Keratograph 5M综合眼表分析仪在评价Sjgren’s综合征患者干眼中的应用
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摘要
目的应用Keratograph 5M眼表综合分析仪评价Sjgren’s综合征患者干眼相关的指标,探讨其临床应用价值。方法横断面研究。选择Sjgren’s综合征患者及健康对照组各40例右眼作为研究对象。检查指标包括干眼主观症状(OSDI)评分、泪液分泌试验I(S I t)、角膜荧光染色评分检查,以及应用Keratograph 5M眼表综合分析仪进行泪河高度测量、非接触首发泪膜破裂时间(NIKf-BUT)、非接触平均泪膜破裂时间(NIKav-BUT)测定,以及睑板腺功能检查。分析Keratograph 5M测得的泪河高度、NIKf-BUT、NIKav-BUT与S I t的相关性,Sjgren’s综合征患者睑板腺状况评分与OSDI评分及NIKav-BUT的相关性用Pearson相关及线性回归进行分析。结果 Sjgren’s综合征患者OSDI评分、角膜荧光染色评分、睑板腺缺失面积评分均高于健康对照组(P<0.01),而S I t、泪河高度、NIKf-BUT、NIKav-BUT均低于健康对照组(P<0.01)。Sjgren’s综合征患者测得的NIKav-BUT时间越短,S I t越短(r=0.529,P<0.01);泪河高度越低,S I t越短(r=0.597,P<0.01)。睑板腺缺失面积评分与OSDI评分呈正相关(r=0.949,P<0.01),与NIKav-BUT呈负相关(r=-0.80,P<0.01)。结论 Keratograph 5M眼表综合分析仪能够直观地评价Sjgren’s综合征患者干眼患者眼表状况,是一种非接触性、无创、可重复性较好的干眼检查手段,睑板腺功能障碍在Sjgren’s综合征的辅助诊断方面具有临床应用价值。
Objective To assess the clinical application of Keratograph 5 M in dry eye associated with Sjgren's syndrome. Methods Cross-sectional study. Forty eyes of 40 patients with Sjgren's syndrome were enrolled. All participants completed the Ocular Surface Disease Index( OSDI) questionnaire,Schirmer I test and corneal fluorescein staining scoring.All participants underwent imaging with a Keratograph 5 M. Lower tear meniscus height images were captured( TMH),noninvasive first break-up time( NIKf-BUT),non-invasive average break-up time( NIKav-BUT) and the meibomian glands status were measured for each subject. A Pearson correlation and linear regression were used to study the correlations among the TMH,NIKf-BUT,NIKav-BUT with Schirmer I,and the relationships between scores for the meibomian gland status and ODSI questionnaire compared to NIKav-BUT. Results Both NIKav-BUT and TMH had a positive correlation with Schirmer I test r = 0. 529,0. 597,P < 0. 01). The Meibomian gland dropout score had a positive correlation with OSDI( r = 0. 949,P< 0. 01) and a negative correlation with NIKav-BUT( r =-0. 80,P < 0. 01) in Sjgren's syndrome patients. Conclusions Keratograph 5 M can provide a direct evaluation of dry eye with Sjgren's syndrome patients that is non-contacting,non-invasive and has excellent repeatability. Meibomian gland dysfunction has great value in the diagnosis of systemic condition induced by Sjgren's syndrome.
Objective To assess the clinical application of Keratograph 5 M in dry eye associated with Sjgren's syndrome. Methods Cross-sectional study. Forty eyes of 40 patients with Sjgren's syndrome were enrolled. All participants completed the Ocular Surface Disease Index( OSDI) questionnaire,Schirmer I test and corneal fluorescein staining scoring.All participants underwent imaging with a Keratograph 5 M. Lower tear meniscus height images were captured( TMH),noninvasive first break-up time( NIKf-BUT),non-invasive average break-up time( NIKav-BUT) and the meibomian glands status were measured for each subject. A Pearson correlation and linear regression were used to study the correlations among the TMH,NIKf-BUT,NIKav-BUT with Schirmer I,and the relationships between scores for the meibomian gland status and ODSI questionnaire compared to NIKav-BUT. Results Both NIKav-BUT and TMH had a positive correlation with Schirmer I test r = 0. 529,0. 597,P < 0. 01). The Meibomian gland dropout score had a positive correlation with OSDI( r = 0. 949,P< 0. 01) and a negative correlation with NIKav-BUT( r =-0. 80,P < 0. 01) in Sjgren's syndrome patients. Conclusions Keratograph 5 M can provide a direct evaluation of dry eye with Sjgren's syndrome patients that is non-contacting,non-invasive and has excellent repeatability. Meibomian gland dysfunction has great value in the diagnosis of systemic condition induced by Sjgren's syndrome.
引文
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[14]田磊,宋文秀,王智群,等.Keratograph 5M眼表综合分析仪在干眼诊断中的应用研究[J].首都医科大学学报,2017,(1):11-16.
[15]Lemp MA,Foulks GN.The definition and classification of dry eye disease:report of the definition and classification subcommittee of the international dry eye workshop[J].Ocular Surf,2007,5:75-92.
[16]Knop E,Knop N,Millar T,et al.The international workshop on meibomian gland dysfunction:report of the subcommittee on anatomy,physiology,and pathophysiology of the meibomian gland[J].Invest Ophthalmol,Vis Sci,2011,52(4):1938-1978.
[17]Menzies KL,Srinivasan S,Prokopich CL,et al.Infrared Imaging of Meibomian Glands and Evaluation of the Lipid Layer in Sj9gren’s Syndrome Patients and Nondry Eye Controls[J].Invest Ophthalmol Vis Sci,2015,56(1):836-841.
