趋化因子受体CXCR3在围绝经期干眼患者中的表达

目的:探讨分析以CXCR3为代表的趋化因子受体家族在围绝经期干眼患者中干眼发生、发展过程中的特征及临床意义。方法:选择围绝经期干眼患者30例,非围绝经期干眼患者30例,用印迹细胞学的方法分别取围绝经期、非围绝经期干眼患者结膜上皮细胞,经流式细胞学分析,比较两组CXCR3阳性细胞表达率的差异。结果:围绝经期干眼组泪膜破裂时间(BUT)、基础泪液分泌(Schirmer I test)值均显著低于非围绝经期干眼组(F=4.076,5.023,P<0.05);围绝经期干眼组CXCR3阳性细胞表达率显著高于非围绝经期的表达率(P<0.01)。CXCR3阳性细胞表达率与泪膜破裂时间、基础泪液分泌值均呈显著的负相关(r=-0.753,-0.684,P<0.05)。结论:可能由于性激素失衡,CXCR3及其配体介导的干眼眼表炎症在围绝经期是高发时期,其表达变化与干眼症临床检查指标密切相关。     

围绝经期女性干眼发病相关影响因素分析

围绝经期女性是干眼的高发人群。近年来关于围绝经期妇女干眼发病的研究多从炎症等局部因素或雌激素缺乏等因素论述。然而我们认为与临床其他类型干眼相比,影响该特殊类型干眼发病的相关因素颇多。本文就泪腺和结膜异常、性激素缺乏、心理障碍、全身慢性疾病、生活环境及生活习惯等方面对围绝经期干眼发病的影响进行综述。     

干眼的诊断与治疗规范

干眼是由于泪液的质或量异常引起泪膜不稳定和眼表损害所导致的最常见的眼表疾病之一.干眼症指有引起干眼的局部及全身性原因,有干眼的症状而无眼表损害者.角膜结膜干燥症为干燥综合征(Sj(o)gren syndrome,SS)的眼表改变,是干眼病的一种.干眼是干眼症及干眼病的总称[1].     

眼睑刷上皮病变与干眼相关性的初步观察

目的 探讨眼睑刷上皮病变(LWE)在不同人群中的患病率和影响因素及其与干眼的相关性.方法 为患病率研究.选择2006年9月至2007年3月于北京大学第一医院眼科就诊的141例(141只眼)患者,根据有无干眼症状及常规干眼检查(泪膜破裂时间、Schirmer I 试验及角膜荧光素染色)结果将患者分为3组:A组60例(60只眼,无干眼症状且常规干眼检查阴性)、B组51例(51只眼,有干眼症状且常规干眼检查阴性)及C组30例(30只眼,干眼组).再根据是否配戴角膜接触镜,将A组分为A1(不戴镜,30例,30只眼)和A2(戴镜,30例,30只眼)亚组,将B组分为B1(不戴镜,21例,21只眼)和B2(戴镜,30例,30只眼)亚组.行荧光素钠和丽丝胺绿染色,观察眼睑刷的病变情况,依病变程度将其分为0～3级.B组中23例(23只眼)LWE患者和C组30例(30只眼)患者行结膜印迹细胞学检查并分级.各组间年龄比较采用t检验和方差分析;各组的LWE患病率及染色分级比较均采用卡方检验;结膜印迹细胞学检测结果比较采用秩和M-W检验.结果 A、B及C组中LWE患病率分别为18.30%(11例)、86.3%(44例)及100.0%(30例);其中A,亚组、A2亚组分别为13.3%(4例)和23.3%(7例),B1亚组、B2亚组分别为81.0%(17例)和90.0%(27例).A、B及C组3组间比较差异有统计学意义(X2=78.256,P＜0.01).戴镜组(A2业组和B2哑组)分别较不戴镜组(A1亚组和B1亚组)的LWE患病率高,但二者间比较差异无统计学意义(X2=1.002,P=0.253;X2=0.854,P=0.301).B组中LWE患者印迹细胞染色结果分别为:0级17例(74.0%),1级6例(26.0%),无2级和3级;C组的印迹细胞染色结果分别为:无0级,1级12例(40.0%),2级15例(50.0%),3级3例(10.0%),两样本问比较差异有统计学意义(M-W=36.0,P＜0.01).所观察的141例患者中,有LWE者85例,无LWE者56例.有LWE的患者中,单纯荧光素钠染色阳性16例(18.8%)、单纯丽丝胺绿染色阳性12例(14.1%)、两者均阳性57例(67.1%).结论 在有干眼症状但常规干眼检查阴性的人群中LWE患病率很高.LWE可能是十眼的早期表现之一.     

