中国干眼诊断标准诊断干眼与亚洲干眼诊断标准的符合率

Concordance between Chinese dry eye diagnostic criteria and Asian dry eye diagnostic criteria

目的对首诊的干眼患者临床表现和体征进行分析,探讨中国干眼诊断标准诊断干眼与亚洲干眼诊断标准的符合情况。方法采用横断面研究方法,于2016年12月至2018年5月在厦门大学附属厦门眼科中心、首都医科大学附属北京同仁医院、四川大学华西医院、上海市普陀区中心医院4个临床研究中心连续纳入首次就诊的干眼患者141例141眼。所有患者均自行完成中国干眼问卷,眼表疾病指数量表(OSDI)和干眼相关生活质量评分问卷(DEQS)调查以评估干眼相关症状,患者均接受泪膜破裂时间(BUT)、角结膜荧光素钠染色、睑板腺形态和功能检查、无麻醉泪液分泌试验(SchirmerⅠ试验)检查以评估干眼相关体征,评估受检眼干眼症状与体征之间的关联;根据有无角膜荧光素染色将受检眼分为角膜染色阳性组和角膜染色阴性组,采用各问卷评分方法评估两个组受检眼干眼症状情况。根据《干眼临床诊疗专家共识》标准将受检眼分为水液缺乏型干眼组、蒸发过强型干眼组、混合型干眼组和泪液动力学异常型干眼组,比较组间受检眼干眼相关体征的差别。结果受检眼中国干眼问卷总评分为12.00(7.00,16.00)分,OSDI问卷总评分为25.00(17.50,36.93)分,DEQS问卷总评分为32.02(15.77,52.34)分。最常见的症状是受检眼中有眼干燥感者130眼,占92.2%;有眼疲劳症状者109眼,占77.3%;有异物感者108眼,占76.6%。眼干、异物感、畏光评分与角膜染色评分均呈弱正相关(r=0.177、0.297、0.172,均P<0.05);受检眼眼痛不适、畏光、视力波动评分与泪液分泌量呈弱负相关(r=-0.178、-0.197、-0.174,均P<0.05)。43.3%(61眼)患者使用视频终端。蒸发过强型干眼75眼,占53.2%;混合型干眼43眼,占30.5%;水液缺乏型干眼18眼,占12.8%;泪液动力学异常型干眼3眼,占2.1%。结论首次就诊的干眼患者以轻中度干眼为主,症状与体征具有一定关联。蒸发过强型干眼是最常见的干眼类型。中国干眼诊断标准诊断干眼与亚洲干眼诊断标准的符合率为97.2%。

Objective To analyze the clinical manifestations and signs of the first diagnosed dry eye patients,and to explore the concordance between the Chinese dry eye diagnostic criteria and the Asian dry eye diagnostic criteria.Methods A cross-sectional multicenter study was conducted.One hundred and forty-one eyes of 141 patients who were diagnosed as dry eye for the first time were included in Xiamen Eye Center of Xiamen University,Beijing Tongren Hospital,West China Hospital of Sichuan University and Shanghai Putuo District Center Hospital from December 2016 to May 2018.All patients completed the Chinese Dry Eye Questionnaire,Ocular Surface Disease Index(OSDI)and Dry Eye-Related Quality-of-life Score Questionnaire(DEQS)to evaluate the symptoms of dry eye.Tear film breakup time(BUT),keratoconjunctival fluorescein staining,meibomian gland morphology and function examination,and SchirmerⅠtest were performed to evaluate dry eye signs and the association between dry eye symptoms and signs.The eyes were divided into corneal staining positive and negative group according to the presence or absence of corneal fluorescein staining,and the dry eye symptoms of the two groups were assessed by the three questionnaires.The eyes were divided into tear-deficient dry eye,evaporative dry eye,mixed dry eye and abnormal tear dynamics dry eye to compare the difference of dry eye signs among the groups.This study adhered to the Declaration of Helsinki.The study protocol complied with Chinese regulations and rules on clinical trial research and was approved by Ethics Committees of Xiamen Eye Center of Xiamen University(No.2017003),Beijing Tongren Hospital,Capital Medical University(No.TREC2016-29),West China Hospital of Sichuan University(No.2016310)and Shanghai Putuo District Center Hospital(No.PTEC-A-2016-18-1).Written informed consent was obtained from patients before entering the cohort.Results The total score of Chinese Dry Eye Questionnaire,OSDI questionnaire and DEQS questionnaire was 12.00(7.00,16.00),25.00(17.50,36.93)and 32.02(15.77,52.34),respectively.It was found that 130 eyes(92.2%)had dryness,and 109 eyes(77.3%)had ocular fatigue and 108 eyes(76.6%)had foreign body sensation.Dryness,foreign body sensation,photophobia and poor vision were weakly positively correlated with corneal staining(r=0.177、0.297、0.172,all at P<0.05).Pain,photophobia and poor vision were negatively correlated with tear secretion(r=-0.178,-0.197,-0.174;all at P<0.05).It was found that 43.3%of dry eye patients had used visual display terminals.Among the 141 eyes,75 eyes(53.2%)were with over evaporation dry eye,43 eyes(30.5%)with mixed dry eye,18 eyes(12.8%)with aqueous-deficient dry eye and 3 eyes(2.1%)with abnormal tear dynamics dry eyes.Conclusions Initial diagnosis of dry eye patients is mainly mild to moderate.Dry eye signs and symptoms are correlated.Over evaporation dry eye is the most common type of dry eye.The concordance between the Chinese dry eye diagnostic criteria and the Asian Dry Eye Society diagnostic criteria reaches 97.2%.