[1]熊超,赖瑶,艾丽珍,等.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[J].眼科新进展,2021,41(1):069-74.[doi:10.13389/j.cnki.rao.2021.0015]
　XIONG Chao,LAI Yao,AI Lizhen,et al.The value of infrared photography combined with in vivo confocal microscopy in the early diagnosis of patients with mild meibomian gland dysfunction[J].Recent Advances in Ophthalmology,2021,41(1):069-74.[doi:10.13389/j.cnki.rao.2021.0015]
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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/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
41卷
期数:
2021年1期
页码:
069-74
栏目:
应用研究
出版日期:
2021-01-05

文章信息/Info

Title:
The value of infrared photography combined with in vivo confocal microscopy in the early diagnosis of patients with mild meibomian gland dysfunction
作者:
熊超; 赖瑶; 艾丽珍; 张风俊; 余进海; 廖洪斐
330006　江西省南昌市，南昌大学附属眼科医院
Author(s):
XIONG Chao; LAI Yao; AI Lizhen; ZHANG Fengjun; YU Jinhai; LIAO Hongfei
The Affiliated Eye Hospital of Nanchang University，Nanchang 330006， Jiangxi Province，China
关键词:
睑板腺功能障碍; 形态; 共聚焦显微镜; 红外照相
Keywords:
meibomian gland dysfunction;  morphology;  confocal microscopy;  infrared photography
分类号:
R777.1
DOI:
10.13389/j.cnki.rao.2021.0015
文献标志码:
A
摘要:
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。
Abstract:
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-2］was 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.

参考文献/References:

