口服阿奇霉素治疗中重度睑板腺功能障碍的临床疗效

目的:观察分析口服阿奇霉素治疗中重度睑板腺功能障碍(MGD)的临床疗效以及用药后睑板腺结构功能的改变。方法:前瞻性临床研究。选取2016年4月至2017年1月就诊于福建医科大学附属第二医院眼科门诊,经眼表综合分析仪检查及裂隙灯显微镜检查诊断为中重度MGD的患者49例(98眼),分为观察组26例和对照组23例。观察组予人工泪液滴眼,并口服阿奇霉素500mg每天1次,共3d,然后停药7d,10d为1个治疗周期,共治疗3个周期。对照组仅接受人工泪液滴眼治疗。所有患者首诊及每次随诊均进行改良睑板腺压榨,并配合眼睑热敷及睑缘清洁。观察并比较2组患者治疗前及接受治疗1个月时的国际眼表疾病指数(OSDI)、首次泪膜破裂时间(NIF-BUT)、平均泪膜破裂时间(NIAvg-BUT)、泪河高度(TMH)、眼红分析(R-scan)、睑板腺丢失率、睑板腺开口评分、睑脂质量评分、睑脂排出能力评分、角膜荧光素钠染色(FL)、泪液分泌试验(SⅠT)等指标的变化。组间数据比较采用独立样本t检验和Mann-WhitneyU检验,组内数据比较采用配对t检验和Wilcoxon配对秩和检验。结果:对照组治疗后睑板腺开口评分(Z=-3.093)、睑脂质量评分(Z=-2.501)、睑脂排出能力评分(Z=-3.175)、FL(Z=-2.602)较治疗前改善,差异均有统计学意义(P<0.05),余指标差异均无统计学意义。观察组治疗后OSDI(t=6.174)、睑板腺丢失率(t=2.402)、睑板腺开口评分(Z=-5.192)、睑脂质量评分(Z=-5.073)、睑脂排出能力评分(Z=-4.807)、FL(Z=-3.587)较治疗前改善,差异均有统计学意义(P<0.05),余指标差异均无统计学意义。2组治疗后OSDI(t=-3.778)、NIAvg-BUT(Z=-2.043)、睑板腺丢失率(t=-2.123)、睑板腺开口评分(Z=-6.318)、睑脂质量评分(Z=-5.852)、睑脂排出能力评分(Z=-3.951)、SⅠT(Z=-2.462)差异均有统计学意义(P<0.05),且观察组改善更明显,余指标差异均无统计学意义。结论:口服阿奇霉素联合人工泪液滴眼可用于治疗中重度MGD,能改善MGD患者眼部的主观症状和体征,并改善睑板腺功能。

Oral Azithromycin for the Treatment of Moderate to Severe Meibomian Gland Dysfunction

Objective: To observe the clinical efficacy of oral azithromycin in patients with moderate to severe meibomian gland dysfunction (MGD), and the structural changes in meibomian glands. Methods: This was a prospective clinical study. Forty-nine patients (98 eyes) who had moderate to severe MGD were recruited in the Second Affiliated Hospital, Fujian Medical University, from April 2016 to January 2017. All patients underwent comprehensive ocular surface examination and slit lamp examination and were divided into two groups: 26 patients in the observation group and 23 patients in the control group. The observation group was given artificial tears and oral azithromycin 500 mg once daily for 3 days, then stopped for 7 days. There were 10 days in a treatment cycle with a total of three cycles for the treatment.The control group received only artificial tear treatment. All patients underwent modified meibomian gland compression during the first visit and for each follow-up, all of which were combined with eyelid hot compress and blepharospasm cleaning. Then an ocular check-up was performed, including the following aspects: Ocular surface disease index (OSDI), noninvasive first break-up time (NIF-BUT), noninvasive average break-up time (NIAvg-BUT), tear meniscus height (TMH), R-scan, loss rate of the meibomian gland, assessment of meibomian gland orifices, meibum quality score, meibum expression score, fluorescein stain test (FL), and Schirmer Ⅰ test (SⅠT) between pre-therapy and post-treatment. Data were analyzed by an independent samples t test, Mann-Whitney U test, paired t test and Wilcoxon paired rank sum test. Results: After treatment, the assessment of meibomian gland orifices (Z=-3.093), meibum quality score (Z=-2.501), meibum expression score (Z=-3.175) as well as FL (Z=-2.602) of the control group were improved compared with those before treatment, with statistically significant differences (P<0.05). However, there were no statistically significant differences in other indexes in the control group. After treatment, the OSDI (t=6.174), loss rate of the meibomian gland (t=2.402), assessment of meibomian gland orifices (Z=-5.192), meibum quality score (Z=-5.073), meibum expression score (Z=-4.807), and FL (Z=-3.587) of the observation group were improved compared with those before treatment, with statistically significant differences (P<0.05). There were no statistically significant differences in other indexes in the observation group. Statistically significant differences were observed in OSDI (t=-3.778), NIAvg-BUT (Z=-2.043), loss rate of the meibomian gland (t=-2.123), assessment of meibomian gland orifices (Z=-6.318), meibum quality score (Z=-5.852), meibum expression score (Z=-3.951) and SⅠT (Z=-2.462) between the two groups after treatment (P<0.05) and the observation group improved more obviously, but no statistically significant differences in other indexes after treatment. Conclusions: Oral azithromycin can be used to treat patients with moderate to severe MGD, relieve symptoms and partially regain the function of the meibomian gland.