干眼病的唇腺活检43例分析

Sjogren综合征主要侵害外分泌腺,组织学上以园细胞浸润为特征,损害程度相似.因此唇腺活检常用以确定诊断和判断病情.我们曾对43例干眼病做了唇腺活检,其中,干性角结膜炎(Kcs)29例,原发性和继发性Sjogren综合征各3例,Stevens-Johnson综合征5例,沙眼性干眼病2例及老年性泪腺萎缩1例.分析于下.     

围绝经期综合征睑板腺功能障碍患者的眼表及睑板腺形态和功能表现

背景 围绝经期综合征(PMS)是女性必经的重要时期,可伴随生理、病理及雌性激素水平的改变,同时会伴随一系列眼部及全身健康问题.眼部病变主要体现在眼表系统,影响患者的视觉和生活质量.目的 探讨PMS睑板腺功能障碍(MGD)患者眼表及睑板腺的形态和功能改变. 方法 采用病例对照研究方法,收集2015年1-8月在武警后勤学院附属医院42例确诊为PMS-MGD的患者,进行眼表疾病指数评估(OSDI)问卷、裂隙灯显微镜检查、干眼相关指标检查、睑板腺相关指标检查等,全身检查包括妇科基本检查及评分、围绝经期特征的性激素水平检查等,以48名同龄健康妇女作为对照组,均将右眼检查数据纳入统计分析,比较PMS-MGD组患者与对照组受检者的眼表及睑板腺形态和功能改变.结果 与对照组受检者比较,PMS-MGD组患者血液卵泡刺激素(FSH)、黄体生成激素(LH)水平明显高于对照组,差异均有统计学意义(t=55.217、76.769,均P＜0.01);患者外周血中雌二醇(E2)水平明显低于对照组,差异有统计学意义(t=-46.358,P＜0.01).PMS-MGD组患者OSDI评分为25.00(18.00,32.00),对照组为1.00(1.00,2.00),差异有统计学意义(Z=-8.043,P＜0.05).OSDI问卷调查显示PMS-MGD组患者的主要主观症状为异物感,其次依次为视物模糊、畏光、眼酸眼痛和视力下降;调查还显示患者中看电视时症状加重者16例,占38.10％,使用计算机或自助提款机时加重者10例,占23.81％,阅读困难者6例,占14.29％,夜间开车困难者4例,占9.52％,有风时症状加重者4例,占9.52％,干燥环境下加重者14例,占33.33％,空调环境下加重者16例,占38.10％,有10例患者在上述状况下未出现症状加重的表现,占23.81％,2例患者在有风环境及空调环境下同时有自觉症状加重.PMS-MGD组OSDI评分、角膜荧光染色评分均明显高于对照组,差异均有统计学意义(均P＜0.05);患者泪膜破裂时间(BUT)短于对照组,差异有统计学意义(t=-10.276,P＜0.05).PMS-MGD组患者睑缘异常评分、睑板腺缺失评分、睑板腺开口评分及睑板腺分泌物性质评分均明显高于对照组,差异均有统计学意义(Z=-7.258、-6.517、-6.195、-6.973,P＜0.05).2个组间受检眼泪液分泌试验比较差异无统计学意义(P＞0.05).结论 PMS-MGD组患者MGD功能发生改变,眼表刺激症状明显,并影响正常生活,主诉以异物感最多,看电视时及空调环境下症状加重的患者比例高,睑板腺形态明显异常.     

