糖皮质激素冲击治疗对甲状腺相关眼病患者泪膜脂质层厚度的影响

目的 探讨糖皮质激素对甲状腺相关眼病患者眼表变化的影响。方法 对甲状腺相关眼病患者（30例60眼）在接受糖皮质激素冲击治疗前后进行泪膜破裂时间、眨眼频率、不完全眨眼比例、泪膜脂质层厚度及泪膜脂质层流动性等检查,对比分析冲击治疗前后各项检测指标的差异。结果 糖皮质激素冲击治疗后甲状腺相关眼病患者泪膜破裂时间较冲击治疗前延长（中位数分别为5.0 s和7.0 s,P<0.01）,泪膜脂质层厚度平均值、最大值和最小值均较冲击治疗前增大（平均值中位数分别为59 nm和64.5 nm,最大值中位数分别为73.5 nm和78.8 nm,最小值中位数分别为52.4 nm和57.5 nm;P均<0.01）,而眨眼频率、不完全眨眼比例和泪膜脂质层流动性与冲击治疗前相比差异无统计学意义（P均>0.05）。结论 糖皮质激素治疗能够改善甲状腺相关眼病患者泪膜油脂分泌,从而维持泪膜稳定性。

Effect of glucocorticoid shock therapy on lipid layer thickness of tear film in patients with thyroid-associated ophthalmopathy

Objective To explore the effect of glucocorticoid on ocular surface changes in the patients with thyroid-associated ophthalmopathy. Methods Sixty eyes of 30 patients with thyroid-associated ophthalmopathy were examined for the break-up time of tear film (BUT), blinks, incomplete blinks, tear film lipid layer thickness (LLT) and the fluidity of tear film lipid layer before and after glucocorticoid treatment. The differences of each detection index were compared and analyzed. Results The BUT of the patients with thyroid-associated ophthalmopathy was significantly longer after glucocorticoid treatment versus before glucocorticoid treatment (the medians were 5.0 s and 7.0 s, respectively; P<0.01). The average, maximal and minimal values of LLT were significantly increased after glucocorticoid treatment than those before glucocorticoid treatment (average, maximal and minimal values of LLT before and after treatment were 59 nm and 64.5 nm, 73.5 nm and 78.8 nm, and 52.4 nm and 57.5 nm, respectively; all P<0.01). There were no significant differences in the blinks, incomplete blinks or the fluidity of tear film lipid layer between before and after glucocorticoid treatment (all P>0.05). Conclusion Glucocorticoid treatment can improve the lipid secretion of tear film, thus maintaining the stability of tear film.