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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2020, Vol. 10 ›› Issue (05) : 275 -280. doi: 10.3877/cma.j.issn.2095-2007.2020.05.004

论著

LipiView眼表面干涉仪辅助评估病毒性乙型肝炎患者干眼发生情况的临床研究
张薇1, 李上2, 董宏伟1, 阮方1, 李小娜1, 接英2,†()   
  1. 1. 100069　首都医科大学附属北京佑安医院眼科
    2. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　北京市眼科研究所　北京市眼视光与视觉科学重点实验室
  • 收稿日期:2020-09-04 出版日期:2020-10-28
  • 通信作者: 接英
  • 基金资助:
    国家自然科学基金项目(81970764); 丰台区卫生计生系统科研项目(2016-59)

The evaluation the occurrence of dry eye in patients with viral hepatitis B using LipiView ocular surface interferometer

Wei Zhang1, Shang Li2, Hongwei Dong1, Fang Ruan1, Xiaona Li1, Ying Jie2,†()   

  1. 1. Department of Opthalmology, Beijing You′an Hosptial, Capital Medical University, Beijing 100069, China
    2. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
  • Received:2020-09-04 Published:2020-10-28
  • Corresponding author: Ying Jie
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引用本文：

张薇, 李上, 董宏伟, 阮方, 李小娜, 接英. LipiView眼表面干涉仪辅助评估病毒性乙型肝炎患者干眼发生情况的临床研究[J]. 中华眼科医学杂志(电子版), 2020, 10(05): 275-280.

Wei Zhang, Shang Li, Hongwei Dong, Fang Ruan, Xiaona Li, Ying Jie. The evaluation the occurrence of dry eye in patients with viral hepatitis B using LipiView ocular surface interferometer[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2020, 10(05): 275-280.

目的

探讨LipiView眼表面干涉仪在辅助评估病毒性乙型肝炎患者干眼的发生情况。

方法

选取2017年3月至2019年6月来首都医科大学附属北京佑安医院眼科门诊137例(274只眼)病毒性乙型肝炎患者为研究对象。其中，男性61例(122只眼)，女性76例(152只眼)。年龄23~78岁，平均年龄(49.3±14.1)岁。对全部患者进行眼表疾病指数(OSDI)问卷调查、泪膜破裂时间(TBUT)、泪液分泌试验(Schirmer Ⅰ)及LipiView眼表面干涉仪等检查，根据OSDI得分将患者分为干眼组和正常组。年龄、OSDI、TBUT、Schirmer Ⅰ值、PBR及LLT，以均数±标准差表示。采用独立样本t检验进行比较；采用Pearson相关性分析LipiView眼表面干涉仪检测结果与传统干眼检测指标间的相关性。

结果

137例(274只眼)病毒性乙型肝炎可疑干眼症患者中，共检出干眼患者125例(250只眼)。干眼组OSDI值为(31.99±14.73)分，正常组(7.50±2.21)分。经t检验，干眼组OSDI值显著高于正常组，差异有统计学意义(t＝15.212，P<0.05)。干眼组和正常组患者的Schirmer Ⅰ值分别为(5.37±2.19)mm/5 min和(14.27±4.62)mm/5 min。经t检验，干眼组显著低于正常组，差异有统计学意义(t＝14.992，P<0.05)。干眼组和正常组患者的TBUT检查结果分别为(8.73±3.55)s和(15.51±6.84)s。经t检验，干眼组显著低于正常组，差异有统计学意义(t＝10.583，P<0.05)。干眼组和正常组患者的LLT分别为(64.40±18.75)nm和(77.58±16.76)nm；干眼组和正常组患者的LLT Min分别为(51.93±19.42)nm。干眼组患者的LLT及LLT Min明显低于正常组。经t检验，差异有统计学意义(t＝2.344，3.624；P<0.05)。干眼组和正常组患者的PBR分别为(62.52±21.49)%和(34.27±10.51)%。干眼组的PBR明显高于正常组。经t检验，差异有统计学意义(t＝2.186，P<0.05)。干眼组和正常组患者的LLT Max分别为(78.24±19.67)nm和(84.25±11.17)nm；干眼组和正常组患者的眨眼频率分别为(7.96±4.31)次/20 s和(8.83±2.40)次/20 s。经t检验，干眼组和正常组患者的LLT Max及眨眼频率差异无统计学意义(t＝1.040，0.689；P>0.05)。OSDI的12项评分均与LLT存在相关性，随着OSDI评分的增加，LLT变薄。就总分而言，LLT与干眼组OSDI各项评分呈负相关；就各项而言，异物感受、针刺疼痛、电视使用及电脑使用等项评分均与LLT呈负相关，检验结果具有统计学意义(r＝-0.234，-0.212，-0.253，-0.227；P<0.05)；而惧光流泪、视物模糊、视力低下、书报阅读、暗光驾驶、吹风受凉、干燥气候及冷气气候等项评分与LLT均无相关性，检验结果无统计学意义(r＝0.087，-0.097，-0.115，-0.075，-0.082，-0.124，-0.137，-0.149；P>0.05)。干眼组患者的LLT与Schirmer Ⅰ无相关性，其检验结果无统计学意义(r＝-0.238，P>0.05)，而干眼组患者的LLT与TBUT呈正相关性，其检验结果具有统计学意义(r＝0.217，P<0.05)。