航天科技人员干眼相关因素的调查分析及健康指导

目的:调查分析航天科技人员干眼的发病情况及相关影响因素,并根据研究结果指导其用眼卫生,改善生活工作习惯,从而加强眼部健康。方法:对2013-09/2014-06于我院体检中心进行健康体检的在职航天科技人员经过初筛,针对有干眼常见症状者进行问卷调查评分及客观临床检查。临床检查包括基础泪液分泌量检测(SchirmerⅠ)、泪膜破裂时间(BUT)测定、角结膜荧光素染色(FL),以确诊干眼。结果:在随机发放的1 000份调查问卷中有干眼主诉症状者606例(60.6%),经检查后确诊干眼的为432例(43.2%);干眼在航天科技人员主诉人群中的阳性率为71.3%;航天科技人员干眼病患病人数较多,病因除性别、年龄外,还与空调、暖气、视频终端、睡眠时间等多种影响因素密切相关。结论:干眼已逐渐成为一种流行性疾病,其症状表现多样,病因复杂,航天科技人员干眼的致病因素主要与其工作环境及方式、局部因素有关,因此应引起足够重视,根据导致干眼的不同因素给予相应的健康指导,以减少干眼的发生及控制干眼的症状。同时在眼科体检中也应把干眼筛查相关的系列检查作为常规检查项目。     

干眼病的诊断,附45例分析

干眼病诊断困难。如干性角结膜炎(kcs)和原发性Sjogren综合征的早期,容易漏诊或错诊。晚期上皮皮肤样变后,干眼易诊,鉴别诊断却又困难。现将近年所见45例干眼病的主要临床特点作一分析,并着重研讨二类较常见干眼病的诊断问题。     

15例儿童干眼症误诊为弱视原因分析

目的通过分析临床上将儿童干眼误诊为弱视的原因,进一步了解儿童干眼症,以避免及减少误诊。方法回顾性病例分析。对大理州人民医院门诊诊断为弱视的4～7岁患儿15例行验光检查,验配度数处于临界,伴有部分眼表刺激症状,且弱视治疗效果不佳,进行干眼相关检查。结果15例患儿进行干眼检查[Schirmer′s Ⅰ试验（SIT）、泪膜破裂时间（BUT）、泪河宽度（TMH）]后确诊为干眼,经干眼药物治疗后视力恢复。结论儿童干眼在临床上易被漏诊及误诊,应做详细的病史采集及眼部专科检查,对干眼高危儿童应行干眼检查。     

围绝经期性激素水平下降所致兔干眼症模型的建立

目的 建立围绝经期性激素水平下降所致的干眼症白兔模型,为探讨围绝经期性激素水平下降导致干眼症的发病机制和实验治疗提供依据.方法 对6只成年白兔采用双侧卵巢切除术制作干眼症模型,术后饲养45 d,同时取6只正常白兔作空白对照,2组均采用Schirmer Ⅰ试验观察其基础泪液分泌量、测定泪膜破裂时间观察其泪膜稳定性的改变,并进行形态学(光镜、免疫组织化学)检测.结果 白兔模型建立后,模型兔Schirmer Ⅰ实验测量值明显低于正常白兔(P＜0.01)、泪膜破裂时间明显短于正常白兔(P＜0.01),泪腺导管及腺泡上皮细胞中IL-1β、TNF-α、Fas、FasL、Bax阳性表达的细胞数均明显高于正常白兔(P＜0.01),而TGF-1β、bcl-2阳性表达的细胞数与正常相比差异无统计学意义.结论 双侧卵巢切除术是成功的围绝经期性激素水平下降导致的干眼症白兔模型的造模方法,能模拟围绝经期干眼症自然临床病理过程,为研究实验治疗围绝经期干眼症提供了较为理想的动物模型.     

Is complete androgen insensitivity syndrome associated with alterations in the meibomian gland and ocular surface?

PURPOSE: This study's purpose was to determine whether complete androgen insensitivity syndrome (CAIS) is associated with alterations in the meibomian gland and ocular surface. METHODS: Individuals with CAIS, as well as age-matched female and male controls, completed questionnaires which assessed dry eye symptoms and underwent slit lamp evaluations of the tear film, tear meniscus, lids and lid margins and conjunctiva. The quality of meibomian gland secretions was also analyzed. RESULTS: Our results demonstrate that CAIS is associated with meibomian gland alterations and a significant increase in dry eye signs and symptoms. Clinical assessment revealed that CAIS women, as compared to controls, had a significant increase in telangiectasia, keratinization, lid erythema and orifice metaplasia of the meibomian glands, and a significant decrease in the tear meniscus and quality of meibomian gland secretions. Questionnaire results showed that dry eye symptoms were increased over twofold in CAIS individuals, as compared to controls, including a significant increase in the sensations of dryness, pain and light sensitivity. CONCLUSION: Our results suggest that androgen insensitivity may promote meibomian gland dysfunction and an increase in the signs and symptoms of dry eye.     

