不同程度睑板腺萎缩与睑板腺功能障碍干眼患者泪膜脂质层厚度的相关性研究

Exploration of correlation between different degrees of meibomian gland atrophy and tear film lipid layer thickness in patients with meibomian gland dysfunction and dry eyes

目的应用Lipi View眼表面干涉仪分析睑板腺功能障碍(meibomian gland dysfunction,MGD)干眼患者的泪膜脂质层厚度(lipid layer thickness,LLT),并探讨不同程度的睑板腺萎缩与LLT的相关性。方法选取2021年8月至2021年11月于上海市第一人民医院眼科门诊确诊的MGD干眼患者及无MGD有干眼症状患者各10例患者、20只(眼)作为研究对象。应用Lipi View眼表面干涉仪测定泪膜LLT,Keratograph 5M眼表综合分析仪进行非接触首发泪膜破裂时间(noninvasive flrst break-up time,NIKf-BUT)、非接触平均泪膜破裂时间(noninvasive average break-up time,NIKav-BUT)测定、泪河高度测定(tear meniscusheight,TMH),并检测角膜荧光素染色和基础泪液分泌(SchirmerⅠ)试验和眼表疾病评分指数(ocularsurface diseaseindex,OSDI)。根据睑板腺缺失面积评分,将睑板腺萎缩程度分为轻、中、重3个等级。结果MGD患者平均泪膜LLT较对照组薄[(59.12±16.12)nmvs(87.36±8.85)nm],差异有统计学意义(P<0.05);MGD患者NIKf-BUT、NIKavBUT、SchirmerⅠ及TMH均低于对照组(P<0.01);OSDI评分高于对照组(P<0.01)。MGD患者中,轻度睑板腺萎缩5只(眼),平均泪膜LLT为(76.47±8.73)nm;中度睑板腺萎缩8只(眼),平均泪膜LLT为(63.39±6.82)nm;重度睑板腺萎缩7只(眼),平均泪膜LLT为(41.84±9.69)nm,组间比较差异有统计学意义(P=0.001)。MGD患者LLT与睑板腺萎缩面积呈负相关(r=-0.80,P<0.01),然而,LLT与NIKf-BUT、NIKav-BUT、TMH、SchirmerⅠ及OSDI相关性均无统计学差异(P>0.05)。结论LLT可作为早期评估睑板腺功能的重要敏感性生物标志物,Lipi View眼表面干涉仪作为非侵入性、可重复性高的检查方法,可客观、准确测量LLT。LLT与MGD患者睑板腺萎缩程度呈负相关,MGD患者因睑板腺萎缩、分泌的各类睑酯减少,从而导致LLT变薄,使得泪膜稳定性下降及干眼症状进一步加重。

Objective To investigate the lipid layer thickness(LLT)in dry eyes with meibomian gland dysfunction(MGD)examined with LipiView interferometer,and explore the correlation between different degrees of meibomian gland atrophy and LLT.Methods A total of twenty dry eyes with MGD and twenty dry eyes without MGD were included in the outpatient department of ophthalmology,Shanghai First People’s Hospital,from August 2021 to November 2021.LLT was measured with LipiView interferometer.Noninvasive first break-up time(NIKf-BUT),noninvasive average break-up time(NIKav-BUT)and tear meniscus height(TMH)were detected with Keratograph 5M.SchirmerⅠtest and ocular surface disease index(OSDI)were examined.According to the atrophy area score of meibomian gland,the degree of meibomian gland atrophy was divided into mild,moderate and severe.Results LLT was significantly thinner in MGD group than that in normal control group[(59.12±16.12)nm vs(87.36±8.85)nm,P<0.05].Compared with control group,NIKf-BUT,NIKav-BUT,SchirmerⅠtest and TMH in MGD group were reduced and OSDI was significantly increased(P<0.01).In MGD group,5 eyes were mild with LLT(76.47±8.73)nm,and 8 eyes were moderate with LLT(63.39±6.82)nm,and 7 eyes were severe with LLT(41.84±9.69)nm.There was significant difference among the three groups(P=0.001).For the MGD group,LLT showed significantly negative correlation with atrophy area score of meibomian gland(r=-0.80,P<0.01).However,LLT had no correlation with NIKf-BUT,NIKav-BUT,TMH,SchirmerⅠtest,or OSDI(P>0.05).Conclusion LLT can be used as an important sensitive biomarker for early evaluation of meibomian gland function.LipiView interferometer,as a non-invasive and reproducible examination method,can objectively and accurately measure LLT.LLT is negatively correlated with the degree of meibomian gland atrophy in patients with MGD.Due to meibomian gland atrophy and the reduction of various eyelid esters secreted by patients with MGD,LLT becomes thinner,which reduces the stability of tear film and further aggravates the symptoms of dry eye.