结论

Lipiview眼表面干涉仪可以无创、快速、客观评价病毒性肝炎患者脂质层厚度和不完全眨眼比例，为干眼诊断和治疗提供了依据，可有效提示病毒性乙型肝炎患者的干眼病情及治疗转归症状。

关键词: 乙型肝炎, 干眼, LipiView眼表面干涉仪, 眼表
Objective

The aim of this study was to evaluate dry eye in patients with viral hepatitis B using LipiView ocular surface interferometer.

Methods

A total of 137 patients (274 eyes) with viral hepatitis B visiting the Department of Ophthalmology Beijing You′an Hospital from March 2017 to June 2019 were selected. Among them, 61 were males (122 eyes) and 76 were females (152 eyes). The age was 23 to 78 years with the average age of (49.3±14.1) years. The ocular surface disease index (OSDI) questionnaire survey, tear film rupture time (TBUT), tear secretion test (Schirmer Ⅰ), and LipiView ocular surface interferometer were performed. Patients were divided into dry eye group and normal group according to the OSDI score. Age, OSDI, TBUT, Schirmer Ⅰ, PBR and LLT were expressed as mean±standard deviation. The independent sample t test was used to compare the results of two groups; the Pearson correlation was used to analyze the correlation between the results of the LipiView ocular surface interferometer and the traditional dry eye test indicators.

Results

Among 137 cases (274 eyes) of suspected dry eye patients with viral hepatitis B, 125 cases (250 eyes) were detected. The OSDI value of the dry eye group and the normal group were (31.99±14.73) points, (7.50±2.21) points. After t testing analysis, the OSDI value of the dry eye group was significantly higher than that of the normal group, and the difference between them was statistically significant (t=15.212, P<0.05). The Schirmer Ⅰ values of patients in the dry eye group and the normal group were (5.37±2.19) mm/5 min, (14.27±4.62) mm/5 min. After t testing analysis, the dry eye group was significantly lower than the normal group, the difference between them was statistically significant (t=14.992, P<0.05). The TBUT results of the dry eye group and the normal group were (8.73±3.55) s, (15.51±6.84) s, respectively. After t testing analysis, the dry eye group was significantly lower than the normal group, the difference between them was statistically significant (t=10.583, P<0.05). The LLT of the dry eye group and the normal group were (64.40±18.75) nm and (77.58±16.76) nm, respectively. The LLTMin of the dry eye group and the normal group were (51.93±19.42) nm and (73.75±24.75) nm, respectively . The LLT and LLTMin of the dry eye group were significantly lower than those of the normal group. After t testing analysis, the difference between them was statistically significant (t=2.344, 3.624; P<0.05). The PBR of the dry eye group and the normal group were (62.52±21.49)%, (34.27±10.51)%, respectively. The PBR of the dry eye group was significantly higher than that of the normal group. After t testing analysis, the difference between them was statistically significant(t=2.186, P<0.05). The LLTMax of the dry eye group and the normal group were (78.24±19.67) nm, (84.25±11.17) nm, respectively. The blink frequency of the dry eye group and the normal group were (7.96±4.31) times/20 s and (8.83± 2.40) times/20 s. After t testing analysis, there was no significant difference in LLTMax and blinking frequency between them (t=1.040, 0.689; P>0.05). The 12 scores of OSDI were all correlated with LLT. As the OSDI score increased, LLT become thinner. In terms of total scores, LLT was negatively correlated with OSDI scores in the dry eye group (r=-0.267, P<0.05). The foreign body perception, acupuncture pain, television use, computer use, etc, were negatively correlated with LLT (r=-0.234, -0.212, -0.253, -0.227; P<0.05); while fear of light and tears, blurred vision, low vision, reading books and newspapers, driving in low light, blowing cold, dry were no correlation with LLT (r=0.087, -0.097, -0.115, -0.075, -0.082, -0.124, -0.137, -0.149; P>0.05). There was no correlation between LLT and Schirmer Ⅰ in the dry eye group with non-significant difference (r=-0.238, P>0.05), while the LLT and TBUT in the dry eye group were positively correlated with significant difference (r=0.217, P<0.05).

