蠕形螨感染和睑板腺功能障碍与复发性角膜糜烂的关系

Association between recurrent corneal erosion syndrome and Demodexinfestation or meibomian gland dysfunction

目的观察蠕形螨感染及睑板腺功能障碍对复发性角膜上皮糜烂(RCES)发病的影响。方法病例对照研究设计。纳入武汉爱尔眼科汉阳医院2018年1—6月复发2次及以上的RCES患者30例30眼作为RCES组。收集同一时间段内性别、年龄相匹配且无其他眼表疾病屈光不正患者31例31眼作为对照组。2个组均行睫毛采样及蠕形螨计数、眼表综合分析仪进行睑板腺红外拍照及裂隙灯显微镜睑脂评分。比较2个组睑板腺评分、睑脂评分及蠕形螨检出率,并将各种数据与患者复发次数行相关分析。结果RCES组和对照组睑板腺缺失评分分别为4(3,4)和2(1,3),睑脂评分分别为15.5(11.0,16.8)和8.0(5.5,10.0),差异均有统计学意义(Z=-4.55、-3.97,均P<0.01),RCES组蠕形螨检出数量为8(4,9),明显高于对照组的0(0,2),差异有统计学意义(Z=-4.13,P<0.00)。RCES组患者蠕形螨检出率为83.3%(25/30),明显高于对照组的38.7%(12/31),差异有统计学意义(χ2=7.60,P<0.01)。RCES组患者角膜上皮糜烂复发次数与睑板腺缺失评分、睑脂评分及蠕形螨检出数量均呈正相关(rs=0.70,P<0.01;rs=0.47,P=0.04;rs=0.73,P<0.01)。结论RCES患者的睑缘蠕形螨感染阳性率和睑板腺功能障碍程度均明显升高,睑缘蠕形螨感染和睑板腺功能障碍与疾病复发次数存在一定联系。

Objective To investigate the effect of Demodex palpebralis infestation and meibomian gland dysfunction(MGD)on the incidence of recurrent corneal erosion syndrome(RCES).Methods A case-control study was performed.Thirty eyes of 30 RCES patients were enrolled from January to June 2018 in Hanyang Hospital of Wuhan Aier Eye Hospital,and served as the RCES group.Thirty-one eyes of 31 simple ametropia patients with matched age and gender were enrolled at the same time and served as the control group.Eyelash microscopic examination was performed for Demodex counting,slit-lamp examination was performed to observe the condition of meibomian gland.Keratograph 5M examination was performed to detect the morphological changes in the meibomian glands.This study was approved by the Ethics Committee of Wuhan Aier Eye Hospital.All subjects were aware of the method and purpose of this study.Results The average meibomian glands score was 4(3,4)in the RCES group,which was significantly higher than 2(1,3)in the control group(Z=-4.55,P=0.00).The average meibomian gland secretion score was 15.5(11.0,16.8)in the RCES group,which was significantly higher than 8.0(5.5,10.0)in the control group(Z=-3.97,P=0.00).The average Demodex numbers was 8(4,9)and 0(0,2)in the RCES and control groups,respectively,with a significant difference between them(Z=-4.13,P<0.00).The average Demodex infection rate was 83.3%(25/30)and 38.7%(12/31)in the RCES and the control groups,respectively(χ2=7.60,P<0.01).The recurrence frequency showed a positive correlation with the meibomian glands scores(rs=0.70,P<0.01),meibomian gland secretion scores(rs=0.47,P=0.04)and Demodex numbers(rs=0.73,P<0.01).Conclusions The infection rate of Demodex palpebralis and the degree of MGD are obviously elevated in RCES patients,and are associated with the relapse frequency of RCES.