Correlation between corneal nerve fiber changes and dry eye in adolescents with primary dry syndrome
-
摘要:
目的 应用角膜共焦激光显微镜分析青少年原发性干燥综合征患者的角膜神经纤维的变化,探讨其与干眼之间的相关性。 方法 选取2020年1月—2022年5月宁波市眼科医院收治的青少年原发性干燥综合征患者的78只左眼为观察组,再选择同期体检的78只健康者左眼作为对照组,入选人员均进行了眼表疾病指数(OSDI)、泪膜破裂试验、泪液分泌试验等指标的检查(均一致),排除了其他原因导致干眼的可能性,比较2组活体共焦光纤显微镜相关指数和OSDI评分。采用Pearson检验分析原发性干燥综合征患者角膜神经纤维变化与干眼的相关性。 结果 观察组的神经纤维直径为(2.12±0.58)μm, 低于对照组的(3.21±0.45)μm,观察组的神经纤维珠数量、朗格汉斯细胞密度、OSDI评分分别为(7.25±2.15)个/100 μm、(636.05±38.15)个/100 μm、(45.23±5.21)分, 均高于对照组的(2.85±1.36)个/100 μm、(13.85±4.02)个/100 μm、(11.23±3.21)分(P<0.05)。Pearson相关性分析显示,原发性干燥综合征患者OSDI评分与神经纤维直径呈负相关关系(r=-0.432,P < 0.05),与神经纤维珠数量、朗格汉斯细胞密度呈正相关关系(r=0.562、0.515,P < 0.05)。 结论 青少年原发性干燥综合征患者干眼与神经纤维直径、神经纤维珠数量、朗格汉斯细胞密度具有相关性,以上指标可作为临床诊断治疗原发性干燥综合征的提示因素。 Abstract:Objective Corneal confocal laser microscopy was applied to analyze changes in corneal nerve fibers in adolescent patients with primary dry syndrome and to discuss their correlation with dry eye. Methods Seventy-eight left eyes of adolescent patients with primary dry eye syndrome admitted to Ningbo Eye Hospital between January 2020 and May 2022 were selected as the observation group, and then 78 left eyes of healthy people with physical examination during the same period were selected as the control group, and the enrolled patients were examined for ocular surface disease index (OSDI) values, tear film break-up test, tear secretion test and other indices (all were consistent), and other causes of dry eye were excluded, and the in vivo confocal fibre-optic microscopy related indices and OSDI scores were compared between the two groups. Pearson ' s test was used to analyse the correlation between corneal nerve fibre changes and dry eye in patients with primary dry syndrome. Results The diameter of the nerve fibres in the observation group was (2.12±0.58)μm, which was smaller than that in the control group [(3.21±0.45)μm]. The number of nerve fibre bundles, Langerhans cell density and OSDI scores of the observation group were (7.25±2.15)/100 μm, (636.05±38.15)/100 μm and (45.23±5.21) points, respectively, which were higher than that in the control group [(2.85±1.36)/100 μm, (13.85±4.02)/100 μm, (11.23±3.21) points, P < 0.05]. Pearson correlation test showed a negative correlation between OSDI score and nerve fibre diameter in patients with primary dry syndrome (r=-0.432, P < 0.05); and a positive correlation with nerve fibre count and Langerhans cell density (r=0.562, 0.515, P < 0.05). Conclusion There is a correlation between dry eye and nerve fibre diameter, number of nerve fibre bundles and Langerhans cell density in juvenile patients with primary dry syndrome, and the above indicators can be used as suggestive factors for clinical diagnosis and treatment of primary dry syndrome. -
Key words:
- Primary dry syndrome /
- Corneal nerve fiber changes /
- Dry eye /
- Correlation
-
表 1 2组活体共焦光纤显微镜相关指数和OSDI评分比较(x±s)
Table 1. Comparison of in vivo confocal fiber optic microscopy correlation indices and OSDI scores between the two groups (x±s)
组别 例数 神经纤维直径(μm) 神经纤维珠数量(个/100 μm) 朗格汉斯细胞密度(个/100 μm) OSDI评分(分) 观察组 78 2.12±0.58 7.25±2.15 636.05±38.15 44.37±4.75 对照组 78 3.21±0.45 2.85±1.36 13.85±4.02 12.06±3.49 t值 13.114 15.275 143.247 48.124 P值 < 0.001 < 0.001 < 0.001 < 0.001 表 2 神经纤维变化与原发性干燥综合征患者干眼的相关性
Table 2. Correlation analysis between nerve fiber changes and dry eye in patients with primary dry syndrome
