红外线照相技术联合活体共聚焦显微镜对轻度睑板腺功能障碍患者早期诊断价值的研究

目的　探究红外线照相技术联合活体共聚焦显微镜（in vivo confocal microscopy,IVCM）在轻度睑板腺功能障碍（meibomian gland dysfunction，MGD）患者中的诊断价值。方法　选取2018年4月至10月于我院就诊的轻度MGD患者30例（30眼）为MGD组，健康受检者17人作为健康组（均取左眼），依次进行OSDI评分、Schirmer I试验、非侵入性泪膜破裂时间（non-invasive tear-film break-up time,NIBUT）、泪河高度(tear meniscus height,TMH)、睑板腺红外线照相及IVCM检查。IVCM主要关注睑板腺开口、腺泡形态及炎症细胞浸润情况。各项计量参数比较均用两独立样本t检验，OSDI评分对睑板腺各项指标的影响采用 Spearman 秩相关性分析。结果　两组的OSDI评分、NITBUT avg及睑板腺缺失率比较，差异均有统计学意义（均为P<0.05）。而Schirmer I试验、TMH两组间差异均无统计学意义（均为P>0.05）。MGD组睑板腺开口直径、开口面积与健康组相比差异均无统计学意义（均为P>0.05）。MGD组腺泡的最长径（92.14±12.11）μm、最短径（48.27±8.12）μm、面积（5796.67±1427.43）μm²及炎症细胞密度（550.74±80.48）个?mm^-2均高于健康组相应指标［（79.94±7.39）μm、（28.96±5.66）μm、（3129.06±353.92）μm²、（270.72±52.76）个?mm^-2］，差异均有统计学意义（均为P<0.05）。MGD组腺泡密度［（55.42±10.21）个?mm^-2］较健康组［（100.37±10.71）个?mm^-2］降低，差异有统计学意义（P<0.05）。OSDI评分与睑板腺腺泡最大直径（r=0.352，P<0.015）、最小直径（r=0.602，P<0.05）、腺泡面积（r=0.652，P<0.05）及结膜炎症细胞密度（r=0.733，P<0.05）均呈显著正相关，与睑板腺腺泡密度呈显著负相关（r=-0.780,P＜0.05）,而与睑板腺开口直径、开口面积均无相关性（均为P＞0.05）。结论　红外线照相技术联合IVCM可帮助解释MGD的病理生理过程。IVCM对轻度MGD的早期诊断具有一定意义。

The value of infrared photography combined with in vivo confocal microscopy in the early diagnosis of patients with mild meibomian gland dysfunction

Objective To explore the diagnostic value of infrared photography combined with in vivo confocal microscopy(IVCM)in patients with mild meibomian gland dysfunction(MGD).Methods Thirty patients with mild MGD who were treated in our hospital from April 2018 to October 2018 were selected as the MGD group,and 17 healthy subjects were used as the control group(all left eyes were taken).Infrared technology and IVCM were applied to observe the meibomian gland morphology in patients with mild MGD and healthy people.OSDI score and schirmer I test(STI),non-invasive tear-film break-up time(NIBUT),tear meniscus height(TMH)were collected,and meibomian gland infrared photography and IVCM examination were performed.IVCM focuses on meibomian gland openings,acinar morphology,and inflammatory cell infiltration.Two independent sample t tests were used to compare each measurement parameter,and the impact of OSDI score on various indicators of the meibomian glands was analyzed by Spearman correlation.Results The differences in OSDI score,NITBUT avg and meibomian gland loss rate between the two groups were statistically significant(all P<0.05).However,there was no significant difference in STI and TMH between the two groups(both P>0.05).The diameter and area of meibomian glands in the MGD were not significantly different from those in the healthy group(both P>0.05).The longest diameter(92.14±12.11)μm,shortest diameter(48.27±8.12)μm,area(5796.67±1427.43)μm2 and inflammatory cell density of acinus(550.74±80.48)cells·mm-2 were significantly higher than those of healthy group(79.94±7.39)μm,(28.96±5.66)μm,(3129.06±353.92)μm2,(270.72±52.76)cells·mm-2(all P<0.05).The density of acinar in the MGD group(55.42±10.21)cells·mm-2was significantly lower than that in the healthy(100.37±10.71)cells·mm-2(P<0.05).The OSDI score was significantly positively correlated with the maximum(r=0.352,P<0.015)and minimum diameters(r=0.602,P<0.05)of the meibomian glands,the acinar area(r=0.652,P<0.05),and the density of conjunctival inflammatory cells(r=0.733,P<0.05),and was significantly negatively correlated with the meibomian gland acinar density(r=-0.780,P<0.05),while,it has nothing to do with the diameter and area of the meibomian gland opening(both P>0.05).Conclusion Infrared technology combined with IVCM can help explain the pathophysiological process of MGD.IVCM has certain significance for the early diagnosis of mild MGD.