3种不同方案治疗蠕形螨相关性睑板腺功能障碍的临床疗效比较

Comparison of efficacy of three different regimens in the treatment of Demodex Folliculorum associated meibomian gland dysfunction

目的比较3种不同方案对蠕形螨相关性睑板腺功能障碍(MGD)的治疗效果。方法选取2020年4月—2020年7月于济南市第二人民医院就诊的睫毛蠕形螨感染阳性的睑板腺功能障碍患者45例(90只眼)随机分为3组:A组15例(30只眼),采用4-松油醇(T4O)治疗;B组15例(30只眼),采用强脉冲光(IPL)治疗;C组15例(30只眼),采用T4O联合IPL治疗。观察并记录3组患者治疗前及治疗结束后蠕形螨数量、眼表疾病指数(OSDI)、泪膜平均脂质层厚度(LLT)、泪膜破裂时间(BUT)、角膜荧光染色(FL)评分、泪液分泌试验(SIT)、睑板腺开口及分泌物性状评分的结果。结果(1)蠕形螨数量及相关因素:治疗后3组蠕形螨数量均较治疗前减少(ZA组=-4.803,ZB组=-4.857,ZC组=-4.805,均P=0.000),C组蠕形螨数量少于A、B组(HA组=16.233,P=0.043;HB组=33.267,P=0.000)。A组蠕形螨数量少于B组(H=-17.033,P=0.031),均有统计学意义。蠕形螨数量与BUT成负相关(r=-0.640,P=0.000),与FL评分成正相关(r=0.943,P=0.000),均有统计学意义;(2)OSDI评分:治疗后,3组OSDI评分均较治疗前改善(t_(A组)=7.393,t_(B组)=5.326,t_(C组)=9.160,均P=0.000),C组OSDI评分优于A、B组(t_(A组)=-2.720,P=0.009;t_(B组)=-2.101,P=0.042),均有统计学意义;(3)LLT、BUT及SIT:治疗后3组LLT均较治疗前改善(t_(A组)=-10.067,t_(B组)=-13.631,t_(C组)=-14.104,均P=0.000);治疗后3组BUT均较治疗前改善(t_(A组)=-6.595,t_(B组)=-9.549,t_(C组)=-18.166,均P=0.000)。而治疗后3组SIT比较均无统计学意义(P>0.05)。两两比较,C组LLT、BUT结果均优于A、B组(LLT:t_(A组)=6.868,P=0.000,t_(B组)=2.534,P=0.013;BUT:t_(A组)=2.004,P=0.048,t_(B组)=4.032,P=0.000);B组LLT较A组更优(t=4.334,P=0.000),A组BUT优于B组(t=2.028,P=0.046);(4)FL、睑板腺开口及分泌物性状评分:治疗结束后3组FL均较治疗前改善(ZA组=-4.745,ZB组=-4.310,ZC组=-4.562,均P=0.000),睑板腺开口均较治疗前改善(ZA组=-4.916,ZB组=-4.774,ZC组=-4.873,均P=0.000),分泌物性状评分均较治疗前改善(ZA组=-4.848,ZB组=-4.796,ZC组=-4.824,均P=0.000),均有统计学意义。两两比较,治疗后C组FL、睑板腺开口及分泌物性状评分均优于A、B两组(FL:HA组=15.983,P=0.032;HB组=31.067,P=0.000;睑板腺开口评分:HA组=25.133,P=0.000;HB组=15.267,P=0.033;分泌物形状评分:HA组=35.717,P=0.000;HB组=18.883,P=0.012);A组FL评分优于B组(H=-15.083,P=0.048),B组睑板腺分泌物性状评分优于A组(H=16.833,P=0.032),均有统计学意义。结论T4O联合IPL能更加有效地杀灭蠕形螨并改善MGD的局部症状。

