科门诊诊断为MGD患者47例,按照年龄将MGD患者分别纳入MGD <40岁组(A1组,28例)和MGD>60岁组(B1组,19例)。根据蠕形螨检测结果将MGD患者分别纳入蠕形螨检出阳性组(Ⅰ组,22例)与蠕形螨检出阴性组(Ⅱ组,25例)。同时,选取无MGD正常人或仅患屈光不正、玻璃体混浊的患者共49例,按照年龄将其分别纳入NMGD <40岁组(A2组,30例)和NMGD> 60岁组(B2组,19例)。主要统计受试者眼部症状(眼痒、眼痛、眼干、异物感、视物模糊)发生率、睫毛蠕形螨检出数量及检出率、睑板腺排出能力评分、睑板腺分泌物性状评分及眼表疾病指数(Ocular Surface Disease Index,OSDI)。结果MGD <40岁组(A1组)与NMGD <40岁组(A2组)睫毛蠕形螨检出数量分别为(1. 14±1. 938)、(0. 17±0. 531)只,差异有统计学意义(P=0. 003,<0. 05),睫毛蠕形螨检出阳性率分别为43%、10%,差异有统计学意义(P=0. 006,<0. 05);MGD> 60岁组(B1组)与NMGD> 60岁组(B2组)睫毛蠕形螨检出数量分别为(1. 89±2. 331)、(0. 68±1. 529)只,差异没有统计学意义(P> 0. 05),睫毛蠕形螨检出阳性率分别为53%、21%,差异没有统计学意义(P> 0. 05);MGD患者睫毛蠕形螨检出阳性组(Ⅰ组)与MGD患者睫毛蠕形螨检出阴性组(Ⅱ组)睑板腺分泌物性状评分分别为(3. 00±1. 11)、(2. 28±1. 28),差异有统计学意义(P=0. 047,<0. 05);Ⅰ组OSDI、睑板腺排出能力评分、眼干、眼痛、眼痒、异物感以及视物模糊发生率与Ⅱ组相比,差异均不具有统计学意义(P> 0. 05);MGD组文化水平与NMGD组相比,差异没有统计学意义(P=0. 382,>0. 05)。结论首先,在40岁以下人群中,睫毛蠕形螨与MGD形成有一定相关性;而在60岁以上人群中,相较于其他影响因素,睫毛蠕形螨对MGD形成的作用并不显著,表明睫毛蠕形螨对MGD形成的影响主要体现在中青年时期,且随着年龄增长,二者之间的关联性进一步降低。另外,睫毛蠕形螨感染与MGD患者发生眼痛、眼干、眼痒、异物感以及视物模糊这些眼部症状和睑板腺分泌功能受损没有相关性。

Objective To investigate the correlation between eyelash Demodex infection and meibomian gland dysfunction( MGD) and to analyze the effect of eyelash Demodex infection on ocular surface symptoms and signs in patients with MGD. Methods Prospective cohort study. 47 patients with MGD diagnosed in the ophthalmology clinic of Guangzhou First People’s Hospital from July 2018 to March 2019 were selected. The MGD patients were assigned to the MGD < 40 years old group( A1 group,n = 28) and MGD > 60 years old Group( B1 group,n = 19) according to the age. According to the Demodex test results,MGD patients were assigned to the Demodex-positive group( I group,n = 22) and the Demodex-negative group( II group,n = 25). At the same time,49 patients without MGD or only with ametropia and vitreous opacity were selected and assigned to the NMGD < 40 years old group( A2 group,n = 30) and NMGD > 60 years old group( B2 group,n = 19) according to their age. The incidence of ocular symptoms( itchiness,pain,dryness,foreign body perception,and blurred vision),the number and rate of detection of eyelash Demodex,meibomian gland ejection score,meibomian gland secretion score,and Ocular Surface Disease Index( OSDI) were analyzed. Results The number of eyelash Demodex was( 1. 14 ±1. 938) in MGD <40 years old group( A1 group) and( 0. 17 ± 0. 531) in NMGD < 40 years old group( A2 group).The difference in the number of eyelash Demodex between these two groups was found to be statistically significant( P =0. 003, < 0. 05). The positive rate of eyelash Demodex was 43 % in MGD < 40 years old group( A1 group) and 10% in NMGD < 40 years old group( A2 group). The difference in the positive rate of eyelash Demodex between these two groups was found to be statistically significant( P = 0. 006, < 0. 05). The number of eyelash Demodex in MGD > 60 years old group( B1 group) was( 1. 89 ± 2. 331) and in NMGD > 60 years old group( B2 group) was( 0. 68 ± 1. 529). The difference in the number of eyelash Demodex between these two groups was not statistically significant( P > 0. 05). The positive rate of eyelash Demodex was 53 % in MGD > 60 years old group( A1 group) and 21% in NMGD > 60 years old group( A2 group). The difference in the positive rate of eyelash Demodex between these two groups was not statistically significant( P > 0. 05). The score of the meibomian gland secretion in the MGD with eyelash Demodex group( I Group) was( 3. 00 ± 1. 11) and in the MGD without eyelash Demodex group( II group) was( 2. 28 ± 1. 28). The difference in the score of the meibomian gland secretion between these two groups was found to be statistically significant( P = 0. 047 < 0. 05). The differences of the OSDI score,the meibomian gland discharge ability score,the incidence rate of dry eye,eye pain,eye itching,foreign body sensation and blurred vision between these two groups were not statistically significant( P > 0. 05). The difference in the culture level between the MGD group and the NMGD group was not statistically significant( P = 0. 382, > 0. 05). Conclusion First,in the population under 40 years old,eyelash Demodex is correlated with MGD. Then in the population over 60 years old,the effect of eyelash Demodex on the formation of MGD compared with other influencing factors is not significant. The results indicated that the effect of eyelash Demodex was mainly reflected in the middle and young age,and the correlation between them was further reduced with the increase of age. In addition,in MGD patients,eyelash Demodex infection was not significantly correlated with the incidence of eye pain,eye dryness,eye itching,foreign body sensation,and blurred vision,as well as the degree of impairment of meibomian gland secretion function.