睑板腺功能障碍患者抑郁状态分析
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摘要
目的分析睑板腺功能障碍(MGD)患者的抑郁状态及其与眼表临床指标间的关系。设计横断面研究。研究对象 923例MGD患者与114例正常对照。方法所有入组对象均进行眼表疾病指数(OSDI)与改良抑郁自评量表(M-SDS)问卷调查,同时进行6项眼表客观检查:泪膜破裂时间(TBUT);角结膜荧光素染色(FL)评分;Schirmer I试验(SIt);用睑板腺红外线照相及ImageJ软件计算睑板腺缺失率;使用LipiView~眼表面干涉仪测量泪膜脂质层厚度(LLT);通过睑板腺评估器以恒定压力施于睑板腺体,观察腺体分泌物性状得出睑板腺产生分泌物评分(MGYSS)。分析MGD患者M-SDS与OSDI、眼表客观检查结果间的相关性。主要指标OSDI问卷评分、M-SDS、TBUT、FL评分、SIt、睑板腺缺失率、LLT、MGYSS。结果 MGD组患者OSDI平均分(33.88±16.13)高于对照组(13.63±8.91)(t=20.47,P<0.001),TBUT平均值(4.16±2.30)s低于对照组(7.28±4.17)s(t=-7.84,P<0.001),FL评分(0.72±1.21)高于对照组(0.23±0.64)(t=6.91,P<0.001),SIt(10.07±8.05)mm与对照组(10.18±8.06)mm无明显差异(t=-0.14,P=0.89),睑板腺缺失率(14.33±12.23)%高于对照组(8.25±10.31)%(t=5.19,P<0.001),LLT(62.02±24.79)薄于对照组(67.45±21.58)(t=-2.24,P=0.03),MGYSS(9.06±7.12)低于对照组(15.61±10.76)(t=-6.33,P<0.001)。MGD组M-SDS平均分(37.91±9.48)高于对照组(31.96±7.82)(t=6.416,P=0.001)。MGD患者组中,青年和中年组M-SDS评分高于老年组(F=6.414,P=0.002)。M-SDS得分与OSDI呈正相关,与年龄呈负相关。多元线性回归分析显示MGD组患抑郁的概率更高(OR=2.789,95%CI:1.004~7.553)(χ~2=4.121,P=0.042)。MGD组85例抑郁患者最严重的抑郁表现为:担心失明、食欲减退、觉得自己可有可无、头脑不清、不再爱己所爱。结论 MGD患者抑郁患病概率较正常人高,患者眼表症状的评分与其抑郁的严重程度呈正相关,中青年MGD患者较老年MGD患者抑郁发生几率偏高。
Objective To analyze the mental status of patients with meibomian gland dysfunction( MGD) and its relationship with clinical parameters of ocular surface. Design Cross-sectional study. Participants 923 MGD patients and 114 controls. Methods All subjects were required to complete the Ocular Surface Disease Index( OSDI),Modified-self-rating depression scale( M-SDS) questionnaire and 6 items of objective ocular surface examinations including TBUT,corneal fluorescein( FL) staining,Schirmer I test( SIt),meibomian gland loss rate( measured by meibomian gland infrared photography and Image J software),lipid layer thickness( LLT)( measured by LipiView~ ocular surface interferometer) and meibomian gland yielding secretion score( MGYSS)( measured by applying a constant pressure to the meibomian glands via a meibomian gland evaluator). The correlation between M-SDS and OSDI and ocular objective examination results of MGD patients was analyzed. Main Outcome Measures OSDI,M-SDS,TBUT,FL,SIt,meibomian gland loss rate,LLT,MGYSS. Results The OSDI of MGD group( 33. 88 ± 16. 13) was higher than that of the control group( 13. 63 ± 8. 91)( t = 20. 47,P < 0. 001). The average TBUT in MGD group was significantly lower than that in control group( 4. 16 ± 2. 30 vs 7. 28 ± 4. 17,t =-7. 84,P < 0. 001).The average FL in MGD group was significantly higher( 0. 72 ± 1. 21 vs 0. 23 ± 0. 64,t = 6. 91,P <0. 001). The SIt( 10. 07 ± 8. 05) mm has no significant difference compared to the control group( 10. 18 ±8. 06)( t =-0. 14,P = 0. 89). Meibomian gland loss rate( 14. 33 ± 12. 23) % was higher than that of the control group( 8. 25 ± 10. 31) %( t = 5. 19,P < 0. 001). LLT( 62. 02 ± 24. 79) was lower than that of the control group( 67. 45 ± 21. 58)( t =-2. 24,P = 0. 03). MGYSS( 9. 06 ± 7. 12) was lower than the control group( 15. 61 ± 10. 76)( t =-6. 33,P < 0. 001). The average score of M-SDS in MGD group( 37. 91± 9. 48) was higher than that in control group( 31. 96 ± 7. 82)( t = 6. 42,P = 0. 001). Among 923 patients in MGD group,the M-SDS scores of youth and middle-age groups were higher than the elderly group( F =6. 414,P = 0. 002). Correlation test showed M-SDS was positively correlated with OSDI,but negatively correlated with age. Multivariate linear regression analysis showed,the odds of depression in MGD group were higher than control group( OR = 2. 789,95 % CI: 1. 004 ~ 7. 553)( χ~2= 4. 121,P = 0. 042). Among the 85 depressed patients in the MGD group,the most severe symptoms of depression were: fear of blindness,loss of appetite,feeling useless,confusion and lack of interest. Conclusion Patients with MGD are more susceptible to depression,which may be related to the effect of MGD symptoms on mental status. The youth and middle-aged MGD patients had higher prevalence of depression compared with senile MDG patients.
