干眼综合组合系统治疗睑板腺功能障碍相关干眼临床观察

Efficacy of a Dry Eye Combined Treatment System with Meibomian Gland Dysfunction-Related Dry Eye

摘要: 目的：观察干眼综合组合系统治疗睑板腺功能障碍相关干眼临床疗效。方法：前瞻性随机对照临床设计。选取2016年8月至2017年8月在西安市第四医院干眼门诊就诊，确诊为睑板腺功能障碍相关干眼患者65例，共130只眼，应用随机表随机数余数分组法分为试验组(A组) 32例、对照组(B组) 33例。试验组应用干眼综合组合治疗系统，连续治疗7天为一个疗程，间隔两周开始第二个疗程，连续治疗3个疗程，对照组应用传统热敷按摩的方法，两组眼部用药相同。分别于治疗前，治疗3个疗程后对患者进行干眼问卷调查(OSDI)，泪膜破裂时间(BUT)、角膜荧光染色(FL)及非侵入泪河高度检查，睑板腺分泌状态、睑板腺分泌性状检测。两组计量资料比较服从正态分布的使用T检验，不服从正态分布的使用秩和检验，治疗前后比较采用配对样本T检验或相关样本秩和检验；计数资料比较采用Pearson卡方检验，单项有序计数资料比较采用非参数检验。结果：试验组患者平均年龄(49.57 ± 14.97)岁，对照组年龄(54.00 ± 13.54)岁，试验组男性9例，女性21例，对照组男性。女性均15例。术前两组患者各项临床检查值无统计学差异(p > 0.05)。试验组治疗后患者的的OSDI评分(Z = 0.961 p = 0.336)、睑板腺分泌状态(Z = 1.310 p = 0.190)和睑板腺分泌性状评分(Z = 1.400 p = 0.161)均得到下降，与治疗前比较差异均有统计学意义(p < 0.001)；治疗后的BUT较治疗前增加，差异有统计学意义(Z = 6.699, p < 0.001)；治疗前后的泪河高度经比较差异无统计学意义(t = 1.453, p = 0.151)。治疗后两组患者比较，实验组的OSDI评分(t = 2.654, p = 0.010)、睑板腺分泌状态(Z = 5.750, p < 0.001)和睑板腺分泌性状评分(Z = 3.842 p < 0.001)均低于对照组，差异均有统计学意义(p < 0.05)，实验组的BUT高于对照组，差异有统计学意义(Z = 4.106, p < 0.001)。结论：干眼综合组合系统治疗睑板腺相关干眼的疗效优于传统热敷按摩临床效果，且明显改善患者主观眼部不适症状。

Abstract: 0bjective: To observe the clinical effect of dry eye combined treatment system in the treatment of Meibomian Gland Dysfunction-related Dry Eye. Methods: Prospective randomized controlled clinical trial. From August 2016 to August 2017 in Xi’an Fourth hospital, choose 65 patients diagnosed with MGD-related dry eye, a total of 130 eyes, after application of a random number table randomly divided into packets remainder, 33 cases in the control group (group B) 32cases in the test example group (A group). The experimental group was treated with dry eye combined treatment system for 7 days as a course .The second course of treatment was started for two weeks later. The patients in the control group were treated with traditional hot packs. The two groups had the same eye drugs. Before treatment and after 3 courses of treatment, patients were applying dry eye questionnaire (in OSDI), tear film breakup time check (BUT), corneal fluoresce in staining (FL), meibomian gland secretion state, meibomian gland secretion characters detection of non-invasive tear river height. The measurement data comparison of two groups obeys the normal distribution of the use of T test, does not obey the normal distribution of the use of rank and test, before and after treatment comparison uses paired sample T test or the relevant sample rank test; count data comparison uses Pearson chi-square test, single ordinal count data comparison uses nonparametric test. Results: The average age of patients in the test group is 49.57 ± 14.97 years old, the age of the control group is 54.00 ± 13.54 years old, the test group 9 males and 21 females, the control group’s female and male both 15 cases. There was no significant difference between the two groups before operation (p > 0.05). Test group after treated patient OSDI score (Z = 0.961 p = 0.336), meibomian secretion state (Z = 1.310 p = 0.190) and meibomian gland trait score (Z = 1.400 p = 0.161) that were decreased, and the difference was statistically significant (p < 0.001). The difference of BUT that was increased after treatment was statistically significant (Z = 6.699, p <0.001). There was no significant difference in the height of the tears before and after treatment (t = 1.453, p = 0.151). After treatment, the OSDI score (t = 2.654 p = 0.010), tibial gland secretion (Z = 5.750 p < 0.001) and tarsal gland secretion traits (Z = 3.842 p < 0.001) were decreased and the difference was statistically significant (p <0.05). The BUT of the experimental group was higher than the control group, the difference was statistically (Z = 4.106, p < 0.001). Conclusion: The effect of dry eye combined treatment system on the Meibomian Gland Dysfunction-related Dry Eye is better than the traditional hot pack massage group, and it can improve the subjective eye feeling.