神经纤维指标 原发性干燥综合征 r值 P值 神经纤维直径 -0.432 0.036 神经纤维珠数量 0.562 0.008 朗格汉斯细胞密度 0.515 0.043 -
[1] 董怡. 原发性干燥综合征诊疗规范的必要性与重要性[J]. 中华内科杂志, 2020, 59(4): 267-268. doi: 10.3760/cma.j.cn112138-20200113-00023DONG Y. The necessity and importance of diagnosis and treatment standardization of primary dry syndrome[J]. Chin J Intern Med, 2020, 59(4): 267-268. doi: 10.3760/cma.j.cn112138-20200113-00023 [2] 贾蝉忆, 张霞, 谢华灵, 等. 润燥解毒液漱口缓解干燥综合征口干的疗效研究[J]. 现代医药卫生, 2021, 37(17): 2905-2908. doi: 10.3969/j.issn.1009-5519.2021.17.007JIA C Y, ZHANG X, XIE H L, et al. Study on the efficacy of moistening and detoxifying liquid gargle in relieving dry mouth in dry syndrome[J]. Cecil Medicine, 2021, 37(17): 2905-2908. doi: 10.3969/j.issn.1009-5519.2021.17.007 [3] 王梦洁, 徐子琦, 刘英. 原发性干燥综合征的中西医治疗新进展[J]. 现代中西医结合杂志, 2021, 30(4): 443-448. doi: 10.3969/j.issn.1008-8849.2021.04.023WANG M J, XU Z Q, LIU Y. New advances in Chinese and Western medicine treatment of primary dry syndrome[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2021, 30(4): 443-448 doi: 10.3969/j.issn.1008-8849.2021.04.023 [4] 成拾明, 阮坤炜, 韩芳芳, 等. 异硫氰酸荧光染色法在真菌性角膜炎诊断中的应用观察[J]. 临床眼科杂志, 2020, 28(5): 423-426. doi: 10.3969/j.issn.1006-8422.2020.05.009CHENG S M, RUAN K W, HAN F F, et al. Application of fluorescent isothiocyanate staining in the diagnosis of fungal keratitis[J]. J Clin Ophthalmol, 2020, 28(5): 423-426. doi: 10.3969/j.issn.1006-8422.2020.05.009 [5] 但超, 谢华桃, 王峥嵘, 等. 角膜激光共聚焦显微镜在单眼感染性角膜炎疾病诊断中的应用[J]. 现代生物医学进展, 2022, 22(8): 1444-1449. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX202208009.htmDAN C, XIE H T, WANG Z R, et al. Application of corneal laser confocal microscopy in the diagnosis of monocular infectious keratitis[J]. Modern Biomedical Progress, 2022, 22(8): 1444-1449. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX202208009.htm [6] 中华医学会风湿病学分会. 干燥综合征诊治指南(草案)[J]. 中华风湿病学杂志, 2003, 7(7): 446-448. doi: 10.3760/j:issn:1007-7480.2003.07.019Chinese Society of Rheumatology. Guidelines for the diagnosis and treatment of dry syndrome (draft)[J]. Chin J Rheumatol, 2003, 7(7): 446-448. doi: 10.3760/j:issn:1007-7480.2003.07.019 [7] 郑巧, 张琪. 共焦显微镜在角膜病变中应用的新进展[J]. 国际眼科杂志, 2019, 19(9): 1503-1506. https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK201909018.htmZHENG Q, ZHANG Q. New advances in the application of confocal microscopy in corneal lesions[J]. International Journal of Ophthalmology, 2019, 19(9): 1503-1506 https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK201909018.htm [8] 黄丽玉, 郭阳. 原发性干燥综合征合并神经系统病变研究进展[J]. 中国现代神经疾病杂志, 2019, 19(1): 54-59. doi: 10.3969/j.issn.1672-6731.2019.01.012HUANG L Y, GUO Y. Progress in the study of primary dry syndrome combined with neurologic lesions[J]. Chinese Journal of Modern Neurological Diseases, 2019, 19(1): 54-59. doi: 10.3969/j.issn.1672-6731.2019.01.012 [9] 柏志义, 李媛, 王海瑜, 等. 20例不同证型原发性干燥综合征患者口腔菌群特征[J]. 中医杂志, 2023, 64(1): 43-48. doi: 10.3969/j.issn.0411-8421.2023.01.021BO Z Y, LI Y, WANG H Y, et al. Characteristics of oral flora in 20 patients with different types of primary dry syndrome[J]. Tradit Chin Med, 2023, 64(1): 43-48. doi: 10.3969/j.issn.0411-8421.2023.01.021 [10] 李方烃, 沈重成, 英鑫, 等. 基于共聚焦显微镜图像拼接方法分析干眼患者角膜神经形态[J]. 中华眼视光学与视觉科学杂志, 2022, 24(1): 27-33. doi: 10.3760/cma.j.cn115909-20210616-00244LI F T, SHEN C C, YING X, et al. Analysis of corneal nerve morphology in dry eye patients based on confocal microscopy image stitching[J]. Chin J Optom Ophthalmol Vis Sci, 2022, 24(1): 27-33. doi: 10.3760/cma.j.cn115909-20210616-00244 [11] 蒋鹏飞, 黎冬冬, 彭俊, 等. 