干燥综合征干眼患者症状和体征分离的特征分析  

Characteristics of inconsistent symptoms and signs of dry eye in patients with Sjgren syndrome

作　　者：沈重成 张钦[1] 李方烃[1] 赵明威[1] Shen Zhongcheng;Zhang Qin;Li Fangting;Zhao Mingwei(Department of Ophthalmology,Peking University People's Hospital,Beijing Key Laboratory of Ocular Disease and Optometry Science,Beijing 100044,China)

机构地区：[1]北京大学人民医院眼科,眼病与视光医学北京市重点实验室,北京100044

出　　处：《中华实验眼科杂志》2025年第4期336-342,共7页Chinese Journal Of Experimental Ophthalmology

基　　金：国家重点研发计划(2020YFC2008200);北京大学人民医院研究与发展基金(RDY2020-03)。

摘　　要：目的分析干燥综合征(SS)干眼患者症状和体征分离的临床特征。方法采用病例对照研究,纳入2021年1—10月于北京大学人民医院干眼门诊就诊的干眼患者38例38眼,根据是否患有SS分为非SS(NSS)组25例25眼和SS组13例13眼,均纳入右眼数据进行研究。2个组患者均进行主观症状评分和客观临床指标评估,其中主观症状评分采用眼表疾病指数(OSDI)量表、患者标准眼干(SPEED)问卷和干眼问卷5(DEQ-5)评估;客观临床指标评估包括Schirmer试验Ⅰ(SⅠt)、泪膜破裂时间(TBUT)、眼表染色评分(OSS)、美国国立眼科研究所(NEI)评分、眼睑Marx线评分、无创泪膜破裂时间(NIBUT)、无创泪河高度(NITMH)、睑板腺缺失面积比、角膜上皮下神经数量、神经总长度、平均神经长度、最大神经长度、最小神经长度、神经弯曲度和树突状细胞数量。比较2个组间主观症状和临床指标差异,并进行眼部症状评分与客观临床指标的相关性分析。结果SS组OSDI量表评分、SPEED评分和DEQ-5评分分别为10.9(2.1,23.1)、4.0(2.0,7.0)和7.0(3.5,9.5)分,均明显低于NSS组的37.5(26.0,64.9)、10.5(7.0,13.0)和13.0(6.8,14.3)分,差异均有统计学意义(Z=-2.70、-3.01、-2.14,均P<0.05)。SS组TBUT长于NSS组,差异有统计学意义(Z=-2.10,P=0.038)。2个组SⅠt、眼表OSS总分、眼睑Marx线评分、NIBUT、NITMH、睑板腺缺失面积比、角膜上皮下神经数量、神经总长度、平均神经长度、最大神经长度、最小神经长度、神经弯曲度和树突状细胞数量差异均无统计学意义(均P>0.05)。SS组患者相较于NSS组患者鼻侧结膜OSS更高,差异有统计学意义(Z=-2.32,P=0.023)。NSS组患者各主观症状评分与客观临床指标均无明显相关性(均P>0.05)。SS组患者SPEED评分与上睑Marx线评分呈正相关(r s=0.573,P=0.041),OSDI评分与最小神经长度呈负相关(r s=-0.606,P=0.037)。结论与体征相同的NSS干眼患者相比,SS干眼患者鼻侧结膜�Objective To analyze the clinical characteristics of inconsistent symptoms and signs of dry eye in patients with Sj gren syndrome(SS).Methods A case-control study was performed.Thirty-eight patients(38 eyes)who visited the dry-eye outpatient department at Peking University People's Hospital were enrolled from January to October 2021.The patients were divided into a non-SS(NSS)group(25 cases,25 eyes)and a SS group(13 cases,13 eyes)according to without or with SS.The data of right eyes were analyzed.The patients'subjective symptoms were scored and their objective clinical parameters were evaluated.Evaluation of subjective symptoms included Ocular Surface Disease Index(OSDI),Standard Patient Evaluation of eye dryness(SPEED)Questionnaire and Dry Eye Questionnaire-5(DEQ-5).Objective clinical parameters included SchirmerⅠtest(SⅠt),tear film breakup time(TBUT),SICCA ocular staining score(OSS),National Eye Institute(NEI)score,Marx line score,non-invasive tear film breakup time(NIBUT),non-invasive tear meniscus height(NITMH),meibomian gland loss area ratio,the number of corneal subepithelial nerves,total nerve length,mean nerve length,maximum nerve length,minimum nerve length,nerve curvature,and number of dendritic cells.Differences in subjective symptoms and clinical parameters were compared between the two groups,and correlation analysis between ocular symptom scores and objective clinical parameters was performed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Peking University People's Hospital(No.RDY2020-03).Written informed consent was obtained from each subject.Results The OSDI,SPEED and DEQ-5 scores of SS group were 10.9(2.1,23.1),4.0(2.0,7.0)and 7.0(3.5,9.5),respectively,which were significantly lower than 37.5(26.0,64.9),10.5(7.0,13.0)and 13.0(6.8,14.3)of NSS group(Z=-2.70,-3.01,-2.14;all P<0.05).TBUT was longer in the SS group than in the NSS group,and the difference was statistically significant(Z=-2.10,P=0.038).No significant difference was foun

关 键 词：干眼 干燥综合征 眼表疾病指数 患者标准眼干问卷 干眼问卷5 眼表综合分析仪 活体激光扫描共聚焦显微镜 

分 类 号：R777[医药卫生—眼科]