复发性儿童睑缘炎导致干眼的临床观察

目的探讨儿童期反复发作的睑缘炎导致相关性干眼治疗后泪膜功能的变化。方法选取2013年4月~2014年1月就诊于山西省眼科医院门诊角膜科的患儿36例(55只眼)进行观察,治疗前后分别行眼前节检查,对比睑板腺功能评分、泪膜破裂时间(trar break-up time,BUT)检查、泪液分泌试验(Schirmer I test,SIt)及角膜荧光素染色试验(fluorescein,FL)。结果患儿的泪膜功能均有不同程度的异常。患者治疗前后的睑板腺功能评分、BUT试验和FL评分有明显变化;SIt差异无统计学意义(P0.05);睑板腺功能评分与BUT呈负相关(r=-0.667,P=0.000),与FL呈正相关(r=0.722,P=0.000),与SIt无明显相关性(r=-0.108,P=0.457)。结论在临床上睑缘炎导致的蒸发过强型干眼患儿,若睑缘炎得到良好的治疗,并且联合使用人工泪液,配合局部外用中药,患儿的自觉症状能够明显好转,泪膜稳定性有所提高,且可防止睑缘炎的复发。     

儿童轻度过敏性结膜炎中干眼的研究及治疗

目的〖KG*2〗探讨儿童轻度过敏性结膜炎中干眼发生的原理及不同方案疗效,为过敏性结膜炎的治疗提供指导依据。 〖HTH〗方法〖KG*2〗回顾性分析4～10岁轻度过敏性结膜炎患儿（观察组）101例及健康儿童（对照组）100例。过敏性结膜炎患儿检测过敏原。比较2组泪膜破裂时间(tear film breakup time,BUT)、角膜荧光素染色（fluorescein,FL）评分、泪河高度（tear meniscus height,TMH）,分析BUT、FL评分、TMH与病程的相关性。观察组根据治疗方案中是否有人工泪液分为A组42例和B组59例,比较A、B组治疗前后BUT、FL评分、TMH。 〖HTH〗结果〖KG*2〗观察组BUT短于对照组;FL评分高于对照组（P＜0.01）;2组TMH差异无统计学意义(P＞0.05）。观察组过敏性结膜炎BUT与病程呈负相关（r=-0.439,P＜0.01）,FL评分与病程呈正相关（r=0.396,P＜0.01）,TMH与病程无相关性（r=0.043,P＞0.05）。治疗后,A、B组BUT长于治疗前,FL评分低于治疗前,A组TMH高于治疗前;A组BUT长于B组,FL评分低于B组,TMH高于B组,差异有统计学意义（P＜0.05）。 〖HTH〗结论〖KG*2〗儿童过敏性结膜炎通过降低双眼泪膜稳定性,破坏角膜上皮完整性,造成干眼症状,而对泪液分泌无显著影响。病程越长泪膜稳定性越低,角膜上皮破坏越严重。联合人工泪液治疗过敏性结膜炎效果更佳。     

探讨过敏性结膜炎导致干眼症的临床分析

目的探究分析过敏性结膜炎导致干眼症的临床情况。方法选择医院眼科门诊部2018年3月至2019年2月诊断为过敏性结膜炎患者为观察组55例(110只眼睛),男26例(52只眼睛),女29例(58只眼睛),平均年龄(44.26±13.08)岁,该组患者为过敏性结膜炎。经诊断较多的患者出现眼痒,并且出现异物感、灼烧感、干涩、视力模糊、瞬目次数增减、视疲劳以及畏光等临床表现特征,使得患者无法正常生活。对照组患者55例(110只眼睛),男30例(60只眼睛),女25例(50只眼睛),平均年龄(44.51±13.15)岁,此组患者为健康者。经过试验证明,观察组患者的大多过敏源都为阳性。以上两组均采用泪液分泌试验、裂隙灯检验、角膜荧光素染色试验、泪河线的测量以及泪膜破裂时间检查。结果左右眼的TMH、FL、SIt以及BUT的指标进行分析,其结果显示左右眼之间的指标存在着一定的相关性,P0.05;经过两组的相关指标进行对比,观察组的FL明显高于对照组,但是观察组的TMH、BUT以及SIT明显低于对照组,P0.05,差异具有统计学意义。结论由于患者出现过敏性结膜炎,从而引起自身的泪膜稳定性出现异常情况,引发患者出现干眼症,并且疾病的严重程度与患者自身的泪膜功能变化存在紧密的联系。     

