Objective To analyze the signs of Demodex infection on palpebral margin and to accurately evaluate the indications of the eyelash examination for Demodex,which can provide a reliable basis for the pathogenic diagnosis.Methods A prospective case observational study was performed.The general status,examine results of eyelash epilation for Demodex and local clinical features of patients clinically diagnosed as Demodex blepharitis from Dececember 2015 to March 2016 at Beijing Tongren Eye Center were collected and analyzed.Logistic regression was applied to analyze the correlation between the positive rate and clinical signs.Chi-square test and Kruskal-Wallis H test were applied to compare the positive rate and the load of Demodex among patients with different clinical traits and different total number of concurrent signs.Results Eighty patients (960 eyelashes) were analyzed and 857 mites were detected.The Demodex positive rate of eyelashes with non-cylindrical dandruff (46.1％) and with cylindrical dandruff (45.4％) were higher than that without dandruff (34.4％),the differences were statistically significant (both at P ＜ 0.05).Eyelashes with dilated follicular openings,white spots at infundibulum of follicle,misdirected eyelashes and telangiectasia of lid margin around eyelash had higher Demodex positive rate and Demodex load than those without above-mentioned clinical signs,the differences were statistically significant (both at P＜0.01).The Demodex positive rate of eyelashes with scale was significantly lower than that without this sign (P =0.023).White spots at infundibulum of follicle and misdirected eyelashes were two major risk factors for mite detection (OR =5.588,P =0.000,OR=5.546,P=0.000).The positive rate and the load of Demodex increased as the total number of concurrent signs increased.Conclusions There are limitations in clinical diagnosis of Demodex blepharitis according to signs of cylindrical dandruff.Eyelashes with no cylindrical dandruff,white spots at infundibulum of follicle and misdirected eyelashes are three high-risk clinical indications of pathogenic examination in Demodex blepharitis.Eyelashes with higher total number of concurrent signs have high positive rate and load of Demodex during eyelash epilation.%目的 探讨睑缘蠕形螨感染的体征特点,以准确掌握睫毛蠕形螨检查的适应证,为病原学诊断提供可靠的依据.方法 采用回顾性病例观察研究.对2015年12月至2016年3月于北京同仁医院眼科中心拟诊为蠕形螨睑缘炎患者的一般资料、睫毛蠕形螨检查结果及局部体征情况进行分析.采用Logistic回归法分析蠕形螨检出率与各临床体征间的相关性.分别采用x2检验和Kruskal-Wallis H检验比较不同临床特征患者以及不同并发体征总数患者的蠕形螨检出率和检出量. 结果 共收集患者80例960根睫毛的临床资料,共检出螨虫857只.非套袖样分泌物组患者蠕形螨检出率为46.1％,套袖样分泌物组患者为45.4％,均高于无分泌物组的34.2％,差异均有统计学意义(均P＜0.05).有毛孔扩张、漏斗部白点、睫毛乱生、睫毛分泌物、毛细血管扩张体征的睫毛蠕形螨检出率和平均螨虫检出量比无相应体征的睫毛高,差异均有统计学意义(均P＜0.01).有鳞屑体征的睫毛蠕形螨检出率低于无此体征的睫毛,差异有统计学意义(P=0.023).漏斗部白点和睫毛乱生为螨虫检出的两大危险因素(OR=5.588,P=0.000;OR=5.546,P=O.000).蠕形螨检出率、检出量随体征总数的增加而增加.结论 套袖样分泌物对临床诊断蠕形螨睑缘炎存在局限性.非套袖样分泌物、漏斗部白点、睫毛乱生为螨虫感染的三大高危体征,是睫毛螨虫检查的适应证.体征总数较多患者的睫毛利于提高检出率及检出量.
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