干眼症患者泪液炎症因子与症状体征相关性研究[J]. 国际眼科杂志, 2020, 20(4): 699-702. https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK202004031.htmJIANG P F, LI D D, PENG J, et al. Correlation between tear inflammatory factors and symptoms in patients with dry eye[J]. Int J Ophthalmol-Chi, 2020, 20(4): 699-702. https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK202004031.htm [12] 陈士军, 陈芳, 胡明翠, 等. 误诊为类风湿关节炎的原发性干燥综合征八例分析[J]. 临床误诊误治, 2019, 32(10): 3-6. doi: 10.3969/j.issn.1002-3429.2019.10.002CHEN S J, CHEN F, HU M C, et al. Analysis of eight cases of primary dry syndrome misdiagnosed as rheumatoid arthritis[J]. Clin MisDiagn Misther, 2019, 32(10): 3-6. doi: 10.3969/j.issn.1002-3429.2019.10.002 [13] 吴若兰, 郑旭, 王怡平, 等. 转录因子Blimp-1在原发性干燥综合征中的表达和作用[J]. 中华微生物学和免疫学杂志, 2020, 40(4): 276-277, 282. doi: 10.3760/cma.j.cn112309-20200114-00023WU R L, ZHENG X, WANG Y P, et al. Expression and role of transcription factor Blimp-1 in primary desiccation syndrome[J]. Chinese Journal of Microbiology and Immunology, 2020, 40(4): 276-282. doi: 10.3760/cma.j.cn112309-20200114-00023 [14] 徐辉, 李丽, 郑小勤, 等. 6例原发性干燥综合征相关肝衰竭临床特征分析[J]. 传染病信息, 2022, 35(6): 533-537. doi: 10.3969/j.issn.1007-8134.2022.06.011XU H, LI L, ZHENG X Q, et al. Clinical characterization of six cases of primary dry syndrome-associated liver failure[J]. Infectious Disease Information, 2022, 35(6): 533-537. doi: 10.3969/j.issn.1007-8134.2022.06.011 [15] 梁华, 田淼元, 李奇玮, 等. 原发性干燥综合征神经病变危险因素的Meta分析[J]. 中国免疫学杂志, 2023, 39(3): 610-615. doi: 10.3969/j.issn.1000-484X.2023.03.028LIANG H, TIAN M Y, LI Q W, et al. Meta-analysis of risk factors for neuropathy in primary dry syndrome[J]. Cell Mol Immunol, 2023, 39(3): 610-615. doi: 10.3969/j.issn.1000-484X.2023.03.028 [16] 杨钊, 陈琦. 活体共聚焦显微镜下干燥综合征角膜潜基质神经纤维变化与临床症状相关性分析[J]. 国际眼科杂志, 2020, 20(5): 749-753. https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK202005004.htmYANG Z, CHEN Q. Analysis of correlation between changes in corneal latent stromal nerve fibers and clinical symptoms in dry syndrome under in vivo confocal microscopy[J]. Int J Ophthalmol-Chi, 2020, 20(5): 749-753. https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK202005004.htm [17] 许砚秋, 杨恩浩, 朱丰林, 等. 原发性干燥综合征神经系统受累的诊治进展[J]. 中国免疫学杂志, 2022, 38(12): 1516-1522. doi: 10.3969/j.issn.1000-484X.2022.12.020XU Y Q, YANG E H, ZHU F L, et al. Progress in the diagnosis and treatment of neurologic involvement in primary dry syndrome[J]. Cell Mol Immunol, 2022, 38(12): 1516-1522. doi: 10.3969/j.issn.1000-484X.2022.12.020 [18] 张卫平, 陈莉, 王婧玲, 等. SWE应用于原发性干燥综合征周围神经病变的研究[J]. 中国超声医学杂志, 2019, 35(5): 454-457. doi: 10.3969/j.issn.1002-0101.2019.05.025ZHANG W P, CHEN L, WANG J L, et al. SWE applied to peripheral neuropathy in primary dry syndrome[J]. Chin J Ultrasound Med, 2019, 35(5): 454-457. doi: 10.3969/j.issn.1002-0101.2019.05.025 [19] 张遥, 徐雁, 赵久良, 等. 原发性干燥综合征相关神经系统损害52例临床特征[J]. 中华内科杂志, 2019, 58(7): 525-530.ZHANG Y, XU Y, ZHAO J L, et al. Clinical features of 52 cases of primary dry syndrome-associated neurological damage[J]. Chin J Intern Med, 2019, 58(7): 525-530. [20] 毛伦林, 季莉莉, 华敏, 等. 以中枢神经系统损害为首发表现的原发性干燥综合征一例[J]. 中国现代神经疾病杂志, 2021, 21(10): 905-911. doi: 10.3969/j.issn.1672-6731.2021.10.013MAO L L, JI L L, HUA M, et al. A case of primary dry syndrome with central nervous system damage[J]. Chinese Journal of Modern Neurological Diseases, 2021, 21(10): 905-911. doi: 10.3969/j.issn.1672-6731.2021.10.013 -

计量
- 文章访问数: 126
- HTML全文浏览量: 76
- PDF下载量: 6
- 被引次数: 0