126例干眼病因分析

目的 分析干眼的病因,为干眼症的诊断提供重要依据.方法 回顾126例干眼病例的临床资料,对干眼的症状、泪膜破裂时间、泪液分泌、角膜荧光素染色、睑板腺功能检查、裂隙灯检查及眼表损害等进行分析.结果 126例患者中泪膜破裂时间均异常(100％),泪液分泌试验低于正常83例(65.87％),角膜荧光染色异常者13例(10.32％),睑板腺开口阻塞30例(23.81％).结论 干眼症状与多种因素有关,了解干眼相关因素积极寻找干眼症的病因,为临床诊断提供主要依据,减少误诊的发生.     

Characterising the ocular surface and tear film in a population-based birth cohort of 45-year old New Zealand men and women

PurposeTo assess the prevalence of dry eye disease, aqueous tear deficiency, meibomian gland dysfunction, and asymptomatic ocular surface disease in a population-based cohort of 45-year-old New Zealand men and women.MethodsThis cross-sectional study of 885 participants (442 females, 443 males) was based on a population-representative birth cohort of individuals born between April 1 1972 and March 31 1973 in Dunedin, New Zealand (the Dunedin Multidisciplinary Health and Developmental Study). Participants were assessed at 45 years of age, and dry eye symptomology, ocular surface characteristics, and tear film quality were evaluated for each participant within a single clinical session. The diagnosis of dry eye disease was made according to the validated rapid non-invasive dry eye assessment algorithm.ResultsClinical dry eye signs were present in 402 (45%) participants, of which 78 (9%) participants fulfilled the diagnostic criteria for dry eye disease, and 322 (37%) had asymptomatic ocular surface disease. Among participants with dry eye disease, 22 (2%) exhibited aqueous tear deficiency, and 65 (7%) had meibomian gland dysfunction. Females were more likely to be affected by dry eye disease, meibomian gland dysfunction, and asymptomatic ocular surface disease (all p < 0.05).ConclusionsClinical dry eye signs were present in almost half of this population-based cohort of 45-year-old New Zealanders, although only 9% of participants fulfilled the diagnostic criteria for dry eye disease. The high prevalence of asymptomatic ocular surface disease presents an opportunity for preventative public health intervention.     

上海市北新泾社区60岁及以上人群干眼的流行病学调查

目的 调查上海市北新泾社区60岁及以上人群干眼的患病情况,从而了解社区人群干眼的患病特征,更好地制定干眼的防治措施.方法 2008年1～5月对上海市北新泾社区60岁及以上人群作抽样调查,所有样本均进行问卷调查并进行裂隙灯、Schirmer I test、BUT、荧光素染色及DR-1干眼仪等检查.依据目前公认的国内干眼诊断标准进行诊断,并对其结果运用SPSS统计软件包进行分析处理.结果在800分问卷中,共746人参与答卷,应答率为93.25%.其中诊断为干眼者185例,男性65例,女性120例.并得出本课题社区调查对象中干眼的患病率为24.8%(185/746),男性患病率为22.0%,女性患病率为26.6%.全身疾病(高血压、糖尿病、冠心病、哮喘、过敏、吸烟)及用药可能促进干眼的发生. 结论 干眼是多因素导致的疾病,60岁及以上人群干眼的发病与老年人泪液分泌功能下降、睑板腺功能障碍有关.     