高龄白内障患者手术前后泪膜变化

目的了解高龄患者白内障手术后泪膜的变化情况。方法 选择行白内障手术的高龄（〉80岁）患者48例（60眼）作为高龄组，随机抽取老年性白内障患者54例（60眼）作为对照组，分别于术前，术后1、3、7、30、90及180d行症状、泪膜破裂时间（bmak-up time，BUT）、基础泪液分泌试验（schimmer Itest，SIt）、角膜荧光素染色（FL）调查。砖果①与术前相比，两组术后3个月内主诉眼部不适症状的患者较术前明显增加。术后老年组1周SIt明显增加．1个月BUT明显缩短、FL明显增高（P〈0．05）。对照组1周BUT和SIt，1个月FL与术前比较差异有统计学意义（P〈0．05）；②两组术后BUT和SIt比较显著缩短（P〈0，05），SIt的恢复程度没有显著区别，老年组BUT和FL的恢复较对照组时间长。结论白内障手术在一段时期内可影响泪膜的稳定性，高龄患者的术后恢复时间较长，应注意术前对泪膜功能检测和术中、术后对泪膜的保护。     

结膜印迹细胞学与干眼症状和体征的相关性

目的 分析丫啶橙荧光染色结膜印迹细胞学（CICAO）检查与干眼症状和体征的相关性。方法 选取152例（303眼）干眼患者和60名（120眼）正常对照者,采集干眼患者症状（干涩感、异物感、烧灼感、眼睛红、分泌物增多、眼睑沉重感、视疲劳、畏光、流泪、痒感、眼痛、视力波动）,对所有受试者进行泪液分泌试验（SIt）、泪膜破裂时间(BUT)、角膜荧光素钠染色(FL)、虎红染色(RB)及CICAO检查。采用Spearman等级相关分析检验CICAO与干眼症状及SIt、BUT、FL和RB的相关性。结果 CICAO与干眼症状中的干涩感、流泪、眼痛有显著相关性（r=0.337, r=－0.278, r=0.395;均P＜0.05)。CICAO与RB、SIt、BUT、FL均有显著相关性（r=0.757,r=－0.668,r=－0.549,r=0.428;均P＜0.01)。结论 CICAO与干眼症状的相关性较低,与RB、SIt、BUT、FL均具有显著相关性。CICAO可为干眼的临床分级诊断和治疗提供可靠的依据。     

逍遥散加味方对过敏性结膜炎患者泪膜功能的影响

目的探讨逍遥散加味方对过敏性结膜炎患者泪膜功能的影响。方法取2013年3月至2015年4月中国中医科学院望京医院眼科门诊60例诊断为过敏性结膜炎患者,中医辨证为肝郁气滞型。将所有患者随机分为观察组和对照组,每组30例。观察组局部点色甘酸钠滴眼液联合逍遥散加味方干预治疗;对照组单纯局部点色甘酸钠滴眼液,两组干预治疗2周后,观察临床症状积分、基础泪液分泌试验(SIt)、泪膜破裂时间(BUT)、角膜荧光素染色(FL)情况。结果对照组治疗后临床症状积分较治疗前明显下降(P0.05),其他指标与治疗前比较差异无统计意义(P0.05)。观察组与本组治疗前比较,治疗后患者临床症状积分显著下降,SIt明显增多,BUT延长,FL积分减少,差异有统计意义(P0.05)。治疗后两组各项指标间差异均有统计意义(P0.05),说明观察组疗效显著优于对照组。结论逍遥散加味方联合色甘酸钠滴眼液,能明显改善过敏性结膜炎患者泪膜功能,减少干眼症的发生。     

