活体共聚焦显微镜对甲状腺相关眼病患者睑板腺微观结构的观察研究

Observation on the Microstructure of Meibomian Gland in Patients with Thyroid-associated Ophthalmopathy by In Vivo Confocal Microscopy

目的运用活体共聚焦显微镜(IVCM)评估甲状腺相关眼病(TAO)患者睑板腺(MG)微观结构的变化,并探讨其与患者临床指标之间的相关性。方法本研究为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门诊的40例(80眼)TAO患者为TAO组,并以31例(62眼)非TAO患者为对照组。所有受试者分别进行眼表疾病指数(OSDI)问卷调查、泪膜破裂时间(BUT)测定、角膜荧光素染色(CFS)、泪液分泌试验(SⅠT)、MG缺失率检测、睑脂质量评分、MG表达能力评分及IVCM检查。下眼睑睑板腺IVCM观察指标包括MG开口面积(MOA)、MG腺泡密度(MAD)、MG腺泡最长径(MALD)、MG腺泡最短径(MASD)、MG腺泡不规则程度(MAI)、睑脂反射率(MSR)、腺泡壁不均匀程度(AWI)、腺泡间隙不均匀程度(API)及MG纤维化程度(MF)。结果TAO组与对照组所有IVCM指标的差异均有统计学意义(均P<0.05)。TAO组中位数MOA(1707.00μm^(2))和MAD(78.50个/mm^(2))均低于对照组(中位数分别为3915.50μm^(2)和110.50个/mm^(2))(均P<0.01)。TAO组中位数MALD(115.49μm)和MASD(43.16μm)均高于对照组(中位数分别为55.71μm和26.53μm)(均P<0.01)。TAO组MAI、MSR、AWI、API和MF均高于对照组(均P<0.05)。AWI和API分别与临床活动性评分(CAS)呈正相关(r=0.640,P<0.01;r=0.683,P<0.01),MF与CAS呈负相关(r=-0.228,P=0.042)。结论IVCM可有效显示TAO患者MG微观结构的变化,并为阻塞和炎症在眼表病变过程中的作用提供了强有力的体内证据,有助于进一步理解TAO发生干眼的机制。

Objective To assess changes in the microstructure of meibomian gland(MG)in patients with thyroid-associate ophthalmopathy(TAO)by in vivo confocal microscopy(IVCM)and to explore their correlation with clinical indicators.Methods A prospective case-control study design was adopted.Forty TAO patients(80 eyes)and 31 controls(62 eyes)were selected in the ophthalmology clinic of Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from March 2019 to January 2020.Ocular surface disease index(OSDI)questionnaire,tear film breakup time(BUT),corneal fluorescein staining(CFS),SchirmerⅠtest(SⅠT),MG dropout rate,meibum quality score,MG expression score,and IVCM examination were tested in all study subjects.The IVCM indicators of MG in the lower eyelid included the MG orifice area(MOA),the MG acinar density(MAD),the MG longest diameter(MALD),the MG shortest diameter(MASD),the MG acinar irregularity(MAI),the meibum secretion reflectivity(MSR),the acinar wall inhomogeneity(AWI),the acinar periglandular interstices inhomogeneity(API),and the severity of MG fibrosis(MF).Results The difference in all IVCM indicators between TAO group and control group was statistically significant(all P<0.05).The median MOA(1707.00μm^(2))and MAD(78.50/mm^(2))in the TAO group were lower than the control group(3915.50μm^(2)and 110.50/mm^(2),respectively)(all P<0.01).The median MALD(115.49μm)and median MASD(43.16μm)in TAO group were higher than that in control group(55.71μm and 26.53μm,respectively)(all P<0.01).The MAI,MSR,AWI,API and MF in TAO group were higher than that in control group(all P<0.05).The AWI and API were positively correlated with CAS(r=0.640,P<0.01;r=0.683,P<0.01),and the MF was negatively correlated with CAS(r=-0.228,P=0.042).Conclusion IVCM can effectively display the changes of MG microstructure in TAO patients.It can also provide strong in vivo evidence for the role of obstruction and inflammation in the development of ocular lesions,which is helpful for further understanding of the mechanism of dry eye in TAO.