背景 围绝经期综合征(PMS)是女性必经的重要时期,可伴随生理、病理及雌性激素水平的改变,同时会伴随一系列眼部及全身健康问题.眼部病变主要体现在眼表系统,影响患者的视觉和生活质量.目的 探讨PMS睑板腺功能障碍(MGD)患者眼表及睑板腺的形态和功能改变. 方法 采用病例对照研究方法,收集2015年1-8月在武警后勤学院附属医院42例确诊为PMS-MGD的患者,进行眼表疾病指数评估(OSDI)问卷、裂隙灯显微镜检查、干眼相关指标检查、睑板腺相关指标检查等,全身检查包括妇科基本检查及评分、围绝经期特征的性激素水平检查等,以48名同龄健康妇女作为对照组,均将右眼检查数据纳入统计分析,比较PMS-MGD组患者与对照组受检者的眼表及睑板腺形态和功能改变.结果 与对照组受检者比较,PMS-MGD组患者血液卵泡刺激素(FSH)、黄体生成激素(LH)水平明显高于对照组,差异均有统计学意义(t=55.217、76.769,均P＜0.01);患者外周血中雌二醇(E2)水平明显低于对照组,差异有统计学意义(t=-46.358,P＜0.01).PMS-MGD组患者OSDI评分为25.00(18.00,32.00),对照组为1.00(1.00,2.00),差异有统计学意义(Z=-8.043,P＜0.05).OSDI问卷调查显示PMS-MGD组患者的主要主观症状为异物感,其次依次为视物模糊、畏光、眼酸眼痛和视力下降;调查还显示患者中看电视时症状加重者16例,占38.10％,使用计算机或自助提款机时加重者10例,占23.81％,阅读困难者6例,占14.29％,夜间开车困难者4例,占9.52％,有风时症状加重者4例,占9.52％,干燥环境下加重者14例,占33.33％,空调环境下加重者16例,占38.10％,有10例患者在上述状况下未出现症状加重的表现,占23.81％,2例患者在有风环境及空调环境下同时有自觉症状加重.PMS-MGD组OSDI评分、角膜荧光染色评分均明显高于对照组,差异均有统计学意义(均P＜0.05);患者泪膜破裂时间(BUT)短于对照组,差异有统计学意义(t=-10.276,P＜0.05).PMS-MGD组患者睑缘异常评分、睑板腺缺失评分、睑板腺开口评分及睑板腺分泌物性质评分均明显高于对照组,差异均有统计学意义(Z=-7.258、-6.517、-6.195、-6.973,P＜0.05).2个组间受检眼泪液分泌试验比较差异无统计学意义(P＞0.05).结论 PMS-MGD组患者MGD功能发生改变,眼表刺激症状明显,并影响正常生活,主诉以异物感最多,看电视时及空调环境下症状加重的患者比例高,睑板腺形态明显异常.%Background Perimenopausal syndrome (PMS) which changes in physiology,pathology and hormone levels,brings a series of ocular and systemic health problems,such as dry eye,meibomian gland dysfunction (MGD),obesity,coronary heart disease and osteoporosis etc.Objective This study aimed to examine the changes of the ocular surface and the meibomian glands in PMS-MGD patients.Methods A case-control study was performed from January to August 2015 in the Affiliated Hospital of the Armed Police College.Forty-two patients with PMS-MGD were included in this study.Ocular surface disease index (OSDI) questionnaire was carried out to assess the ocular surface symptoms,and the ocular surface examination,dry-eye related tests and morphological and functional examinations of meibomian gland as well as the detect of serum sex hormone levels were conducted under the informed consent.Results Compared with the control group,the serum follicle-stimulating hormone (FSH),luteinizing hormone (LH) and estradiol 2 (E2) were significantly higher in the PMS-MGD group (t =55.217,76.769,-46.358,all at P＜0.01).The scores of OSDI were 25.00 (18.00,32.00) and 1.00 (1.00,2.00) in the PMS-MGD group and the control group,respectively,showing significant difference between them (Z =-8.043,P＜ 0.05).According to the severity of ocular surface symptoms by the analysis of OSDI questionnaire,foreign body sensation was dominant and then was blurred vision,photophobia and eye acid,vision loss in turn.Watching TV aggravated symptoms in 16 patients (38.10％),computer or ATM aggravated symptoms in 10 subjects (23.81％),reading aggravated symptoms in 6 subjects (14.29％),driving at night aggravated symptoms in 4 subjects (9.52％),winding worse symptoms in 4 subjects (9.52％),dry environment worsen symptoms in 14 subjects (33.33％),air conditioning environment worsen symptoms in 16 subjects (38.10％).The corneal fluorescent staining score of the PMS-MGD group was significantly higher than that of control group (P＜0.05),and BUT was less than that of control group (t=-10.276,P＜0.05).All four MGD parameters (eyelid margin scores,meibomian gland scores,meibomian gland secretion scores,and meibomian gland dropout scores) in the PMS-MGD group were significantly higher than those of the control group (Z=-7.258,-6.517,-6.195,-6.973,P＜0.005).There was not statistical significance in S Ⅰ t test between the two groups (P＞0.005).Conclusions PMS-MGD patients occur the morphology and functional changes,leading to the ocular surface symptoms,and foreign body sensation,watching TV and air conditioning aggravates the symptoms.
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