过敏性结膜炎与干眼症发生的相关性研究

目的:探讨过敏性结膜炎与干眼症发生的相关性。方法:选择我院2015年2月-2016年2月收治的65例过敏性结膜炎患者入组观察组,选择同期在我院进行眼部检查的40例正常志愿者入组对照组。所有患者均接受裂隙灯检查、泪膜破裂时间检查、角膜荧光素染色试验、基础泪液分泌实验等。回顾性分析两组患者的检查结果,分析过敏性结膜炎与干眼症发生的相关性。结果:观察组患者34例出现干眼症,且检查发现其泪膜功能存在不同程度的异常,Si T、BUT、FL等指标与对照组患者相比,差异有统计学意义(P0.05)。结论:过敏性结膜炎患者的泪膜功能存在一定的异常情况,其稳定性较低,易导致干眼症的发生,一旦出现干眼症的症状,要及时进行处理。     

浅析儿童由于过敏性结膜炎所导致的干眼症的研究观察

目的本文主要是分析了儿童过敏性结膜炎所造成的泪膜功能变化。方法治疗组和对照组分别进行裂隙灯、泪膜破裂时间检查、泪液分泌实验、角膜荧光素染色实验。结果患儿的泪膜功能均有不同程度的异常,泪膜破裂时间、泪液分泌实验、角膜荧光素染色与对照组比较均有明显的统计学差异。治疗组患儿的泪膜破裂时间与泪液分泌实验、角膜荧光素染色检查不具有相关性,泪膜破裂时间与角膜荧光素染色检查有相关性。结论过敏性结膜炎会降低患儿的泪膜稳定性,造成干眼症;该病往往是双眼发生,并且泪膜功能的改变与之疾病的严重程度有着明显的关系。     

三联手术治疗青光眼合并白内障术后患者泪膜功能的临床分析

目的:探讨小梁切除联合白内障超声乳化人工晶状体植入术治疗青光眼合并白内障手术前后对泪膜功能的影响。方法:选取青光眼合并白内障患者30例(30眼)为观察对象,以对侧健眼为对照,于术前1 d及术后1月、3月、6月分别记录泪膜破裂时间(BUT)、泪液分泌试验(SIt)、角膜荧光素染色(FL)及泪膜干涉图像检查结果,术前与健眼对照,术后不同时间结果与术前对照。结果:术前与健眼比较:患眼的BUT缩短(P<0.05)、SIt减少(P<0.05)、FL评分高于健眼(P<0.05)、泪膜正常干涉图像比率低于健眼(P<0.05)。患眼手术前后比较:术后1个月,BUT比术前缩短(P<0.05),SIt比术前减少(P<0.05),FL评分比术前增高(P<0.05),泪膜正常干涉图像比率比术前减少(P<0.05);术后3个月,BUT及FL评分仍存在差异(P<0.05),而SIt及泪膜正常干涉图像比率已接近术前水平(P>0.05);术后6个月,4项试验与术前比较均无统计学意义(P>0.05)。结论:青光眼合并白内障患者术前已存在泪膜功能异常,三联手术后早期会对患者泪膜功能造成影响,降低泪膜的稳定性,远期泪膜功能会逐渐恢复到术前水平。     