Systemic risk factors of dry eye disease subtypes: A New Zealand cross-sectional study

PurposeTo evaluate systemic risk factors of dry eye disease, aqueous tear deficiency, and meibomian gland dysfunction.MethodsThree hundred and seventy-two community residents (222 females, 150 males; mean ± SD age, 39 ± 22 years) were recruited in a cross-sectional study. Past medical history, dry eye symptomology, ocular surface characteristics, and tear film quality were evaluated for each participant within a single clinical session. The diagnosis of dry eye disease, aqueous tear deficiency, and meibomian gland dysfunction were based on the global consensus recommendations of the Tear Film and Ocular Surface Society's Dry Eye Workshop II (TFOS DEWS II) and International Workshop on Meibomian Gland Dysfunction.ResultsOverall, 109 (29%) participants fulfilled the TFOS DEWS II criteria for dry eye disease, 42 (11%) had aqueous tear deficiency, and 95 (26%) had meibomian gland dysfunction. Multivariate logistic regression analysis demonstrated that systemic rheumatologic disease and antidepressant medication were independently associated with aqueous tear deficiency (both p < 0.05). Significant risk factors for meibomian gland dysfunction included age, East Asian ethnicity, migraine headaches, thyroid disease, and oral contraceptive therapy (all p ≤ 0.01).ConclusionsBoth etiological subtypes of dry eye disease were associated with a number of systemic risk factors. These findings would support routine systemic inquiry of dry eye disease and associated systemic conditions and medications, in order to facilitate opportunistic screening and timely inter-disciplinary referral where necessary.     

干眼患者115例的临床特点分析

目的　分析各种类型干眼患者的临床特点。方法　回顾性分析 115例 ( 2 2 9只眼 )干眼患者的临床资料 ,包括症状、病因、全身病、裂隙灯检查、泪膜破裂时间检查 (break uptime,BUT)、基础泪液分泌试验 (SchirmerⅠtest,SⅠt)、反射泪液分泌试验 (SchirmerⅡtest,SⅡt)、角结膜荧光素(fluorescent,Fl)染色、虎红 (rosebangle ,Rb)染色及睑板腺功能的检查。对Sj gren综合征 (Sj grensyndrome,SS)者行血清类风湿因子、自身抗体及涎腺分泌功能检查。结果　 115例中 ,水液缺乏性干眼(aqueousteardeficiency ,ATD)者 5 6例 ( 48 7% ) ,蒸发过强型干眼者 40例 ( 34 8% ) ,混合型干眼者 16例( 13 9% ) ,结膜松弛综合征者 4例 ( 3 5 % )。SS患者 13例 ( 11 3% )。在各型干眼患者中 ,女性多于男性 ,尤其是ATD患者 ,原发性SS ATD患者 10 0 %为女性 ,43例非SS水液缺乏性干眼 (non SSaqueousteardeficiency ,NSTD)者中女性 35例 ( 81 4% )。临床特点 :干涩症状者 6 3例 ( 84 0 % ) ,视疲劳者 5 4例( 72 0 % ) ,异物感者 48例 ( 6 4 0 % ) ,视力波动者 42例 ( 5 6 0 % ) ,睑板腺功能障碍 (meibomainglanddysfunction ,MGD)者 35例 ( 30 4% )。各类型干眼患者的BUT、Rb、Fl间均有明显的相关性 ,Rb与Fl间相关性高 (r =     

中西医结合治疗肝肾阴虚型干眼症的疗效观察

目的:通过对肝肾阴虚型干眼症患者采用“复明片”加减联合睑板腺疏通法临床治疗的疗效观察,说明中西医结合治疗肝肾阴虚型干眼症可以收到良好的效果。方法:对符合干眼症诊断标准的400例患者的性别、年龄、症状、临床表现进行详细记录并进行严格的中医辨证分型,并对辩证为“肝肾阴虚”型的干眼症患者90例随机分三组治疗:A组30例给予“复明片”加减联合睑板腺疏通法加人工泪液治疗;B组30例给予睑板腺疏通法加人工泪液治疗;C组30例给人工泪液治疗。三组患者的自觉症状、泪液分泌试验（SchirmerⅠtest,SⅠt）、泪膜破裂时间（tear break-up time,BUT）、角膜荧光素染色(fluorescein staining,FL)和角膜地形图的角膜表面规则指数（surface regularity index,SRI）和角膜表面不规则指数（surface asymmetry index,SAI）结果作为观察指标,对观察数据进行统计分析,每组治疗前后行配对资料的秩和检验;对三组的疗效行多个样本间两两比较的秩和检验。结果:A组观察指标改善情况及疗效明显优于B,C两组;B组的又优于C组;三组的有效率分别是90.0%,73.3%和53.3%;结论:对肝肾阴虚型干眼症,采用“复明片”加减联合睑板腺管疏通术和人工泪液的治疗方法可以取得良好的治疗效果。睑板腺功能障碍（MGD）直接相关或合并MGD是干眼症的病因之一;同时角膜地形图可以协助诊断和评价干眼症的严重程度和治疗效果。      

