Keratograph 5M眼表综合分析仪在干眼诊断中的应用研究

摘要

目的 应用Keratograph 5M眼表综合分析仪(K5M)对比干眼病人和正常志愿者的非侵入性泪膜破裂时间(noninvasive Keratograph tear breakup time,NIKBUT)和泪河高度(tear meniscus height,TMH),探讨NIKBUT和TMH联合应用在干眼诊断中的作用.方法 选取干眼病人110例,110眼(干眼组);正常志愿者108人,108眼(对照组).所有入选受检者均完成眼表疾病评分指数(Ocular Surface Disease Index,OSDI)问卷调查;应用K5M测量TMH和NIKBUT[首次泪膜破裂时间(first noninvasive Keratograph tear breakup time,NIKBUTf)和平均泪膜破裂时间(average noninvasive Keratograph tear breakup time,NIKBUTav)];角膜荧光染色测量传统泪膜破裂时间(tear film breakup time,BUT)和角膜荧光素染色评分;Schirmer Ⅰ试验(SⅠt)测量泪液分泌量.比较分析2组受检者各参数,并绘制受试者工作特征曲线(receiver operating characteristic curve,ROC).结果 干眼组和对照组OSDI评分、BUT、SⅠt值、角膜染色评分,差异均有统计学意义(P均＜0.001).其中干眼组和对照组的NIKBUTf值分别为(5.9±3.96)s和(8.78±4.33) s(P ＜0.001);NIKBUTav值分别为(8.07 ±4.34)s和(12.67 ±4.43) s(P ＜0.001);TMH分别为(0.22 ±0.06) mm和(0.28 ±0.09) mm(P ＜0.001).ROC分析显示,NIKBUTf、NIKBUTav和TMH单独诊断干眼的曲线下面积、灵敏度、特异度分别为0.740、80％和67.59％;0.798、64.55％和83.33％;0.660、33.63％和94.44％.三参数联合诊断干眼的曲线下面积、灵敏度、特异度分别为0.829、67.3％和86.1％.结论 K5M能够有效测量干眼病人和正常志愿者眼表TMH和NIKBUT,且所测得参数两组间差异有统计学意义(P＜0.05).TMH和NIKBUT单独应用对于干眼的诊断效率欠佳,但联合参数能够明显提高诊断效率,具有实际临床应用价值.%Objective To compare the noninvasive Keratograph tear breakup time (NIKBUT) and tear meniscus height (TMH) of patients with dry eye disease (DED) and healthy control subjects using Keratograph 5M (K5M) and to investigate the role of NIKBUT and TMH in the diagnosis of DED.Methods In this prospective study,110 eyes with DED (DED group) and 108 healthy control eyes (Control group) were enrolled.All subjects completed the Ocular Surface Disease Index (OSDI) questionnaire.NIKBUT,which included the first NIKBUT (NIKBUTf) and average NIKBUT (NIKBUTav),and TMH were measured by K5M.The fluorescein tear breakup time (BUT),corneal staining and SchirmerⅠ test were also applied.All parameters were compared between the DED and Control groups.The receiver operating characteristic curves (ROC) were plotted to distinguish DED from the nornal eyes.Results There were significant difference between DED and Control group for the values of OSDI,BUT,corneal staining score and Schirmer Ⅰ test (all P ＜0.001).In the DED group,the NIKBUTf,NIKBUTav and TMH were (5.9 ±3.96) s,(8.07 ±4.34) s and (0.22 ±0.06) mm,respectively;while in the Control group,the values were (8.78 ± 4.33) s,(12.67 ± 4.43) s and (0.28 ± 0.09) mm,respectively (between the two groups,all P ＜ 0.001).For ROC analysis,the area under the curve (AUC),sensitivity and specificity were 0.740,80％ and 67.59％ for NIKBUTf;0.798,64.55％ and 83.33％ for NIKBUTav;0.660,33.63％ and 94.44％ for TMH,respectively.For the combo of the three parameters,the AUC,sensitivity and specificity were 0.829,67.3％ and 86.1％,respectively.Conclusion Keratograph 5M offers an effective method for measuring NIKBUT and TMH properties of both patients with DED and healthy subjects.The three parameters exhibited significant differences between the two groups.Although the diagnostic efficiency was poor with NIKBUT or TMH alone,but the combined parameter showed a high sensitivity for the diagnosis of DED,with practical clinical application.