糖尿病患者病情与泪膜功能和角结膜上皮改变的相关性分析

目的：探讨糖尿病患者病程、血糖控制状况以及糖尿病视网膜病变与泪膜功能和角结膜上皮改变的相关性。方法：分别测定54例（108眼）2型糖尿病患者（糖尿病组）和30例（60眼）对照组泪膜破裂时间（BUT），行基础泪液分泌（Schirmer-I)试验、角膜荧光素染色（FL）、结膜印迹细胞学（CLC）检查，并将检测结果与糖尿病病程、血糖控制状况以及糖尿病视网膜病变情况进行相关性分析。结果：糖尿病组BUT值、Schirmer-I试验值均低于对照组，且BUT值、Schirmer-I试验异常率均高于对照组（均P＜0．05）。糖尿病组较对照组结膜上皮细胞鳞状化生级别增加、杯状细胞密度下降，且角膜FL累积分增加（均P＜0．01）。糖尿病病程、血糖控制状况以及糖尿病视网膜病变严重程度与BUT值、Schirmer-I试验值、结膜上皮细胞鳞状化生级别、杯状细胞密度和角膜FL累积分间有显著的相关性（均P＜0．01）。结论：糖尿病患者存在泪膜功能的损害以及角结膜上皮的损害，且糖尿病病程长、血糖控制状况差和糖尿病视网膜病变严重者，损害程度亦重。     

Pediatric allergic conjunctivitis and allergic rhinitis

Objective: To assess the relationship between allergic conjunctivitis(AC) and allergic rhinitis(AR) in pediatric ophthalmology and E.N.T outpatient clinic. Methods:Eight hundred and ninety two patients were enrolled in survey during Mar. 2005～ Jan. 2007, 407 allergic conjunctivitis cases were placed in the ophthalmology clinic group and 485 allergic rhinitis cases were from the E.N.T clinic. The comorbid disorders, histories, symptoms, signs of patients were recorded. Type 1 allergy was tested in 479 cases by a specific IgE antibody blood test. Eosinophils were detected in superficial conjunctival scrapings of the superior tarsal conjunctiva and mucosa surface scrapings of middle nasal meatus in 88 cases with both diseases. Results:302(74%), 374(92%), 116(29%) in 407 cases with allergic conjunctivitis had concomitant eczema, rhinitis and asthma, respectively; 334(69%), 430(89%), 145(30%) in 485 cases with allergic rhinitis had concomitant eczema, allergic conjunctivitis and asthma, respectively. The prevalence of allergic conjunctivitis concomitant allergic rhinitis and allergic rhinitis concomitant allergic conjunctivitis had no significant difference(x2=2.6, P > 0.05). The prevalence of allergic conjunctivitis and allergic rhinitis concomitant eczema and asthma also had no significant difference (x2=3.08; x2=0.21, P > 0.05). The degree of severity of two kinds of disease symptoms is not parallel, in the patients with seasonal allergic conjuctivitis(SAC) and perennial allergic conjunctivitis(PAC), the clinical signs of AR were always severer(x2=258.2, P < 0.05) than those of AC. However, the results coincided with the cases with vernal keratoconjuctivitis(VKC)(x2=66.5, P < 0.05); Eosinophils were revealed in 50(57%) conjunctival scrapings and nasal mucosa scrapings(x2=1.5, P > 0.05), 47(53%) cases had positive results in both scrapings. The main aeroallergens were house dust mites, house dust and fungi, and the main food-allergens were fish, crab and shrimp. Conclusion:The two disorders were shown to share more similarities than differences, as suggested that allergic conjunctivitis should be considered in future guidelines on preventing the development of rhinitis and asthma in children.     

