水液缺乏型干眼和混合型干眼患者睑板腺形态及功能差异

目的　探讨水液缺乏型干眼和混合型干眼患者睑板腺形态及功能差异。方法　选取四川大学华西医院2018年9月至12月眼科门诊收治的干眼患者67例（67眼），其中水液缺乏型干眼患者32例32眼（水液缺乏型组），混合型干眼患者35例35眼（混合型组）。分别统计两组患者眼表疾病指数问卷调查表得分，采用LipiViewⅡ眼表面干涉仪测量患者泪膜脂质层厚度、不完全瞬目比例，拍摄并记录两组患者上、下睑睑板腺缺失率（MGDR），并进行睑板腺缺失严重程度的评估，检测或记录患者泪膜破裂时间、角膜荧光素染色（FL）评分、泪液分泌试验。结果　水液缺乏型组和混合型组患者眼表疾病指数评分分别为（26.59±17.16）分和（29.31±15.77）分，差异无统计学意义（t=0.676,P=0.501）。水液缺乏型组患者上睑MGDR和FL评分均高于混合型组患者，差异均有统计学意义（均为P<0.05）；两组患者泪膜脂质层厚度、不完全瞬目比例、下睑MGDR、泪膜破裂时间、泪液分泌试验结果相比，差异均无统计学意义（均为P>0.05）。水液缺乏型组患者上睑睑板腺缺失严重程度分级较混合型组增高（P<0.05），下睑睑板腺缺失严重程度分级两组差异无统计学意义（P>0.05）。水液缺乏型组患者上、下睑MGDR与FL评分均无相关性（r=0.281，P=0.119；r=0.012，P=0.947）。混合型组上睑MGDR与FL评分呈正相关性（r=0.399，P=0.018），下睑MGDR与FL评分无相关性（r=0.077，P=0.660）。结论　水液缺乏型干眼患者存在睑板腺缺失和萎缩，较混合型干眼患者上睑睑板腺萎缩更严重，角膜损伤更加明显。

Morphologic and functional differences of meibomian gland in patients with aqueous-deficient dry eyes and mixed dry eyes

Objective　To investigate the morphologic and functional differences of meibomian gland in patients with aqueous-deficient dry eyes (ADDE) and mixed dry eyes. Methods　A total of 67 patients (67 eyes) with dry eyes diagnosed at the West China Hospital of Sichuan University from September to December 2018 were selected in this study, including 32 patients (32 eyes) with aqueous-deficient dry eyes (ADDE group) and 35 patients (35 eyes) with mixed dry eyes (mixed group). Each group’s ocular surface disease index (OSDI) score was recorded. LipiView II was used to measure the lipid layer thickness (LLT) and partial blink rate (PBR). The meibomian gland dropout rate (MGDR) of the upper and lower eyelids was recorded and assessed. The tear film breakup time (BUT), corneal fluorescence staining (FL) score and Schimer I test (SIt) were detected or recorded.Results　The OSDI scores of the ADDE group and mixed group were 26.59±17.16 and 29.31±15.77, respectively, and the difference between the two groups had no statistical significance (t=0.676, P=0.501). The upper eyelid MGDR and FL scores of the ADDE group were higher than those of the mixed group, with the difference being statistically significant (P<0.05). There were no significant differences in the LLT, PBR, lower eyelid MGDR, tear film BUT and SIt between the two groups (all P＞0.05). The upper eyelid MGDR in the ADDE group was higher than that in the mixed group (P<0.05), while the lower eyelid MGDR in the two groups showed no statically significant difference (P＞0.05). Both of the upper and lower eyelid MGDR in the ADDE group were not correlated with the FL score (r=0.281, P=0.119; r=0.012, P=0.947). In the mixed group, the upper eyelid MGDR was positively correlated with the FL score (r=0.399, P=0.018), and the lower eyelid MGDR had no correlation with the FL score (r=0.077, P=0.660).Conclusion　Patients with ADDE are more likely to suffer meibomian gland loss and atrophy, and their upper eyelid meibomian gland atrophy and corneal damage are more serious than patients with mixed dry eyes.