戒毒人员干眼症临床症状与检查结果的相关性研究

Correlation between symptoms and sign of drug users with dry eye

摘要:

目的：探讨戒毒人员干眼症症状与临床检查结果的相关性。

方法：选取2017-10/2018-02在上海市杨浦区某戒毒所强制戒毒的干眼症患者87例87眼(干眼症组)，选取同期强制戒毒的非干眼症人员90例90眼作为对照(均选取右眼)。所有受检者均进行5项干眼调查问卷(dry eye questionnaire-5，DEQ-5)和眼表疾病指数评分(ocular surface disease index，OSDI)问卷调查、病史及症状询问、泪河高度、泪膜破裂时间(break-up time， BUT)、荧光素钠染色(fluorescein， FL)评分、泪液渗透压、泪液分泌试验(SchirmerⅠtest，SⅠt)及睑板腺功能检查，并采用Pearson和Spearman相关法分析戒毒人员干眼症症状和体征间的关系。

结果：强制戒毒的干眼症患者DEQ-5问卷和OSDI问卷评分均与BUT值呈负相关(r=-0.791、-0.894，均P<0.01)，与FL评分均呈正相关(r=0.652、0.571，均P<0.05)，与泪河高度、泪液渗透压、SⅠt、睑板腺功能分级均无明显相关性。强制戒毒的干眼症患者中疲劳感、干燥感、视力波动是最常见的3种症状，畏光与泪河高度呈负相关(r_s=-0.218，P=0.023)； 干燥感、疲劳感、胀痛/刺痛和视力波动与BUT均呈负相关(r_s=-0.057、-0.197、-0.053、-0.068，均P<0.05)； 干燥感、疲劳感和视力波动与FL均呈正相关(r_s=0.169、0.201、0.226，均P<0.05)； 流泪与泪液渗透压呈正相关(r_s =0.315，P=0.013)； 干燥感与SⅠt呈正相关(r_s =0.324，P=0.043)； 视力波动与睑板腺功能呈正相关(r_s=0.227，P=0.011)。干眼症组和非干眼症组受检者泪河高度、FL评分、泪液渗透压的差异均有统计学意义(P<0.05)，但BUT、SⅠt及睑板腺功能的差异均无统计学意义(P>0.05)。

结论：戒毒人员干眼症临床症状不明显，与检查结果相关性较差，临床医生接诊时应重视病史询问、体征检查以及诊断的精细化、个体化。

Abstract:

AIM: To investigate the correlation between symptoms and sign of drug users with dry eye.

METHODS: Eighty-seven patients(87 eyes)with dry eye syndrome who were abstained from a compulsory rehabilitation center in Yangpu District of Shanghai from October 2017 to February 2018 were selected as test group. And 90 eyes of 90 patients with non-dry eye syndrome who were abstained from the same center during the same period were selected as control group. All subjects were selected for the right eye. All the patients were analyzed including dry eye questionnaire-5, ocular surface disease index(OSDI)questionnaire survey, symptoms, tear height test, break-up time test, sodium fluorescein staining test, tear osmotic pressure, Schirmer Ⅰ test and Meibomian gland function tests. Pearson and Spearman correlations were used to analyze the relationship between symptoms and signs of drug users with dry eye.

RESULTS: Both the DEQ-5 questionnaire and the OSDI questionnaire scores were negatively correlated with BUT values(r=-0.791, -0.849, P<0.01), and were also positively correlated with corneal fluorescein sodium staining(DEQ-5: r=0.652, P<0.01; OSDI: r=0.571, P<0.05). The scores of DEQ-5 questionnaire and OSDI questionnaire were not significantly correlated with tear height, tear osmotic pressure, Schirmer Ⅰ test, and Meibomian gland functional score. Fatigue, dryness, and visual acuity were the three most common symptoms(69.0%, 63.2%, 55.2%, respectively). The negative correlation was shown between photophobia and tear height(r=-0.218, P=0.023). Dryness, fatigue, pain/sting, visual acuity were also negatively correlated with BUT(r=-0.057,-0.197, -0.053, -0.068, P<0.05). The positive correlation was shown between dryness, fatigue, visual acuity and FL(r=0.169, 0.201, 0.226, P<0.05), tearing and tear osmotic pressure(r=0.315, P=0.013), dryness and Schiemer Ⅰ(r=0.324, P=0.043). Visual acuity was positively correlated with meibomian gland function(r=0.227, P=0.011). The difference in tear height, corneal fluorescein sodium staining, and tear osmotic pressure were statistically significant between dry eye patients and normal group(P<0.05). The differences in BUT, Schirmer Ⅰ test and meibomian gland function were not statistically significant(P>0.05).

CONCLUSION: The clinical symptoms of dry eye in drug users are not obvious, and their correlation with the test results is poor. Clinicians should pay attention to the medical history inquiry, physical examination, and the refinement and individualization of diagnosis.