Th1/Th2/Th17细胞在实验性过敏性结膜炎中的作用研究

目的  探讨Th1/Th2/Th17细胞在实验性过敏性结膜炎发病中的可能作用。方法  40只Brown Norway大鼠随机分为3组：空白组、对照组和实验组。应用鸡卵清蛋白（OVA）复制大鼠过敏性结膜炎模型。取3组大鼠眼球及上下眼睑进行病理学分析,计数穹隆部结膜嗜酸性粒细胞浸润数。ELISA法测定大鼠血清IgE、IgG1、IgG2a和脾细胞培养上清液IL-17、IL-4、IL-6、IL-10、IFN-γ含量。流式细胞仪测定大鼠外周血和脾脏Th17细胞。结果  实验组大鼠穹隆部眼结膜嗜酸性粒细胞浸润数较空白组和对照组升高（P <0.01）。实验组大鼠血清IgE、IgG1较空白组和对照组升高（P <0.01）,血清IgG2a较空白组和对照组降低（P <0.01）。实验组大鼠血清脾细胞培养上清液IL-17、IL-4、IL-6、IL-10水平较空白组和对照组升高（P <0.01）,IFN-γ水平较空白组和对照组降低（P <0.01）。实验组大鼠外周血和脾脏Th17细胞均高于空白组和对照组（P <0.01）。结论  Th1/Th2/Th17细胞平衡失衡是大鼠实验性过敏性结膜炎发病的主要原因。恢复Th1/Th2/Th17失衡可能成为过敏性结膜炎治疗的一条新途径。

     

伏九贴疗法合匹多莫德片治疗儿童咳嗽变异性哮喘的临床观察

目的评价伏九贴疗法配合口服匹多莫德片治疗儿童咳嗽变异性哮喘的临床疗效。方法将2008年6月～2009年6月就诊符合儿童过敏性咳嗽诊断标准的64例门诊患儿,按随机数字表分为治疗组和对照组。治疗组32例,给予贴敷伏九贴配合口服匹多莫德片;对照组32例,仅给予口服匹多莫德片。治疗期间停止一切影响免疫功能的药物。两组均以1年为1个疗程,1个疗程结束后统计疗效。结果治疗组痊愈16例,有效13例,无效3例,总有效率为90.6%;对照组痊愈7例,有效12例,无效13例,总有效率为59.3%,治疗组疗效优于对照组（P〈0.05）。结论伏九贴疗法配合口服匹多莫德片对控制儿童咳嗽变异性哮喘患儿有较好疗效,且穴位贴敷疗法无痛无创、副作用小,易于坚持,适合临床推广应用。     

弱视儿童立体视训练联合综合疗法疗效分析

目的研究弱视患儿立体视训练联合综合疗法的视力改善情况以及立体视觉变化。方法将65例130眼患者随机分为两组:治疗组33例66眼,采用立体视训练联合综合疗法治疗;对照组32例64眼,予以综合疗法治疗,观察两组的临床疗效。结果经1年治疗后,治疗组及对照组患眼视力均明显提高。治疗后两组间立体视差异有统计学意义(P<0.01)。治疗组不同类型弱视患者经治疗后,屈光不正性弱视患者的立体视觉恢复最好(P<0.01),屈光参差性弱视患者的立体视恢复差异有统计学意义(P<0.05),而斜视性弱视例数较少,差异无统计学意义。结论立体视训练联合综合疗法对儿童弱视立体视恢复有较好的疗效,立体视可以作为检测弱视眼视力好转的有力证据。     

