摘要：
Objective To investigate the occurrence of meibomian gland dysfunction (MGD) in flight attendants. Methods The case-control analysis was used.The analysis was conducted on 2 385 flight attendants who were in physical examination and medical qualification in the Medical Center of Aviation Hygiene Management Division of China Southern Airlines Ltd.from January 2016 to December 2017.Six hundred and sixty-nine flight attendants who were diagnosed as MGD were defined to MGD group ,including 76 males and 593 females and the average age was (31.5 ± 7.8) years old.Six hundred and eleven gender and age matched healthy people were selected as control group ,including 72 males and 539 females with the average age of (30.8 ± 8.1) years old.Subjects were also divided into wearing group and non-wearing group by contact lenses wearing history.The wearing group was further divided into short-term wearing group (wearing time＜1 year) ,medium-term wearing group (wearing time 1-3 years) and long-term wearing group (wearing time＞3 years). The detection rate of MGD in each group was statistically analyzed.Following examinations were performed in MGD group : the ocular surface disease index (OSDI ) questionnaire , the slit lamp examination of eyelid margin ,the tear film break-up time (BU T ) measurement ,and the tear secretion test (Schirmer Ⅰ test ,SIT) ,and corneal fluorescein staining (CFS).The values of OSDI ,scores of BUT and SIT ,and CFS were all follow a normal distribution and expressed as mean ± standard deviation.The differences of above indexes were compared between MGD group and control group , and between wearing group and non-wearing group.Chi-square test was used to compare the detection rate of MGD in each group.The independent samples t-test was used to compare the measurement indexes between MGD group and control group ,and between wearing group and non-wearing group. Results The detection rate of MGD in flight attendants was 28.05%,and the detection rate in wearing group was 32.75%,which was significantly higher than that of non-wearing group (16.07%). The difference was statistically significant (χ2＝ 66.52 , P＝ 0.000).The detection rate of MGD in short-term wearing group ,medium-term wearing group and long-term wearing group was 21.71%, 32.07%,42.62% respectively.The difference was statistically significant (χ2＝56.02 ,P＝0.000).The OSDI ,eyelid margin ,CFS of MGD group was 29.85 ± 4.36 ,3.26 ± 0.87 ,and 3.84 ± 1.88 respectively , which was higher than that of the control group (7.12 ± 2.20 ,0.41 ± 0.04 ,1.22 ± 0.44) ,and the differences were statistically significant (t＝17.82-26.82 ,P＝0.000).The BUT of MGD group was (3.53 ± 2.16) s ,which was significantly lower than that of control group (10.08 ± 2.15) s (t＝13.57 , P＝0.000).There was no significant difference on SIT between two groups (t＝1.61 ,P＝0.114).The statistical differences of above indexes between MGD group and control group were basically same as the differences between wearing group and non-wearing group. Conclusions The detection rate of MGD is high in flight attendants.Wearing contact lenses is an important reason.The longer wearing time the higher MGD detection rate.%目的 调查分析空中乘务员睑板腺功能障碍(meibomian gland dysfunction ,MGD)的状况. 方法 采用病例对照研究.对象为2016年1月至2017年12月在南方航空有限公司航空卫生管理部医学鉴定中心行体检鉴定的2 385名空中乘务员.受检者中诊断为M GD者669例作为M GD组,其中男性76例、女性593例,年龄(31 .5 ± 7 .8)岁.选取性别、年龄相匹配的健康人611例作为对照组,其中男性72例、女性539例,年龄(30 .8 ± 8 .1)岁.根据角膜接触镜配戴史,分为配戴组和未配戴组;根据配戴时间配戴组进一步分为短期配戴组(配戴时间＜1年) 、中期配戴组(配戴时间1～3年)、长期配戴组(配戴时间＞3年).统计分析各组MGD的检出率.对MGD组分别进行眼表疾病指数(ocular surface disease index ,OSDI)问卷调查、睑缘裂隙灯检查、泪膜破裂时间(tear film break-up time ,BUT )测定、泪液分泌试验(Schirmer Ⅰ test ,SIT )、角膜荧光素染色(corneal fluorescein staining ,CFS)评分. OSDI 、睑缘评分、BUT 、SIT和CFS的数值均符合正态分布,以均值±标准差表示.比较分析M GD组与对照组、配戴组与未配戴组以上各指标的差异.各组M GD检出率的比较采用卡方检验,M GD组与对照组、配戴组与未配戴组的各项计量指标比较采用独立样本 t检验. 结果 空中乘务员M GD的检出率为28 .05%,其中配戴组的检出率为32 .75%,明显高于未配戴组的16.07%,且差异有统计学意义(χ2＝66 .52 , P＝0 .000) ;短期配戴组、中期配戴组、长期配戴组的检出率分别是21 .71%、32 .07%、42 .62%,且组间差异有统计学意义(χ2＝56 .02 , P＝0 .000 ) . M GD组OSDI为(29 .85 ± 4 .36)、睑缘评分(3 .26 ± 0 .87)、CFS(3 .84 ± 1.88) ,均高于对照组的(7.12 ± 2.20 、0.41 ± 0 .04、1 .22±0 .44),且差异均具有统计学意(t＝7 .50～26 .82,P＜0 .01).MGD组BUT 为(3 .53± 2 .16)s ,较对照组(10 .08 ± 2 .15)s明显降低(t＝ 13 .57 , P＝ 0 .000).两组 SIT 差异无统计学意义(t＝1 .61 ,P＝0 .114).配戴组与未配戴组上述各指标比较的统计学差异同MGD组与对照组比较结果基本一致. 结论 空中乘务员M GD检出率较高,配戴角膜接触镜是重要的影响因素;配戴时间越长,M GD的检出率越高.
