角膜结膜染色评分新方法在原发性干燥综合征的应用

摘要

目的 角膜、结膜损伤是干眼病的重要表现,目前缺乏安全有效的染色方法及可操作性强的评分标准,本文旨在对干燥综合征国际合作联盟(Sj(o)gren's International Collaborative Clinical Alliance,SICCA)研究中提出的眼表染色评分(ocular staining score,OSS)方法进行介绍并对干燥综合征(Sj(o)gren's syndrome,SS)患者OSS评分分布进行分析.方法 以2004年10月至2008年6月在北京协和医院参加SICCA研究符合2002年SS国际分类(诊断)标准的174例患者作为研究对象,所有患者均按照标准化操作规范进行角膜荧光素染色、结膜丽丝胺绿染色、SchirmerⅠ试验和泪膜破碎时间(tear break up time,BUT)检查,其中角膜荧光素染色及结膜丽丝胺绿染色联合称为OSS染色.对角膜和结膜染色按照OSS评分标准进行评分.对174例SS患者双眼结膜、角膜以及总OSS评分及分布进行统计分析,使用paired-samples T test对左右眼数据进行比较,使用Distances检验对OSS评分与SchirmerⅠ及BUT的相关性进行分析.结果 所有SS患者右眼和左眼的鼻侧结膜评分分别为(2.12±1.16)和(1.89±1.19),颞侧结膜评分分别为(1.89±1.19)和1.96±1.14),鼻侧及颞侧结膜染色总分分别为(4.01±2.22)和(4.14±2.10),角膜染色评分分别为(2.59±1.60)和(2.71±1.56),左眼、右眼各项评分无统计学差异;左眼OSS评分高于右眼,两者差异有统计学意义[(6.61±3.41) vs.(6.90±3.19),P<0.05];同侧眼鼻侧结膜评分高于颞侧,差异有统计学意义(P<0.01).右眼和左眼角膜染色中出现着染点融合、着染点出现在瞳孔区以及丝状角膜炎的比例分别为43.1%和44.8%、20.1%和22.4%、4.0%和2.3%.OSS与BUT及schirmerⅠ试验相关性分别为-0.573和-0.404,均有统计学意义(均P<0.001).结论 OSS染色评分是一种可操作性强的眼表染色评分方法,有望成为SS诊断中确定眼表损伤程度的新标准.%Objective Ocular staining is one of the most important manifestations of dry eye diseases. Safe staining method and practical evaluation scale are under exploration. A new ocular staining scale ( OSS) proposed by Sjogren ' s syndrome ( SS ) International Collaborative Clinical Alliance ( SICCA ) was introduced into this study and the distribution of OSS in SS patients was analyzed. Methods 174 patients who were confirmed as SS with 2002 SS criteria were chosen from SICCA enrolled patients. All patients completed Schirmer' s test, tear break-up time, corneal fluorescence staining and conjunctival lissamine green staining according to standard operation protocol. OSS was graded. Data of corneal staining, conjunctival staining and OSS was analyzed and the correlations between OSS and Schirmer' s test, BUT were calculated with SPSS. Results The staining value of nasal conjunctival of SS patients' were 2. 12 ?1. 16 on right eyes and 1. 89 ?1. 19 on left eyes, temporal conjunctiva 1. 89 ?1. 19 and 1. 96 ?. 14, nasal and temporal conjunctiva 4. 01 ?. 22 was 4. 14 ?. 10, corneal 6. 61 ?. 41 and 6. 90 ?. 19, OSS 6. 61 ?. 41 and 6. 90 ?. 19. There was no statistical difference between the values of left and right eyes. But staining value of nasal part was higher than the temporal part(P <0. 01). The most frequent manifestation of corneal staining was confusion of staining. Percentage of confusion, emergence in pupil area and filament were 43. 1% , 44. 8% and 20. 1% in right eyes and 22. 4% , 4. 0% and 2. 3% in left eyes. OSS value had high correlation with Schirmer' s test and BUT ( P = 0. 573 , P = - 0. 404). Conclusion OSS grading method is a practical evaluation system. It is promising that OSS grading schema can be a new criteria for ocular surface damage in the SS diagnosis.