Objective To analyze the mental status of patients with meibomian gland dysfunction( MGD) and its relationship with clinical parameters of ocular surface. Design Cross-sectional study. Participants 923 MGD patients and 114 controls. Methods All subjects were required to complete the Ocular Surface Disease Index( OSDI),Modified-self-rating depression scale( M-SDS) questionnaire and 6 items of objective ocular surface examinations including TBUT,corneal fluorescein( FL) staining,Schirmer I test( SIt),meibomian gland loss rate( measured by meibomian gland infrared photography and Image J software),lipid layer thickness( LLT)( measured by LipiView~ ocular surface interferometer) and meibomian gland yielding secretion score( MGYSS)( measured by applying a constant pressure to the meibomian glands via a meibomian gland evaluator). The correlation between M-SDS and OSDI and ocular objective examination results of MGD patients was analyzed. Main Outcome Measures OSDI,M-SDS,TBUT,FL,SIt,meibomian gland loss rate,LLT,MGYSS. Results The OSDI of MGD group( 33. 88 ± 16. 13) was higher than that of the control group( 13. 63 ± 8. 91)( t = 20. 47,P < 0. 001). The average TBUT in MGD group was significantly lower than that in control group( 4. 16 ± 2. 30 vs 7. 28 ± 4. 17,t =-7. 84,P < 0. 001).The average FL in MGD group was significantly higher( 0. 72 ± 1. 21 vs 0. 23 ± 0. 64,t = 6. 91,P <0. 001). The SIt( 10. 07 ± 8. 05) mm has no significant difference compared to the control group( 10. 18 ±8. 06)( t =-0. 14,P = 0. 89). Meibomian gland loss rate( 14. 33 ± 12. 23) % was higher than that of the control group( 8. 25 ± 10. 31) %( t = 5. 19,P < 0. 001). LLT( 62. 02 ± 24. 79) was lower than that of the control group( 67. 45 ± 21. 58)( t =-2. 24,P = 0. 03). MGYSS( 9. 06 ± 7. 12) was lower than the control group( 15. 61 ± 10. 76)( t =-6. 33,P < 0. 001). The average score of M-SDS in MGD group( 37. 91± 9. 48) was higher than that in control group( 31. 96 ± 7. 82)( t = 6. 42,P = 0. 001). Among 923 patients in MGD group,the M-SDS scores of youth and middle-age groups were higher than the elderly group( F =6. 414,P = 0. 002). Correlation test showed M-SDS was positively correlated with OSDI,but negatively correlated with age. Multivariate linear regression analysis showed,the odds of depression in MGD group were higher than control group( OR = 2. 789,95 % CI: 1. 004 ~ 7. 553)( χ~2= 4. 121,P = 0. 042). Among the 85 depressed patients in the MGD group,the most severe symptoms of depression were: fear of blindness,loss of appetite,feeling useless,confusion and lack of interest. Conclusion Patients with MGD are more susceptible to depression,which may be related to the effect of MGD symptoms on mental status. The youth and middle-aged MGD patients had higher prevalence of depression compared with senile MDG patients.
引文
[1]Nichols KK,Foulks GN,Bron AJ,et al.The International Workshop on Meibomian Gland Dysfunction:Executive Summary.Invest Ophthalmol Vis Sci,2011,52(4):1922-1929.
[2]Vehof J,Kozareva D,Hysi PG,et al.Prevalence and risk factors of dry eye disease in a British female cohort.Br J Ophthalmol,2014,98(12):1712-1717.
[3]Zung WW.A self-rating depression scale.Arch Gen Psychiatry,1965,12:63-70.
[4]LabbéA,Wang YX,Jie Y,et al.Dry eye disease,dry eye symptoms and depression:the Beijing Eye Study.Br J Ophthalmol,2013,97(11):1399-1403.
[5]Miller KL,Walt JG,Mink DR,et al.Minimal clinically important difference for the Ocular Surface Disease Index.Arch Ophthalmol,2010,128(1):94-101.
