甲状腺相关眼病患者睑板腺的功能和形态变化

Functional and Morphologic Changes of Meibomian Gland in Patients with Thyroid-associated Ophthalmopathy

目的评估甲状腺相关眼病(TAO)患者睑板腺(MG)功能和形态的变化,并探究其与TAO临床表现之间的相关性。方法采用前瞻性病例对照研究。选取2019年3月至2020年1月就诊于华中科技大学同济医学院附属协和医院眼科的40例(80眼)TAO患者为研究对象,其中活动性TAO 34眼,非活动性TAO 46眼。所有受试者分别进行:①外眼检查,包括眼球突出度、睑裂高度、眼睑闭合不全;②眼表检查,包括眼表疾病指数(OSDI)问卷调查、泪膜脂质层厚度(LLT)、不完全眨眼率(PBR)、非侵入性第1次泪膜破裂时间(NIF-BUT)、非侵入性平均泪膜破裂时间(NIAvg-BUT)、泪膜破裂面积(TBUA)、角膜荧光素染色(CFS)、泪液分泌试验(SⅠT)检测;③睑板腺检查,包括睑缘异常(睑缘血管、MG开口阻塞、睑缘不规则、睑缘增厚)评分、睑脂质量评分、MG表达能力评分及MG缺失率检测。结果TAO组OSDI、PBR、TBUA和CFS均高于对照组(均P<0.05),NIF-BUT低于对照组(P=0.010),其中活动性TAO组CFS评分高于非活动性TAO组(P<0.01),SⅠT评分低于非活动性TAO组(P=0.002)。TAO组睑缘血管扩张、MG开口阻塞、睑脂质量、MG表达能力和MG缺失率评分均高于对照组(均P<0.05),其中活动性TAO组睑缘血管扩张和MG缺失率评分均高于非活动性TAO组(均P<0.01)。Spearman相关性分析结果显示,临床活动性评分(CAS)与CFS(r_(s)=0.475,P<0.01)、睑缘血管扩张评分(r_(s)=0.430,P<0.01)、睑缘增厚评分(r_(s)=0.277,P=0.013)、睑脂质量评分(r_(s)=0.221,P=0.048)以及MG缺失率评分(r_(s)=0.504,P<0.01)均呈正相关,与SⅠT呈负相关(r_(s)=-0.309,P=0.005)。眼睑闭合不全与CFS(r_(s)=0.455,P<0.01)、睑缘血管扩张评分(r_(s)=0.486,P<0.01)、LLT(r_(s)=0.356,P=0.001)以及MG缺失率评分(r_(s)=0.360,P=0.001)呈正相关。结论活动性TAO患者MG功能障碍和形态异常较重。活动性TAO可引起MG周围炎症,导致MG功能障碍,而眼睑闭合不全可引起MG代偿性脂质分泌增加。

Objective To evaluate the changes in function and morphology of meibomian gland(MG)in patients with thyroid-associated ophthalmopathy(TAO)and to explore its association with the clinical manifestations of TAO.Methods Forty TAO patients(80eyes)were recruited in the ophthalmology clinic of the Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from March 2019to January 2020,including 34active TAO eyes and 46inactive TAO eyes.All the subjects underwent external examinations(including proptosis,palpebral fissure height and lagophthalmos examinations),ocular surface examinations[including ocular surface disease index(OSDI)questionnaire,tear film lipid layer thickness(LLT),partial blinking rate(PBR),noninvasive first breakup time(NIF-BUT),noninvasive average breakup time(NIAvg-BUT),tear film breakup area(TBUA),corneal fluorescein staining(CFS),and SchirmerⅠtest(SⅠT)],MG examinations[including evaluation of eyelid margin abnormal score(eyelid vessels,MG obstruction,eyelid irregularity,eyelid thickening),meibum quality score,MG expressibility score,and MG dropout rate].Results OSDI,PBR,TBUA and CFS in TAO group were higher than those in control group(all P<0.05),while NIF-BUT was lower(P=0.010).CFS score in active TAO group was higher than that in inactive TAO group(P<0.01),while SⅠT score was lower(P=0.002).Eyelid margin telangiectasia,MG obstruction,meibum quality,MG expressibility and MG dropout rate scores were higher in TAO group than in control group(all P<0.05).Eyelid margin telangiectasia and MG dropout rate scores were higher in active TAO group than in inactive TAO group(all P<0.01).Spearman correlation analysis result showed that clinical activity score(CAS)was positively associated with CFS(r=0.475,P<0.01),eyelid margin telangiectasia score(r_(s)=0.430,P<0.01),eyelid margin thickening score(r_(s)=0.277,P=0.013),meibum quality score(r_(s)=0.221,P=0.048),MG dropout rate score(r_(s)=0.504,P<0.01),and was negatively associated with SⅠT score(r_(s)=-0.309,P=0.005).The severity of lagophthalmos was positively correlated with CFS(r_(s)=0.455,P<0.01),eyelid margin telangiectasia score(r_(s)=0.486,P<0.01),LLT(r_(s)=0.356,P=0.001)and MG dropout rate score(r_(s)=0.360,P=0.001).Conclusion Patients with active TAO have severer MG dysfunction and morphological abnormalities.Active TAO can cause inflammation around MG,causing MGD.And lagophthalmos can cause compensatory lipid secretion of MG.