两种干眼症状问卷评分与干眼临床检查的关联性研究

背景 目前常用的干眼症状评估问卷有两种,但二种问卷结果的关联性及问卷与临床检查的关联性研究尚未见到.如何有效地评估干眼症状,将患者的主观症状进行量化有助于临床上干眼的正确诊断. 目的 评价标准干眼症状评估(SPEED)问卷和眼表疾病指数(OSDI)问卷两种干眼问卷诊断干眼的一致性及其与干眼体征的相关性.方法 采用前瞻性队列研究设计.对66例干眼患者先依据SPEED问卷进行评分,并分为轻度症状组(＜10分)和重度症状组(≥10分)；然后对同一批患者依据OSDI问卷进行评分,并分为轻度症状组(≤20分)、中度症状组(21～ 45分)和重度症状组(≥46分).所有患者行泪膜镜、泪膜破裂时间(BUT)、角膜荧光素染色、Schirmer Ⅰ试验等干眼临床检查,分析两种问卷与干眼临床检查结果之间的关系. 结果 SPEED问卷评分和OSDI问卷评分与BUT值均呈负相关(r=-0.390,P=0.001；r=-0.395,P=0.001),两种问卷评分与Schirmer Ⅰ试验结果间无明显相关性(r=-0.081,P=0.515；r=-0.080,P=0.525),与泪膜镜分级结果也均无明显相关(r=0.158,P=0.204;r=0.219,P=0.077).SPEED问卷轻度症状组BUT明显长于重度症状组,差异有统计学意义(t=2.339,P=0.022),而2个组间Schirmer Ⅰ试验和泪膜镜分级差异均无统计学意义(t=0.404,P=0.687；t=-0.947,P=0.347)；2个组间荧光素染色阳性率的差异无统计学意义(x2=0.164,P=0.685).OSDI问卷评分轻度症状组、中度症状组、重度症状组间BUT值比较,差异有统计学意义(F=11.871,P=0.000),轻度症状组BUT明显长于中度症状组和重度症状组(P=0.000、0.000)；3个组间Schirmer Ⅰ试验、泪膜镜分级差异均无统计学意义(F=1.432,P=0.246；F=2.799,P=0.068)；3个组间荧光素染色阳性率的差异无统计学意义(x2=6.026,P=0.050).SPEED问卷评分值与OSDI问卷评分值间呈正相关( r=0.697,P=0.000).结论 SPEED问卷和OSDI问卷都是客观评估干眼症状的有效方法,与BUT有相关性,可作为临床诊断干眼的辅助手段；两种问卷可联合使用.

Correlation evaluation between questionnaire and clinical examination in dry eye

Background There are two types of different questionnaires in dry eye diagnosis. But the associations about two questionnaires or questionnaire and clinical examination are still unclear. To effectively quantize the symptoms is helpful for a correct diagnosis of dry eye disease. Objective This survey was to evaluate the Standard Patient Evaluation of Eye Dryness （SPEED）and Ocular Surface Disease Index（OSDI） questionnaire for the diagnosis of dry eye and investigate the correlation between the clinical examinations and questionnaires. Methods A perspective cohort study was designed. Sixty-six patients were enrolled in this study. This study was approved by the Ethic Committee of Peking University First Hospital, and written informed consent was obtained from each subject before any ocular examination. SPEED-based and OSDI-based questionnaires were used to score the dry eye symptom and grouped according to severity of complains. Corneal fluorescence staining, tear fihn breakup time（BUT） , Schirmer I test and tear fihn interferometry were performed in all patients. The correlations between two questionnaires scores and their association with clinical examinations were evaluated. Results The negative correlations were found between the SPEED-based score or OSDI-based score with BUT value（r=0. 390,P=0. 001 ;r=-0. 395,P=0. 001） , hut no significant correlations were seen between the SPEED-based score or OSDI-hased score with Schirmer test（r= -0. 081 ,P=0. 515; r= -0. 080,P= 0. 525） and tear fihn interferometry seore（r = 0. 158,P= 0. 204;r = 0. 219,P= 0. 077 ）. The BUT was significantly prolonged in mild symptom group compared with serious group （t = 2. 339, P = 0. 022） ,but no significant difference was seen in Schirmer I test and tear film interferometry scores using SPEED- based questionnaire （ t = 0. 404, P = 0. 687 ; t = - 0. 947, P = 0. 347 ） ; while the positive fluorescence staining rate between two groups was significantly different （X2 = 0. 164, P = 0. 685 ）. When using OSDI-based questionnaire, significant difference in BUT was seen among mild, moderate and serious symptom groups （ F = 1 I. 871 , P = 0. 000 ） , and BUT in mild symptom group was delayed in comparison with moderat and serious groups（P=0. 000,0. 000）. No significant differences were found in Schirmer I test, tear film interferometry scores and fluorescence staining rate among three groups（F= 1. 432,P = 0. 246; F = 2. 799,P = 0. 068 ; X2 = 6. 026,P = 0. 050）. SPEED score showed a positive correlation with OSDI score （ r = 0. 697, P = 0. 000 ）. Conclusions Both OSDI and SPEED are effective tools for the evaluation of symptoms of dry eye. The two types of questionnaires are consistent in symptoms evaluation.