CAJ | 학술논문

背景泪液高渗透压被认为是引起干眼的核心机制之一,泪液渗透压的测量在干眼临床诊断中具有重要的临床意义,但目前中国关于泪液渗透压与干跟发病的关系的研究资料少见. 目的研究泪液渗透压改变与干眼发病的关系,探讨泪液渗透压检查在干眼诊断及病情评估中的价值.方法连续收集2011年5-8月在温州医科大学附属眼视光医院确诊的61例干眼患者,包括轻中度干眼30例和重度干眼31例,并纳入同期正常志愿者30人,各组受检者的基线特征匹配.所有受检者在知情同意的情况下双眼依次进行视力检查、眼表疾病指数(OSDI)问卷调查评分、泪液渗透压检测、眼前节裂隙灯显微镜检查、泪膜破裂时间(TFBUT)检测、角膜荧光素钠染色评分、结膜丽丝胺绿染色评分、Shirmer试验Ⅰ(SⅠt)和睑板腺功能评估,选取泪液渗透压值较高一侧眼的结果进行分析,比较各组间受检者各检测指标的差异,并对干眼组受检者的泪液渗透压与临床检测结果的相关性进行分析. 结果正常对照组和干眼组受检者泪液渗透压值分别为(296.60±10.81)mOsm/L和(326.46±22.66) mOsm/L,干眼组患者泪液渗透压值高于正常对照者,差异有统计学意义(P＜0.05),此外干眼组患者OSDI评分、TFBUT值、角膜荧光素染色评分、结膜丽丝胺绿染色评分和SⅠt检测值均明显高于正常对照组,差异均有统计学意义(均P＜0.05).重度干眼组泪液渗透压为(341.90±21.15) mOsm/L,明显高于轻中度干眼组患者的(310.50±8.99)mOsm/L,差异有统计学意义(P＜0.017).根据ROC曲线分析,干眼组的泪液渗透压受试者工作特征(ROC)曲线下面积为0.916,干眼诊断泪液渗透压临界点为308 mOsm/L,干眼诊断敏感性为0.79,特异性为1.00.泪液渗透压与OSDI评分、角膜染色评分、结膜染色评分和SⅠt结果均相关(r=0.338、0.407、0.246、-0.461,均P＜0.05),但与TFBUT无明显相关性(r=-0.113,P＞0.05).结论泪液渗透压可能是诊断干眼和评估干眼严重程度的重要指标,泪液渗透压与其他指标的联合应用可提高干眼的诊断价值. 揹景淚液高滲透壓被認為是引起榦眼的覈心機製之一,淚液滲透壓的測量在榦眼臨床診斷中具有重要的臨床意義,但目前中國關于淚液滲透壓與榦跟髮病的關繫的研究資料少見. 目的研究淚液滲透壓改變與榦眼髮病的關繫,探討淚液滲透壓檢查在榦眼診斷及病情評估中的價值.方法連續收集2011年5-8月在溫州醫科大學附屬眼視光醫院確診的61例榦眼患者,包括輕中度榦眼30例和重度榦眼31例,併納入同期正常誌願者30人,各組受檢者的基線特徵匹配.所有受檢者在知情同意的情況下雙眼依次進行視力檢查、眼錶疾病指數(OSDI)問捲調查評分、淚液滲透壓檢測、眼前節裂隙燈顯微鏡檢查、淚膜破裂時間(TFBUT)檢測、角膜熒光素鈉染色評分、結膜麗絲胺綠染色評分、Shirmer試驗Ⅰ(SⅠt)和瞼闆腺功能評估,選取淚液滲透壓值較高一側眼的結果進行分析,比較各組間受檢者各檢測指標的差異,併對榦眼組受檢者的淚液滲透壓與臨床檢測結果的相關性進行分析. 結果正常對照組和榦眼組受檢者淚液滲透壓值分彆為(296.60±10.81)mOsm/L和(326.46±22.66) mOsm/L,榦眼組患者淚液滲透壓值高于正常對照者,差異有統計學意義(P＜0.05),此外榦眼組患者OSDI評分、TFBUT值、角膜熒光素染色評分、結膜麗絲胺綠染色評分和SⅠt檢測值均明顯高于正常對照組,差異均有統計學意義(均P＜0.05).重度榦眼組淚液滲透壓為(341.90±21.15) mOsm/L,明顯高于輕中度榦眼組患者的(310.50±8.99)mOsm/L,差異有統計學意義(P＜0.017).根據ROC麯線分析,榦眼組的淚液滲透壓受試者工作特徵(ROC)麯線下麵積為0.916,榦眼診斷淚液滲透壓臨界點為308 mOsm/L,榦眼診斷敏感性為0.79,特異性為1.00.淚液滲透壓與OSDI評分、角膜染色評分、結膜染色評分和SⅠt結果均相關(r=0.338、0.407、0.246、-0.461,均P＜0.05),但與TFBUT無明顯相關性(r=-0.113,P＞0.05).結論淚液滲透壓可能是診斷榦眼和評估榦眼嚴重程度的重要指標,淚液滲透壓與其他指標的聯閤應用可提高榦眼的診斷價值.