Asthma, atopic eczema and allergic rhino-conjunctivitis in school children

International Study of Asthma and Allergies of Childhood (ISAAC) phase one study had already been completed in two age groups in 156 collaborating centers of 56 countries involving a total of 721601 children. Bangladesh did not participate earlier in this worldwide study. To determine the prevalence of asthma, allergic rhinitis and eczema in school children of Dhaka district using ISAAC protocol. A school based cross sectional study done in 2000 by using both written questionnaires (WQ) and video questionnaires (VQ). Students of class-VIII (13-14 years) filled up both the WQ and VQ and the parents of class I (6-7 years) filled up only the WQ on behalf of the students. Sixty five (6)5 primary schools and 39 high schools were randomly selected from all 19 thanas to cover equally both the urban and rural schools of the entire area of Dhaka district. A total of 6260 written questionnaires were eligible for the analysis (3029 form 6-7 years of class I and 3231 from 13-14 years of class VIII). In addition, the validated international video questionnaires were used for the older age group (3231). The symptoms of atopic diseases in the previous 12 months or ever in all children, both age groups, both sexes and in both urban and rural areas. The life time (ever) and 12-month period (recent) prevalence of three allergic conditions with 95% CI were as follows : wheezing 13.8% (12.9-14.6), 7.6% (6.9-8.2); allergic rhinitis 25.0% (23.9-26.1), 20.0% (19.1-21.1) and eczema 8.7% (CI 8.0-9.4), 6.5% (5.9-7.2). respectively. The prevalence of wheezing and other atopic features in both age groups of 6-7 years and 13-14 years showed higher features of recent wheeze in the younger children than in the older children, recent wheeze 9.1% Vs 6.1%; but the other atopic features were found lower in younger age group, recent rhinitis 16.3% Vs 23.5%, 0.001; conjunctivitis 6.4% Vs 8.3%, 0.001; recent eczema 6.0% Vs 7.1% 0.001. Male children were found to be more suffering from all types allergic conditions than their female peers: recent wheeze 9.0% Vs 5.9%, recent rhinitis 21.9% Vs 17.9%, recent allergic conjunctivitis 8.7% Vs 6.7% and recent eczema 6.8% Vs 6.2%). Though the prevalence of asthma and atopic eczema was lower than those of developed countries but still appeared to be a major health problem for our children. Allergic rhinitis was the commonest of all atopic problems in children. The younger children (6-7 years) were more likely to suffer from wheeze (asthma) but other allergic problems were more in older group of children (13-14 years). Male children were more prone to all types of allergic problems, whether wheeze or other atopic conditions, than the female peers.     

567例变态反应性结膜炎过敏原检测临床分析

目的探讨变态反应性结膜炎过敏原检测方法和过敏原类型分布,了解过敏所占比例情况与临床的相关性。方法对567例变态反应性结膜炎患者采用安脱达试剂进行皮肤点刺试验（SPT）,其中42例附加采用阿罗格试剂进行皮肤点刺试验。结果安脱达试剂检测阳性率83．95％（476例）,阴性率16．05％（91例）,其阳性率患者中42例附加阿罗格试剂检测全部显示阳性结果,螨类居首位占90．19％。结论皮肤点刺试验可直接快速查到变态反应性结膜炎的确切过敏原,螨类是最强的过敏原,同一患者可同时对多种过敏原致敏反应,并与睑结膜滤泡大小数目分布情况密切相关。     

Beclomethasone dipropionate aerosol in the treatment of children with severe perennial rhinitis.

Twenty-two children suffering from severe perennial rhinitis were treated with intranasal beclomethasone dipropionate (300 microgram/day) and an identical placebo aerosol in a double-blind cross-over trial. The results confirmed the value of beclomethasone dipropionate in improving nasal symptoms and signs due to perennial rhinitis, and allergic eye symptoms caused by associated conjunctivitis.     

消风散加减联合富马酸依美斯汀滴眼液治疗过敏性结膜炎临床研究

<正>过敏性结膜炎会引起结膜充血等症状,显著降低患者的生活质量,严重者影响到角膜,导致角膜瘢痕和泛眼膜^[1]。中医药治疗过敏性结膜炎临床疗效显著^[2]。中医学认为本病归属于“时复症”“目痒症”范畴,患者外感风热邪气,郁滞睑肤肌腠,眼睑内遍生卵石状颗粒,眼痒难忍,灼热微痛,发为本病,治疗以祛风止痒为治疗原则。本研究予消风散加减联合富马酸依美斯汀滴眼液治疗过敏性结膜炎,临床效果显著,现报道如下。     

Association between allergic diseases,allergic sensitization and attention-deficit/hyperactivity disorder in children: A large-scale,population-based study

Background

Increasing prevalence of allergic diseases has been matched by parallel trends in attention-deficit/hyperactivity disorder (ADHD). However, previous studies concerning the association between ADHD and allergic diseases have been inconsistent. Moreover, it is not clear whether this association is modified by allergic sensitization status. Therefore, we evaluated the association between allergic diseases, allergic sensitization, and ADHD in children.