睑板腺功能障碍患者睫毛蠕形螨感染治疗的相关研究

摘要

Objective To investigate the prevalence and treatment effects of Demodex species in eyelash follicles in patients with meibomian gland dysfunction (MGD).Methods The MGD patients (MGD group) and normal subjects (control group) were collected from the Ophthalmology Clinic in PUMCH from July 2015 to December 2015.The symptom score of MGD patients was recorded.Eyelash sampling,Demodex counting,tear film break-up time (BUT),cornea fluorescein staining (Fl) and Schirmer test Ⅰa (S Ⅰ aT) were measured for both groups.All the measurements were repeated after 4 weeks of meibomian function treatment for the MGD group.Symptom score,BUT,Fl and S Ⅰ aT were normally distributed and displayed as mean± standard deviation.Demodex counting was not normally distributed and displayed as median (interquartile range P25,P75).Results Forty-four MGD patients (88 eyes) and 48 controls (96 eyes) were recruited.For the MGD and control groups,the number of Demodex was 3.5 (2,7)and 0 (0,7),respectively (Z =-4.912,P=0.000).The percentage of Demodex infestation was 86.4％ and 39.6％,respectively (x2=35.957,P=0.000).The BUT was (3.57±2.09)s and(10.17±3.25)s,respectively (t=-5.154,P=0.000).The Fl was 2.73±1.23 and 0.85±0.33,respectively (t=4.583,P=0.O00).The S Ⅰ aT was (8.75±5.61) s and (14.51±5.29) s,respectively (t=-2.278,P=0.028).The symptom score of the MGD group before and after treatment was 4.77±3.01 and 2.79±2.01,respectively (t=6.224,P=0.O00).The BUT,Fl and number of Demodex of the MGD group after the treatment were (5.43±2.37)s,(1.91±0.66) and 2 (0,3),respectively,and all had significant difference with the data before the treatment (BUT,t=-4.705,P=0.000.FI,t =3.902,P =0.000.number of Demodex,Z=-4.623,P =0.000).The S Ⅰ aT of the MGD group after the treatment was 8.86±6.76,with no significant difference with the data before the treatment (t=-0.277,P=-0.833).Conclusions The Demodex infestation has some effects on the pathogenesis of MGD.The treatment of MGD may help to decrease the number of Demodex and thus relieve the ocular discomfort.%目的 研究睑板腺功能障碍(MGD)患者的睫毛蠕形螨感染情况及睑板腺功能治疗对蠕形螨感染状态的影响.方法 病例对照研究.收集2015年7月至2015年12月在北京协和医院眼科门诊就诊的MGD患者44例(88只眼)(MGD组)及性别年龄相匹配的健康人48名(96只眼)作为对照组.其中MGD组男性21例,女性23例,平均年龄(56±12)岁,对照组男性26名,女性22名平均年龄(53±15)岁.对MGD患者进行主观症状评分,两组患者均进行睫毛采样及蠕形螨计数并记录泪膜破裂时间(BUT)、角膜荧光素染色评分(Fl)和泪液分泌试验(S Ⅰ aT),并在MGD患者接受睑板腺功能治疗4周后再次重复上述检查.主观症状评分、BUT、Fl和SⅠaT的数值符合正态分布,以均值±标准差表示,蠕形螨数量不符合正态分布,以中位数(P25,P75)表示,结果 MGD组和对照组的蠕形螨感染数量分别为3.5(2,7)和0(0,5)(Z=-4.912,P=0.000),蠕形螨阳性率分别为86.4％和39.6％ (x2=35.957,P=0.000),BUT分别为(3.57±2.09)和(10.17±3.25)s(t=-5.154,P=0.000),Fl分别为(2.73±1.23)和(0.85±0.33)分(t=4.583,P=0.000),SⅠaW分别为(8.75±5.61)和(14.51±5.29) mm(t=-2.278,P=0.028).MGD组患者治疗前后的主观症状评分分别为(4.77±3.01)和(2.79±2.01)分(t=6.224,P=0.000).治疗后MGD组患者BUT为(5.43±2.37)s,Fl为(1.91±0.66),蠕形螨数量下降为2(0,3),均较治疗前差异有统计学意义(BUT,t=-4.705,P=0.000;Fl,t=3.902,P=0.000;蠕形螨数量,Z=-4.623,P=0.000);而MGD组患者治疗后的SⅠaT为(8.86±6.76)mm,较治疗前差异无统计学意义(t=-0.277,P=0.833).结论 MGD患者睫毛蠕形螨感染率及感染数量较高.蠕形螨感染可能在MGD的起病过程中起一定作用,热敷按摩及睑缘清洁等MGD治疗措施有助于减少蠕形螨数量,改善患者眼部不适症状.