배경 루액고삼투압피인위시인기간안적핵심궤제지일,루액삼투압적측량재간안림상진단중구유중요적림상의의,단목전중국관우루액삼투압여간근발병적관계적연구자료소견. 목적 연구루액삼투압개변여간안발병적관계,탐토루액삼투압검사재간안진단급병정평고중적개치.방법련속수집2011년5-8월재온주의과대학부속안시광의원학진적61례간안환자,포괄경중도간안30례화중도간안31례,병납입동기정상지원자30인,각조수검자적기선특정필배.소유수검자재지정동의적정황하쌍안의차진행시력검사、안표질병지수(OSDI)문권조사평분、루액삼투압검측、안전절렬극등현미경검사、루막파렬시간(TFBUT)검측、각막형광소납염색평분、결막려사알록염색평분、Shirmer시험Ⅰ(SⅠt)화검판선공능평고,선취루액삼투압치교고일측안적결과진행분석,비교각조간수검자각검측지표적차이,병대간안조수검자적루액삼투압여림상검측결과적상관성진행분석. 결과 정상대조조화간안조수검자루액삼투압치분별위(296.60±10.81)mOsm/L화(326.46±22.66) mOsm/L,간안조환자루액삼투압치고우정상대조자,차이유통계학의의(P＜0.05),차외간안조환자OSDI평분、TFBUT치、각막형광소염색평분、결막려사알록염색평분화SⅠt검측치균명현고우정상대조조,차이균유통계학의의(균P＜0.05).중도간안조루액삼투압위(341.90±21.15) mOsm/L,명현고우경중도간안조환자적(310.50±8.99)mOsm/L,차이유통계학의의(P＜0.017).근거ROC곡선분석,간안조적루액삼투압수시자공작특정(ROC)곡선하면적위0.916,간안진단루액삼투압림계점위308 mOsm/L,간안진단민감성위0.79,특이성위1.00.루액삼투압여OSDI평분、각막염색평분、결막염색평분화SⅠt결과균상관(r=0.338、0.407、0.246、-0.461,균P＜0.05),단여TFBUT무명현상관성(r=-0.113,P＞0.05).결론 루액삼투압가능시진단간안화평고간안엄중정도적중요지표,루액삼투압여기타지표적연합응용가제고간안적진단개치.
Background Tear hyperosmosis is considered to be one of the core mechanisms of dry eye.The measurement of tear osmolarity is important in the clinical diagnosis of dry eye.However,relevant study is lack in Chinese population.Objective The aim was to investigate the relation of tear osmolarity and pathogenesis of dry eye and evaluate the diagnosis value of tear hyperosmosis in dry eye.Methods Sixty-one consecutive dry eye patients were enrolled in Affiliated Eye Hospital of Wenzhou Medical University from May to August in 2011,including 30 mild and moderate dry eyes and 31 severe dry eyes,and 30 normal volunteers with matched age and gender were collected simultaneously under the informed consent.The visual acuity,Ocular Surface Disease Index (OSDI) questionnaire,osmotic pressure of tear,tear film breakup time (TFBUT),corneal fluorescein staining,conjunctival lissamine green staining,Shirmer Ⅰ test (S Ⅰ t) without anesthesia and meibomian function were examined in turn in the subjects,and lateral eyes with higher tear osmotic pressure were analyzed.The differences in above indexes among the different groups were statistically compared,and the correlations between the osmotic pressure of tear and clinical parameters were assessed.Results The osmotic pressure of tear was (326.46 ±22.66) mOsm/L in the dry eye group,which was significantly higher than (296.60± 10.81) mOsm/L in the normal control group (P＜0.05),and the OSDI scores,TFBUT,corneal fluorescine scores,conjunctival staining scores and S Ⅰ t values in the dry eye group were remarkably elevated in comparison with the normal control group (all at P＜0.05).The osmotic pressure of tear was (341.90 ± 21.15) mOsm/L in the severe dry eye group,which was significantly higher than (310.50±8.99) mOsm/L in the mild and moderate group (P＜0.017).The area under the curve for tear osmolarity in the dry eye group was 0.916,and cutoff value of sensitivity and specificity in dry eye diagnosis was 308 mOsm/L,with the sensitivity value 0.79 and specificity 1.00.The significant correlations were found between the osmotic pressure of tear and OSDI scores,corneal fluorescine scores,conjunctival staining scores and S Ⅰ t outcomes (r=0.338,0.407,0.246,-0.461,all at P＜0.05).However,the osmotic pressure of tear was not correlated with TFBUT (r=-0.113,P＞0.05).Conclusions Tears osmotic pressure might be a useful indicator for the diagnosis of dry eye and assessment of severity.A combined application of tear osmolarity measurement with other relevant indexes can improve the diagnostic value.