[18]Siak JJ,Tong L,Wong WL,et al.Prevalence and risk factors of meibomian gland dysfunction:the Singapore Malay eye study[J].Cornea,2012,31(11):1223-1228.
[19]Lin PY,Tsai SY,Cheng CY,et al.Prevalence of dry eye among an elderly Chinese population in Taiwan:the Shihpai Eye Study[J].Ophthalmology,2003,110(6):1096-101.
[20]Jie Y,Xu L,Wu YY,et al.Prevalence of dry eye among adult Chinese in the Beijing Eye Study[J].Eye,2009,23(3):688-693.
[21]Abdelfattah NS,Dastiridou A,Sadda SR,et al.Noninvasive imaging of tear film dynamics in eyes with ocular surface disease[J].Cornea,2015,34(10):48-52.
[22]Nelson JD,Shimazaki J,Benitez-del-Castillo JM,et al.The international workshop on meibomian gland dysfunction:report of the definition and classification subcommittee[J].Invest Ophthalmol Vis Sci,2011,52(4):1930-1937.
[2]A Keszler,LI Adler,MS Gandolfo,et al.Malt lymphoma in labial salivary gland biopsy from Sj9gren's syndrome SS importance of follow-up in early detection[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2013,115(3):28-33.
[3]Dewi van Stein-Callenfels,Jonathan Tan,Elisabeth Bloemena,et al.The role of a labial salivary gland biopsy in the diagnostic procedure for Sj9gren’s syndrome;a study of 94 cases[J].Med Oral Patol Oral Cir Bucal,2014,19(4):372-376.
[4]Koprowski R,Tian L,Olczyk P.A clinical utility assessment of the automatic measurement method of the quality of Meibomian glands[J].Bio Medical Engineering,2017,16(1):82-95.
[5]Knop E,Knop N,Millar T,et al.The international workshop on meibomian gland dysfunction:report of the subcommittee on anatomy,physiology,and pathophysiology of the meibomian gland[J].Invest Ophthalmol Vis Sci,2011,52(4):1938-1978.
[6]Vitali C,Bombardieri S,Jonsnm R,et al.Classification criteria for Sj9gren’s syndrome:a revised version of the European criteria proposed by the American-European Consensus Group[J].Ann Rheum Dis,2002,61(6):554-558.
[7]Oezcura F,Aydin S,Helvaci MR.Ocular surface disease index for the diagnosis of dry eye syndrome[J].Ocular Immunol Inflammation,2007,15(5):389-393.
[8]张玉明,王芳芳,李宝贞,等.干燥综合征患者干眼病的临床分析[J].中华风湿病学杂志,2012,16(8):523-526.
[9]Qi Y,Zhang C,Zhao S,et al.A novel noninvasive ocular surface analyzer for the assessment of dry eye with Meibomian gland dysfunction[J].Exp Therapeutic Med,2017,13:2983-2988.
[10]Koh,S,Ikeda C,Watanabe S et al.Effect of non-invasive tear stability assessment on tear meniscus height[J].Acta Ophthalmol,2015,93(1):135-139.
[11]Research in dry eye:report of the Research subcommittee of the international dry eye workshop[J].Ocul Surf,2007,5:179-193.
[12]李军花,赵云娥,林晓蕾,等.新型角膜地形综合分析仪与Mc Monnies问卷在干眼诊断中的临床应用[J].眼科新进展,2015,35(11):1060-1063.
[13]Pedro Arriola-Villalobos,JoséIgnacio Fernández-Vigo,David Díaz-Valle,et al.Assessment of lower tear meniscus measurements obtained with Keratograph and agreement with Fourier-domain optical-coherence tomography[J].Br J Ophthalmol,2015,7(1):11-16.
[14]田磊,宋文秀,王智群,等.Keratograph 5M眼表综合分析仪在干眼诊断中的应用研究[J].首都医科大学学报,2017,(1):11-16.
[15]Lemp MA,Foulks GN.The definition and classification of dry eye disease:report of the definition and classification subcommittee of the international dry eye workshop[J].Ocular Surf,2007,5:75-92.
[16]Knop E,Knop N,Millar T,et al.The international workshop on meibomian gland dysfunction:report of the subcommittee on anatomy,physiology,and pathophysiology of the meibomian gland[J].Invest Ophthalmol,Vis Sci,2011,52(4):1938-1978.
[17]Menzies KL,Srinivasan S,Prokopich CL,et al.Infrared Imaging of Meibomian Glands and Evaluation of the Lipid Layer in Sj9gren’s Syndrome Patients and Nondry Eye Controls[J].Invest Ophthalmol Vis Sci,2015,56(1):836-841.
[18]Siak JJ,Tong L,Wong WL,et al.Prevalence and risk factors of meibomian gland dysfunction:the Singapore Malay eye study[J].Cornea,2012,31(11):1223-1228.
[19]Lin PY,Tsai SY,Cheng CY,et al.Prevalence of dry eye among an elderly Chinese population in Taiwan:the Shihpai Eye Study[J].Ophthalmology,2003,110(6):1096-101.
[20]Jie Y,Xu L,Wu YY,et al.Prevalence of dry eye among adult Chinese in the Beijing Eye Study[J].Eye,2009,23(3):688-693.
[21]Abdelfattah NS,Dastiridou A,Sadda SR,et al.Noninvasive imaging of tear film dynamics in eyes with ocular surface disease[J].Cornea,2015,34(10):48-52.
[22]Nelson JD,Shimazaki J,Benitez-del-Castillo JM,et al.The international workshop on meibomian gland dysfunction:report of the definition and classification subcommittee[J].Invest Ophthalmol Vis Sci,2011,52(4):1930-1937.