OBJECTIVE To compare the therapeutic effects of three different regimens on Demodex Folliculorum associated meibomian gland dysfunction(MGD).METHODS A total of 45 patients(90 eyes)with MGD with positive infection of Demodex Folliculorum in eyelashes in Jinan Second People's Hospital from April 2020 to July 2020 were selected.They were randomly divided into three groups:15 cases(30 eyes)in group A,which were treated with 4-terpineol(T4O),15 cases(30 eyes)in group B,which were treated with intense pulsed light(IPL),and 15 cases(30 eyes)in group C,which were treated with T4O combined with IPL.The number of Demodex Folliculorum,ocular surface disease index(OSDI),lipid layer thickness(LLT),tear film break-up time(BUT),corneal fluorescence staining(FL)scores,tear secretion test(SIT),meibomain gland opening and secretion character scores were observed and recorded before and after the first treatment in the three groups.RESULTS(1)Number of Demodex Folliculorum and related factors:After treatment,the number of Demodex Folliculorum in the three groups decreased compared with that before treatment(Z_(A)=-4.803,P=0.000;Z_(B)=-4.857,P=0.000;Z_(C)=-4.805,P=0.000).The number of Demodex Folliculorum in group C was less than that in group A and group B(H_(A)=16.233,P=0.043;H_(B)=33.267,P=0.000).The number of Demodex Folliculorum in group A was less than that in group B(H=-17.033,P=0.031).The differences were all statistically significant.The number of Demodex Folliculorum was negatively correlated with BUT(r=-0.640,P=0.000)and positively correlated with FL scores(r=0.943,P=0.000),and the difference were statistically significant.(2)OSDI scores:After treatment,the OSDI scores of the three groups were improved compared with those before treatment(t_(A)=7.393,t_(B)=5.326,t_(C)=9.160,all P=0.000).The OSDI scores in group C were better than those of group A and group B(t_(A)=-2.720,P=0.009,t_(B)=-2.101,P=0.042).Differences were all statistically significant.(3)LLT,BUT and SIT:After treatment,LLT in the three groups was improved compared with that before treatment(t_(A)=-10.067,t_(B)=-13.631,t_(C)=-14.104,all P=0.000).After treatment,BUT in the three groups was improved compared with that before treatment(t_(A)=-6.595,t_(B)=-9.549,t_(C)=-18.166,all P=0.000).However,there was not significant difference in SIT among the three groups after treatment(P>0.05).For pairwise comparison,the results of LLT and BUT in group C were better than those in group A and B(LLT:t_(A)=6.868,P=0.000,t_(B)=2.534,P=0.013;BUT:t_(A)=2.004,P=0.048,t_(B)=4.032,P=0.000).LLT of group B was better than that of group A(t=4.334,P=0.000).BUT of group A was better than that of group B(t=2.028,P=0.046).(4)FL,meibomain gland opening and secretion character scores:After treatment,FL scores in the three groups were improved compared with those before treatment(Z_(A)=-4.745,Z_(B)=-4.310,Z_(C)=-4.562,all P=0.000).Meibomian gland opening scores were improved compared with those before treatment(Z_(A)=-4.916,Z_(B)=-4.774,Z_(C)=-4.873,all P=0.000).Secretion character scores were improved compared with those before treatment(Z_(A)=-4.848,Z_(B)=-4.796,Z_(C)=-4.824,all P=0.000).Differences were all statistically significant.For pairwise comparison,FL scores,meibomian gland opening scores and secretion character scores in group C were better than those in group A and group B after treatment(FL:HA=15.983,P=0.032;HB=31.067,P=0.000;Meibomian gland opening scores:HA=25.133,P=0.000;HB=15.267,P=0.033;Secretion shape scores:HA=35.717,P=0.000;HB=18.883,P=0.012);FL scores of group A were better than those of group B(H=-15.083,P=0.048),and meibomian gland secretion scores of group B were better than those of group A(H=16.833,P=0.032).CONCLUSIONS T4O combined with IPL can more effectively kill Demodex Folliculorum and improve the local symptoms of MGD.