Prevalence of dry eye in Bangkok, Thailand

PURPOSE: To estimate the prevalence of dry eye in the adult population of Bangkok, Thailand. METHODS: Five hundred fifty volunteers 40 years of age or more who presented to the Ramathibodi Hospital for annual eye examinations were enrolled. Interviewers administered a dry eye symptoms questionnaire. Slit-lamp examination and objective dry eye assessment consisting of tear film breakup time (TBUT), fluorescein corneal staining, Schirmer tests, and meibomian gland evaluation were performed. Outcome measures included frequency of symptoms and positive dry eye tests. RESULTS: Thirty-four percent reported significant symptoms, which were defined as having one or more symptoms often or all of the time (95% confidence interval, 28.1-40.6). Approximately one half had meibomian gland disease (MGD) or pingueculum/pterygium (46.2 and 53.8%, respectively). Individuals with significant symptoms tended to be women (83.4%, P = 0.024), had MGD (63.6%, P = 0.006), had current artificial tear use (33.2%, P = 0.024), and had positive TBUT (80.7%, P = 0.000) and fluorescein staining (16.6%, P = 0.013.) The presence of pingueculum/pterygium and MGD were significantly associated with positive dry eye tests. CONCLUSION: This is the first report of prevalence of dry eye inclusive of signs and symptoms in an elderly Thai population. The prevalence of disease diagnosed on the basis of symptoms and dry eye tests was approximately 2 to 3 times higher than reported in whites. Women were more likely to report symptoms. Positive associations with dry eye tests were found in subjects with pingueculum/pterygium and MGD.     

干眼检查方法的研究进展

干眼是以泪膜稳态失衡为主要特征并伴有眼部不适症状的多因素眼表疾病。近年来,干眼的发病率逐年增多,有关干眼的诊断与治疗也在不断地发展、创新,但由于传统检查方法存在相应的弊端而新型检查方法尚缺乏大量的临床试验研究,目前干眼的诊疗仍缺乏一套统一的“金标准”。本文对国内外有关干眼的不同检查方法的文献进行了广泛搜索,包括有前景的检查工具和技术的最新进展及其存在的争议,从而通过泪液量、泪膜的性质、眼睑及睑板腺和眼表上皮细胞损害程度的检查等方面做一综述,为干眼的诊断和治疗提供参考。     

Ageing and the natural history of dry eye disease: A prospective registry-based cross-sectional study

PurposeTo investigate the impact of ageing on ocular surface parameters, and empirically determine optimal prognostic cut-off ages for clinical markers of dry eye disease, aqueous tear deficiency, and meibomian gland dysfunction.MethodsA total of 1331 community residents (785 females, 546 males; mean ± SD age, 38 ± 19 years) were recruited in a prospective registry-based cross-sectional study. Dry eye symptomology, ocular surface characteristics, and tear film quality were evaluated for each participant within a single clinical session, in accordance with the global consensus recommendations of the TFOS DEWS II reports.ResultsMultivariate regression analysis demonstrated positive associations between ageing and clinical markers of dry eye disease (all p ≤ 0.001). The Youden-optimal prognostic cut-off ages for signs of meibomian gland dysfunction occurred during the third decade of life (24–29 years); the optimal predictive ages for lid wiper epitheliopathy, tear film instability, hyperosmolarity, and dry eye symptoms occurred during the fourth decade of life (31–38 years); while the optimal prognostic thresholds for signs of aqueous tear deficiency and ocular surface staining occurred in the fifth and sixth decades of life (46–52 years).ConclusionsAdvancing age is a significant risk factor for dry eye disease, which represents a growing public health concern with the ageing population worldwide. Signs of meibomian gland dysfunction appeared earlier in the natural history of disease progression, and the brief delay prior to the development of other clinical dry eye signs might represent a window of opportunity for preventative interventions in the young adult age group.