[6]Schaumberg DA,Nichols JJ,Papas EB,et al.The International Workshop on Meibomian Gland Dysfunction:report of the subcommittee on the epidemiology of,and associated risk factors for,MGD.Invest Ophthalmol Vis Sci,2011,52(4):1994-2005.
[7]Lane SS,Dubiner HB,Epstein RJ,et al.A new system,the Lipi Flow,for the treatment of meibomian gland dysfunction.Cornea,2012,31(4):396-404.
[8]孟珠,赵少贞.睑板腺功能障碍研究进展.国际眼科纵览,2016,40(6):426-431.
[9]Segal BM,Pogatchnik B,Rhodus N,et al.Pain in primary Sj9gren's syndrome:the role of catastrophizing and negative illness perceptions.Scand J Rheumatol,2014,43(3):234-241.
[10]Arita R,Morishige N,Koh S,et al.Increased tear fluid production as a compensatory response to meibomian gland loss:a multicenter cross-sectional study.Ophthalmology,2015,122(5):925-933.
[11]Szakáts I,Sebestyén M,Németh J,et al.The role of health anxiety and depressive symptoms in dry eye disease.Curr Eye Res,2016,41(8):1044-1049.
[12]Zhang Y,Tong L,Jiang A,et al.Vision-related quality of life and psychological status in Chinese women with Sjogren’s syndrome dry eye:a case-control study.Bmc Womens Health,2016,16(1):75.
[13]Mertzanis P,Abetz L,Rajagopalan K,et al.The relative burden of dry eye inpatients’lives:comparisons to a U.S.normative sample.Invest Ophthalmol Vis Sci,2005,46(1):46-50.
[14]Fine PG.Long-term consequences of chronic pain:mounting evidence for pain as aneurological disease and parallels with other chronic disease states.Pain Med,2011,12(7):996-1004.
[15]Pouyeh B,Viteri E,Feuer W,et al.Impact of ocular surface symptoms on quality oflife in a United States veterans affairs population.Am J Ophthalmol,2012,153(6):1061-1066.
[2]Vehof J,Kozareva D,Hysi PG,et al.Prevalence and risk factors of dry eye disease in a British female cohort.Br J Ophthalmol,2014,98(12):1712-1717.
[3]Zung WW.A self-rating depression scale.Arch Gen Psychiatry,1965,12:63-70.
[4]LabbéA,Wang YX,Jie Y,et al.Dry eye disease,dry eye symptoms and depression:the Beijing Eye Study.Br J Ophthalmol,2013,97(11):1399-1403.
[5]Miller KL,Walt JG,Mink DR,et al.Minimal clinically important difference for the Ocular Surface Disease Index.Arch Ophthalmol,2010,128(1):94-101.
[6]Schaumberg DA,Nichols JJ,Papas EB,et al.The International Workshop on Meibomian Gland Dysfunction:report of the subcommittee on the epidemiology of,and associated risk factors for,MGD.Invest Ophthalmol Vis Sci,2011,52(4):1994-2005.
[7]Lane SS,Dubiner HB,Epstein RJ,et al.A new system,the Lipi Flow,for the treatment of meibomian gland dysfunction.Cornea,2012,31(4):396-404.
[8]孟珠,赵少贞.睑板腺功能障碍研究进展.国际眼科纵览,2016,40(6):426-431.
[9]Segal BM,Pogatchnik B,Rhodus N,et al.Pain in primary Sj9gren's syndrome:the role of catastrophizing and negative illness perceptions.Scand J Rheumatol,2014,43(3):234-241.
[10]Arita R,Morishige N,Koh S,et al.Increased tear fluid production as a compensatory response to meibomian gland loss:a multicenter cross-sectional study.Ophthalmology,2015,122(5):925-933.
[11]Szakáts I,Sebestyén M,Németh J,et al.The role of health anxiety and depressive symptoms in dry eye disease.Curr Eye Res,2016,41(8):1044-1049.
[12]Zhang Y,Tong L,Jiang A,et al.Vision-related quality of life and psychological status in Chinese women with Sjogren’s syndrome dry eye:a case-control study.Bmc Womens Health,2016,16(1):75.
[13]Mertzanis P,Abetz L,Rajagopalan K,et al.The relative burden of dry eye inpatients’lives:comparisons to a U.S.normative sample.Invest Ophthalmol Vis Sci,2005,46(1):46-50.
[14]Fine PG.Long-term consequences of chronic pain:mounting evidence for pain as aneurological disease and parallels with other chronic disease states.Pain Med,2011,12(7):996-1004.
[15]Pouyeh B,Viteri E,Feuer W,et al.Impact of ocular surface symptoms on quality oflife in a United States veterans affairs population.Am J Ophthalmol,2012,153(6):1061-1066.