［1］　亚洲干眼协会中国分会，海峡两岸医药交流协会眼科专业委员会眼表与泪液病学组.我国睑板腺功能障碍诊断与治疗专家共识(2017年)［J］.中华眼科杂志,2017,53(9):657-661.
Asian Dry Eye Association China Branch,The Ocular Surface and Lacrimal Disease Group of the Ophthalmology Professional Committee of the Cross-Strait Medical Exchange Association.Expert consensus on diagnosis and treatment of meibomian gland dysfunction in China(2017) ［J］.Chin J Ophthalmol,2017,53(9):657-661.
［2］　ARITA R,ITOH K,MAEDA S,MAEDA K,TOMIDOKORO A,AMANO S.Efficacy of diagnostic criteria for the differential diagnosis between obstructive meibomian gland dysfunction and aqueous deficiency dry eye［J］.Jpn J Ophthalmol,2010,54(5):387-391.
［3］　宁晓玲，马骎.睑板腺功能测定［J］.中华眼科杂志,2014,50(4):293.
NING X L,MA Q.Measurement of meibomian gland function［J］.Chin J Ophthalmol,2014,50(4):293.
［4］　RANDON M,ARAGNO V,ABBAS R,LIANG H,LABB A,BAUDOUIN C.In vivo confocal microscopy classification in the diagnosis of meibomian gland dysfunction［J］.Eye,2019,33(5):754-760.
［5］　梁庆丰，高超，梁虹.活体共聚焦显微镜对睑板腺功能障碍患者睑板腺形态检测的应用研究［J］.中华眼科杂志,2016,52(9):649-656.
LIANG Q F,GAO C,LIANG H.In vivo confocal microscopy evaluation of meibomian glands in meibomian gland dysfunction patients［J］.Chin J Ophthalmol,2016,52(9):649-656.
［6］　马骎，宁晓玲.泪河高度测定［J］.中华眼科杂志,2015,51(3):224.
MA Q,NING X L.Determination of the height of the tear river［J］.Chin J Ophthalmol,2015,51(3):224.
［7］　IBRAHIM O M,MATSUMOTO Y,DOGRU M,ADAN E S,WAKAMATSU T H,SHIMAZAKI J,et al.In vivo confocal microscopy evaluation of meibomian gland dysfunction in atopic-keratoconjunctivitis patients［J］.Ophthalmology,2012,119(10):1961-1968.
［8］　YIN Y,GONG L.Uneven meibomian gland dropout over the tarsal plate and its correlation with meibomian gland dysfunction［J］.Cornea,2015,34(10):1200-1205.
［9］　WEI A,HONG J,SUN X,XU J.Evaluation of age-related changes in human palpebral conjunctiva and meibomian glands by in vivo confocal microscopy［J］.Cornea,2011,30(9):1007-1012.
［10］　VILLANI E,CANTON V,MAGNANI F,VIOLA F,NUCCI P,RATIGLIA R.The aging meibomian gland:an in vivo confocal study［J］.Invest Ophthalmol Vis Sci,2013,54(7):4735-4740.
［11］　KIM H M,EOM Y,SONG J S.The relationship between morphology and function of the meibomian glands［J］.Eye Contact Lens,2018,44(1):1-5.
［12］　SRINIVASAN S,MENZIES K,SORBARA L,JONES L.Infrared imaging of meibomian gland structure using a novel keratograph［J］.Optom Vis Sci,2012,89(5):788-794.
［13］　ERKAN T K,KOCABEYOGLU S,BEKIRCAN-KURT C E,BEZCI F,ERDEM-OZDAMAR S,IRKEC M.Ocular surface alterations and in vivo confocal microscopic characteristics of corneas in patients with myasthenia gravis［J］.Eur J Ophthalmol,2018,28(5):541-546.
［14］　PULT H,RIEDE-PULT B H.Non-contact meibography:keep it simple but effective［J］.Cont Lens Anterior Eye,2012,35(2):77-80.
［15］　EOM Y,CHOI K E,KANG S Y,LEE H K,KIM H M,SONG J S.Comparison of meibomian gland loss and expressed meibum grade between the upper and lower eyelids in patients with obstructive meibomian gland dysfunction［J］.Cornea,2014,33(5):448-452.
［16］　FINIS D,ACKERMANN P,PISCHEL N,KNIG C,HAYAJNEH J,BORRELLI M,et al.Evaluation of meibomian gland dysfunction and local distribution of meibomian gland atrophy by non-contact infrared meibography［J］.Curr Eye Res,2015,40(10):982-989.
［17］　YIN Y,GONG L.Uneven meibomian gland dropout over the tarsal plate and its correlation with meibomian gland dysfunction［J］.Cornea,2015,34(10):1200-1205.
［18］　诸科璇，谢文加，应靖璐，姚玉峰.运用 Keratograph5M眼表综合分析仪评价干眼患者的泪膜及睑板腺功能［J］.浙江大学学报（医学版）,2016,45(4):422-428.
ZHU K,XIE W,YING J,YAO Y.Evaluation of tear film and meibomian gland function in dry eye patients using Keratograph 5M［J］.Zhejiang Da Xue Xue Bao，2016,45(4):422-428.
［19］　CHENG S,ZHANG M,CHEN H,FAN W,HUANG Y.The correlation between the microstructure of meibomian glands and ocular Demodex infestation:A retrospective case-control study in a Chinese population［J］.Medicine (Baltimore),2019,98(19):e15595.
［20］　WANG Y,LE Q,ZHAO F,HONG J,XU J,ZHENG T,et al.Application of in vivo laser scanning confocal microscopy for evaluation of ocular surface diseases:lessons learned from pterygium,meibomian gland disease,and chemical burns［J］.Cornea,2011,30(Suppl 1):S25-S28.
［21］　FASANELLA V,AGNIFILI L,MASTROPASQUA R,BRESCIA L,DI STASO F,CIANCAGLINI M,et al.In vivo laser scanning confocal microscopy of human meibomian glands in aging and ocular surface diseases［J］.Biomed Res Int,2016,2016:7432131.
［22］　PALAMAR M,DEGIRMENCI C,ERTAM I,YAGCI A.Evaluation of dry eye and meibomian gland dysfunction with meibography in patients with rosacea［J］.Cornea,2015,34(5):497-499.
［23］　BAUDOUIN C,MESSMER E M,ARAGONA P,GEERLING G,AKOVA Y A,BENTEZ-DEL-CASTILLO J,et al.Revisiting the vicious circle of dry eye disease:a focus on the pathophysiology of meibomian gland dysfunction［J］.Br J Ophthalmol,2016,100(3):300-306.

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备注/Memo

备注/Memo:
南昌大学研究生创新专项资金资助(编号：YC2017-S099)
更新日期/Last Update: 2021-01-05