睑板腺功能障碍患者睫毛蠕形螨检出率调查

发布时间：2018-12-09 10:10

【摘要】：目的：调查分析睑板腺功能障碍（Meibomian Gland Dysfunction，MGD）患者毛囊蠕形螨检出率，以及睑缘蠕形螨对于MGD患者眼表的影响。方法：本研究为横断面研究。 1.患者选择：本研究共纳入自2013年2月至2013年6月于我院眼表门诊首次就诊的患者164人，其中睑板腺功能障碍者86人，无睑板腺功能障碍者78人。MGD组与无MGD组之间年龄、性别差异无统计学意义。本研究中采用的MGD诊断标准为：睑缘不规则；睑板腺孔阻塞；睑缘毛细血管扩张；睑缘角质化——四者具有其中之一者，即诊断为MGD。排除标准：具有以下情况者均排除在外：严重全身疾病；感染性角膜炎；急性或亚急性结膜炎；内眼术后小于3个月；近期眼部外伤；既往眼部酸碱烧伤；翼状胬肉等。 2.检查方法：所有患者依次进行下列检查：患者基本信息及疾病史、眼表疾病指数（Ocular Surface Disease Index, OSDI）问卷调查、裂隙灯检查睑缘异常及睑板腺分泌脂质的质与量、角膜地形图检查角膜表面规则性指数（Surface RegularityIndex, SRI）与表面不对称性指数（Surface Asymmetry Index, SAI）、泪膜破裂时间（Tear Film Break-up Time, TF-BUT）、角膜荧光素染色、泪液分泌试验（Schirmer Itest,表麻）、毛囊蠕形螨检测。 3.统计方法：本研究使用SPSS17.0统计软件进行统计学分析。其中MGD组与无MGD组毛囊蠕形螨检出率差异采用χ2检验；MGD患者蠕形螨检出阳性与检出阴性者睑缘异常、SRI与SAI、TF-BUT、Schirmer I试验之间的差异采用Student t检验，OSDI、角膜荧光素染色采用M-W U检验。设定P0.05为具有统计学意义。结果：86位MGD患者中蠕形螨感染者为40人，检出率为46.5%，78位无MGD者蠕形螨感染者为12人，检出率为15.4%，两组之间毛囊蠕形螨检出率存在明显的统计学差异（P＜0.05）。对MGD组蠕形螨感染阳性及阴性（分别为40人与46人）患者眼部异常进行比较发现，MGD组蠕形螨感染阳性与阴性者OSDI（p0.01）、睑缘异常（p0.05）以及角膜荧光素染色评分（p0.01）之间存在明显的统计学差异。而睑板腺分泌脂质的质/量、SRI、SAI、F-BUT及Schirmer I试验（表麻）之间未发现明显的统计学差异。结论：MGD组毛囊蠕形螨检出率明显高于无MGD组，提示蠕形螨感染可能是MGD的一种危险因素。另外，蠕形螨感染可能会加重MGD患者的眼部损害，如OSDI、睑缘异常及角膜染色评分增高。提示在临床工作中，对于MGD患者尤其是行传统治疗效果不佳者应考虑行睑缘蠕形螨检测，必要时行除螨治疗。
[Abstract]:Objective: to investigate the detection rate of Demodex hair follicle in patients with tarsal gland dysfunction (Meibomian Gland Dysfunction,MGD) and the effect of Demodex eyelid edge on the ocular surface of patients with MGD. Methods: this study is a cross-sectional study. 1. Patient selection: a total of 164 patients were enrolled in this study from February 2013 to June 2013, including 86 patients with tarsal gland dysfunction and 78 patients with no tarsal gland dysfunction. The age between MGD group and MGD group. There was no significant difference in sex. The MGD diagnostic criteria used in this study are: irregular eyelid margin; obstruction of eyelid gland foramen; telangiectasia of eyelid margin; keratosis of eyelid margin-one of the four is diagnosed as MGD.. Exclusion criteria: severe systemic disease; infectious keratitis; acute or subacute conjunctivitis; intraocular surgery less than 3 months; recent ocular trauma; previous ocular acid-base burns; pterygium. 2. Methods: all patients were examined as follows: basic information of patients and history of disease, (Ocular Surface Disease Index, OSDI) questionnaire of ocular surface disease index, slit lamp examination of abnormal eyelid margin and the quantity and quality of lipid secreted by eyelid gland. Corneal topography examination of corneal surface regularity index (Surface RegularityIndex, SRI) and surface asymmetry index (Surface Asymmetry Index, SAI),) tear film rupture time (Tear Film Break-up Time, TF-BUT), corneal fluorescein staining, tear secretion test (Schirmer Itest, Epigastric), hair follicle Demodex detection. 3. Statistical methods: this study used SPSS17.0 statistical software for statistical analysis. The difference of detection rate of Demodex hair follicle between MGD group and no MGD group was 蠂 2 test. The difference between SRI and SAI,TF-BUT,Schirmer I test was detected by Student t test and OSDI, corneal fluorescein staining by M-W U test. Set P0.05 as statistically significant. Results: among 86 patients with MGD, 40 were infected with Demodex, 12 were infected with Demodex without MGD, and the positive rate was 15.4. There was significant statistical difference between the two groups in the detection rate of Demodex hair follicles (P < 0.05). The ocular abnormalities of patients with positive and negative Demodex infection (40 and 46) in MGD group were compared. The results showed that OSDI was positive and negative in MGD group (p0.01). There were significant differences in blepharomarginal abnormality (p 0.05) and corneal fluorescein staining score (p 0.01). However, there was no significant difference in the quality / quantity of lipid secreted by meibomian gland, SRI,SAI,F-BUT and Schirmer I test (ephedra). Conclusion: the detection rate of Demodex hair follicles in MGD group was significantly higher than that in MGD group, suggesting that Demodex infection may be a risk factor for MGD. In addition, Demodex infection may aggravate ocular damage in patients with MGD, such as abnormal eyelid margin of OSDI, and increased corneal staining score. It is suggested that in clinical work, the patients with MGD, especially those with poor effect of traditional treatment, should be examined for Demodex palpebri and, if necessary, mites should be treated.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R777.1

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