目的：评估教师群体干眼(DED)与身心健康之间的关系，探讨其机制并提出干预措施。

方法：横断面研究。将山东省临沂市市区3所中小学校教师183人纳入研究。采用眼表疾病指数(OSDI)问卷对DED症状进行量化。采用精简版抑郁、焦虑和压力量表(DASS-21)评估心理状态。采用定量变量独立样本t检验和分类变量的χ²检验来评估潜在影响因素与DED之间的关系。采用Logistic回归分析进行多因素分析，以确定DED的影响因素。采用Pearson相关分析进行OSDI评分与抑郁、焦虑、压力的相关性分析。

结果：共183名教师，其中男44人(24.0%)，女139人(76.0%)，年龄22-57(平均34.2±8.6)岁。DED的患病率为60.0%(109/183，95%CI 52.4%-66.7%)。抑郁患病率为26.2%(48/183，95%CI 19.8%-32.7%)； 焦虑患病率为39.3%(72/183，95%CI 32.2%-46.5%)； 压力患病率为23.0%(42/183，95%CI 16.8%-29.1%)。单因素分析显示，年龄增加、工作年限增加、视频终端(VDT)应用时间增加、书面工作时间延长、睡眠时间减少、较少的饮酒以及较高的抑郁、焦虑、压力评分均为DED的影响因素(均P<0.05)。心理指标采用抑郁评分，进行多因素Logistic回归分析显示，工作年限、VDT应用时间、书面工作时间、睡眠时间、饮酒量及抑郁评分是DED的影响因素(均P<0.05)； 心理指标采用焦虑评分，进行多因素Logistic回归分析显示，工作年限、VDT应用时间、书面工作时间、睡眠时间、饮酒量及焦虑评分是DED的影响因素(均P<0.05)； 心理指标采用压力评分，进行多因素Logistic回归分析显示，工作年限、VDT应用时间、书面工作时间及压力评分是DED的影响因素(均P<0.05)。DED组中，OSDI评分与抑郁、焦虑及压力评分均呈正相关(P<0.05)； 所有参与者组中，OSDI分数与抑郁、焦虑及压力评分均呈正相关(P<0.05)； 重度DED组中，OSDI分数与抑郁、焦虑及压力评分均呈正相关(P<0.05)。

结论：DED在教师群体中发病率较高。饮酒、睡眠减少、较长工作年限、较长的VDT使用时间以及较长的书面工作时间是DED的影响因素。重度DED组中，DED与抑郁、焦虑和压力高度相关。要重视教师的DED及与之相关的身心健康问题，积极预防，早期诊治。

METHODS:Cross-sectional study. A total of 183 teachers from three primary and secondary schools in the urban area of Linyi City, Shandong Province were enrolled in the study. DED symptoms were quantified using the ocular surface disease index(OSDI)questionnaire. A compact version of the depression, anxiety, and stress scale(DASS-21)was used to evaluate psychological state. The relationship between potential influencing factors and DED was evaluated by independent sample t-test of quantitative variables and χ²test of classified variables. Logistic regression analysis was used for multivariate analysis to determine the influencing factors of DED. Pearson correlation coefficient was used to analyze the correlation between OSDI score and depression, anxiety and stress.

RESULTS: There were 183 teachers, including 44 males(24.0%)and 139 females(76.0%), aged from 22 to 57 years, with an average age of(34.2±8.6)years. The prevalence of DED was 60.0%(109/183; 95%CI 52.4%-66.7%). The prevalence of depression was 26.2%(48/183; 95%CI 19.8%-32.7%); anxiety prevalence was 39.3%(72/183; 95%CI 32.2%-46.5%); and stress prevalence was 23.0%(42/183; 95%CI 16.8%-29.1%). The univariate analysis showed that increased age, increased working years, increased visual display terminal(VDT)application time, longer written working hours, reduced sleep hours, less alcohol consumption, and high scores of depression, anxiety and stress were all factors affecting DED(all P<0.05). Using depression scores as the psychological index, multivariate Logistic regression analysis showed that years of work, VDT application time, written working hours, sleep time, alcohol consumption and depression score were the influencing factors of DED(all P<0.05); Using anxiety scores as the psychological index, multivariate Logistic regression analysis showed that years of work, VDT application time, written working hours and stress scores were the influencing factors of DED(all P<0.05); Using stress scores as the psychological index, multivariate Logistic regression analysis showed that years of work, VDT application time, written working hours and stress scores were the influencing factors of DED(all P<0.05). OSDI scores were positively correlated with depression, anxiety, and stress scores in the DED group(P<0.05)and across all participants(P<0.05). In the severe DED group, OSDI scores were positively related to depression, anxiety, and stress scores(P<0.05).

CONCLUSION: The prevalence of DED is high among the teachers. Alcohol consumption, reduced sleep, longer working years, longer VDT usage and longer written working hours are the influencing factors of DED. In severe DED group, DED is highly correlated with depression, anxiety, and stress. We should pay attention to teachers' DED and related physical and mental health problems, and actively prevent and make early diagnosis and treatment.