CAJ | 학술논문

目的探讨睑板腺功能障碍(MGD)与结膜松弛症(CCh)的关系,观察挤压睑板腺分泌排泄法对MGD的临床疗效.方法前瞻性随机病例对照研究.选取CCh患者100例(200眼),男45例,女55例,年龄为46～87岁,平均(72.6±5.5)岁.采用眼表面疾病指数(OSDI)积分法对患者进行眼部症状问卷调查评分；观察患者睑板腺开口；测定泪膜破裂时间(BUT)；对异常睑板腺分泌物行涂片染色；同时利用非接触红外线睑板腺照相系统进行睑板腺检查.对CCh伴有MGD患者随机分为睑板腺挤压治疗组(挤压组,24例)和抗生素眼液、人工泪液治疗组(对照组,22例).治疗后1、2、4、8周进行随访观察,取第8周的数据进行统计学分析.对相关数据进行独立样本t检验或者配对t检验.结果 CCh伴有MGD者46例,占46％.不伴MGD患者的OSDI积分为21.6±5.9,伴MGD患者的OSDI积分为46.3±7.9,差异有统计学意义(t=17.172,P＜0.01).MGD挤压治疗组治疗前的OSDI和睑板腺开口积分分别为45.8±8.9和2.1±0.3,治疗后分别为21.2±4.8和3.2±0.4,差异均有统计学意义(t=22.170、2.688,P＜0.05).不伴MGD患者BUT值为(7.8±0.9)s,伴MGD患者的BUT值为(5.9±0.9)s,差异有统计学意义(t=6.189,P＜0.01).挤压治疗组治疗前BUT值为(5.7±0.9)s,治疗后BUT值为(7.1±0.9)s,差异有统计学意义(t=10.110,P＜0.01).对照组治疗前后除OSDI积分差异有统计学意义外(t=24.330,P＜0.01),BUT及睑板腺开口积分差异无统计学意义.46例伴MGD患者的睑板腺分泌物涂片检查发现,26眼分泌物涂片除脂质外,还含有上皮细胞、正在凋亡的细胞和大量的细胞碎屑及少许炎症细胞,7例奶黄样分泌物涂片可见大量中性粒细胞和少量上皮细胞.结论 CCh多伴发MGD.睑板腺挤压治疗是一种有效的治疗MGD的方法,可以作为伴发MGD的CCh患者的重要的辅助治疗.
목적 탐토검판선공능장애(MGD)여결막송이증(CCh)적관계,관찰제압검판선분비배설법대MGD적림상료효.방법 전첨성수궤병례대조연구.선취CCh환자100례(200안),남45례,녀55례,년령위46～87세,평균(72.6±5.5)세.채용안표면질병지수(OSDI)적분법대환자진행안부증상문권조사평분；관찰환자검판선개구；측정루막파렬시간(BUT)；대이상검판선분비물행도편염색；동시이용비접촉홍외선검판선조상계통진행검판선검사.대CCh반유MGD환자수궤분위검판선제압치료조(제압조,24례)화항생소안액、인공루액치료조(대조조,22례).치료후1、2、4、8주진행수방관찰,취제8주적수거진행통계학분석.대상관수거진행독립양본t검험혹자배대t검험.결과 CCh반유MGD자46례,점46％.불반MGD환자적OSDI적분위21.6±5.9,반MGD환자적OSDI적분위46.3±7.9,차이유통계학의의(t=17.172,P＜0.01).MGD제압치료조치료전적OSDI화검판선개구적분분별위45.8±8.9화2.1±0.3,치료후분별위21.2±4.8화3.2±0.4,차이균유통계학의의(t=22.170、2.688,P＜0.05).불반MGD환자BUT치위(7.8±0.9)s,반MGD환자적BUT치위(5.9±0.9)s,차이유통계학의의(t=6.189,P＜0.01).제압치료조치료전BUT치위(5.7±0.9)s,치료후BUT치위(7.1±0.9)s,차이유통계학의의(t=10.110,P＜0.01).대조조치료전후제OSDI적분차이유통계학의의외(t=24.330,P＜0.01),BUT급검판선개구적분차이무통계학의의.46례반MGD환자적검판선분비물도편검사발현,26안분비물도편제지질외,환함유상피세포、정재조망적세포화대량적세포쇄설급소허염증세포,7례내황양분비물도편가견대량중성립세포화소량상피세포.결론 CCh다반발MGD.검판선제압치료시일충유효적치료MGD적방법,가이작위반발MGD적CCh환자적중요적보조치료.
Objective To investigate the relationship between meibomian gland dysfunction (MGD) and conjunctivochalasis (CCh),and to observe the therapeutic effect of meibomian gland pressing.Methods This was a prospective,randomized,case control study.Two hundred eyes of 100 patients with CCh were included in this study in which the ocular surface disease index (OSDI),meibomian gland outlet score,smears of meibomian gland secretion,and tear break-up time (BUT)were observed and also used to evaluate the therapeutic effect of pressing treatment for MGD.CCh patients with MGD were randomly divided into two groups:24 patients (48 eyes) were treated with pressing treatment and 22 patients (44 eyes) were treated with artificial tears eye drops and antibiotic eye drops (the control group).All patients were followed up at 1,2,4,and 8 weeks.The data from OSDI and BUT for the two groups at the 8-week follow-up were used to conduct with an independent samples t test or paired t test.Results Of the 200 eyes,92 eyes (46％) with MGD.While OSDI scores in CCh without MGD (21.6±5.9) were significantly lower than that in those with MGD (46.3± 7.9) (t=17.172,P＜0.01),OSDI scores in eyes with pressing treatment (21.2±4.8) were significantly lower than that pre-treatment (45.8±8.9) (t=22.170,P＜0.01 ).After pressing treatment,the meibomian gland outlet scores (2.1±0.3) were significantly lower compared with the pre-treatment scores (3.2±0.4)(t=2.688,P=0.025).BUT in pressing-treated eyes significantly improved to be (7.1±0.9) seconds compared with (5.7±0.9) seconds of baseline (t=10.110,P＜0.05).In the control group,there was a significant difference in OSDI (t=24.330,P＜0.01) rather than in BUT and meibomian gland outlet scores between pre- and post-treatment.In addition,lipid,epithelia,apoptosis cells,broken cells and inflammatory cells were observed in some smears of meibemian gland secretion.Conclusion MGD can accompany CCh and exacerbate its symptoms,whereas pressing the meibomian gland is an effective method for treating MGD and attenuating the related symptoms of CCh.