Conclusions

LipiView ocular surface interferometer could non-invasively, quickly and objectively evaluate the lipid layer thickness and incomplete blink ratio of patients with viral hepatitis, which provides a basis for the diagnosis and treatment of dry eye, and effectively indicates the condition of dry eye in patients with viral hepatitis B and the outcome symptoms.

Key words: Hepatitis B, Dry eye, LipiView ocular surface interferometer, Eye surface
表1 两组性别、年龄及OSDI值的比较(±s)
分组 例数 性别(男/女) 年龄(岁) OSDI值(分)
正常组 12 5/7 48.08±16.95 7.50± 2.21
干眼组 125 56/69 37.75±15.41 31.99±14.73
t/χ2值   0.044a 2.031b 15.212b
P值   >0.05 <0.05 <0.05
表2 干眼常规指标检测结果的比较(±s)
分组 例数 泪液分泌试验Ⅰ(mm) 泪膜破裂时间(s)
正常组 12 14.27±4.62 15.51±6.84
干眼组 125 5.37±2.19 8.73±3.55
t值   14.992 10.583
P值   <0.05 <0.05
表3 两组LipiView眼表面干涉仪检测结果的比较(±s)
分组 例数 LLT(nm) LLT最大值(nm) LLT最小值(nm) 眨眼频率(次/20 s) PBR(%)
正常组 12 77.58±16.76 84.25±11.17 73.75±24.75 8.83±2.40 34.27±10.51
干眼组 125 64.40±18.75 78.24±19.67 51.93±19.42 7.96±4.31 62.52±21.49
t值   2.344 1.040 3.624 0.689 2.186
P值   <0.05 >0.05 <0.05 >0.05 <0.05
表4 LLT与干眼组OSDI各项评分的关系
OSDI分项 LLT值(nm) t值 P值
OSDI等级>2 OSDI等级≤2
惧光流泪 63.47±17.12 57.34±15.02 4.492 <0.05
异物感受 64.98±17.53 49.46±12.14 6.578 <0.05
针刺疼痛 58.65±14.46 50.08±14.01 5.857 <0.05
视物模糊 57.93±16.81 47.81±13.26 4.428 <0.05
视力低下 64.32±17.56 56.93±16.88 5.412 <0.05
书报阅读 75.93±18.95 57.63±16.54 6.956 <0.05
暗光驾驶 69.48±18.82 60.45±16.12 5.528 <0.05
电视使用 60.48±17.74 51.55±15.31 7.652 <0.05
电脑使用 64.84±16.15 56.71±13.50 4.585 <0.05
吹风受凉 74.48±18.82 56.22±15.24 5.986 <0.05
干燥气候 67.90±17.12 54.17±14.15 4.739 <0.05
冷气气候 65.49±16.82 55.81±13.33 4.526 <0.05
表5 LLT与干眼组OSDI各项评分的相关性分析
OSDI分项 r值 P值
总分 -0.267 0.032
惧光流泪 0.087 0.430
异物感受 -0.234 0.008
针刺疼痛 -0.212 0.012
视物模糊 -0.097 0.467
视力低下 -0.115 0.542
书报阅读 -0.075 0.382
暗光驾驶 -0.082 0.355
电视使用 -0.253 0.037
电脑使用 -0.227 0.001
吹风受凉 -0.124 0.285
干燥气候 -0.137 0.146
冷气气候 -0.149 0.443
图1 泪膜破裂时间与脂质层厚度的相关性分析
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