Study on the Correlation between Vernal Keratoconjunctivitis and Dry Eye Syndrome in Children
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摘要:
目的 全面评估春季卡他性角结膜炎患儿的干眼状况，了解其伴随干眼的临床特点及与病情严重程度的相关性。 方法 取2015年01至06月儿童医院眼科门诊诊断为春季卡他性角结膜炎的患儿65例（65只眼，右眼数据）为观察组。取年龄、性别与之匹配的正常儿童65例（65只眼，右眼数据）为对照组，分别进行症状评估、裂隙灯检查、泪膜破裂时间（break—up time，BUT）检查、角膜荧光素染色试验（fluorescein，FL）及眼睑刷上皮病变（Lid-wiper epitheliopathy，LWE）检查。对数据进行统计分析和评价。 结果 （1）春季卡他性角结膜炎患儿的干眼症状评分较正常儿童明显升高，两者差异有统计学意义（Z = -8.589 P < 0.01），其中畏光（23.59%）、异物感（18.08%）、瞬目异常（14.49%）、迎风不适（20.90%）是患儿最常见的症状；（2）春卡患儿的裂隙灯检查体征评分明显高于正常儿童组（ Z = -9.902 P < 0.01）；（3）干眼相关检查：春卡患儿的泪膜破裂时间（7.06±3.51）较正常儿童（13.34±4.82）明显缩短（ Z = -6.729 P < 0.01）；角膜荧光素染色评分（1.82±1.69）较正常儿童（0.23±0.46）明显升高（ Z = -6.355 P < 0.01）；眼睑刷上皮病变的评分（1.03±1.00）较正常儿童（0.31±0.50）明显升高（ Z = -4.463 P < 0.01）；（4）春卡患儿干眼症状的严重程度与患儿的体征评分相关（ r = 0.259 P < 0.05）；角膜荧光素染色评分与体征评分相关（ r = 0.269 P < 0.05）；泪膜破裂时间与角膜荧光素染色（ r = -0.283 P < 0.05）及眼睑刷上皮病变（ r = -0.252 P < 0.05）的严重程度相关；角膜荧光素染色与眼睑刷上皮病变（ r = 0.307 P < 0.05）的严重程度相关。 结论 春季卡他性角结膜炎的患儿伴随明显的干眼，其干眼的严重程度与患儿结膜炎的严重程度呈正相关。为进一步探讨春卡患儿病情转归过程中的干眼变化情况提供了基础，也为春卡患儿急性期使用人工泪液辅助治疗提供了用药依据。 Abstract:Objective To evaluate the condition of dry eyes in children with vernal keratoconjunctivitis in spring, and to explore the clinical characteristics as well as correlation with the severity of the disease. Method 65 children who were diagnosed with VKC in outpatient department from January to June in 2015 were recruited as the observation group. The control group consisted of 65 normal children matched in age and sex. Dry eye questionnaire, slit-lamp examination, break-up time test（BUT）, fluorescein staining（FL）and Lid-wiper staining of Lid-wiper epitheliopathy（LWE）were performed in both groups. Statistical analyses were used to assessing these data. Results （1）The dry eye symptom scores of children with vernal keratoconjunctivitis in spring were significantly higher than those of normal children（Z = -8.589 P < 0.01）. Photophobia（23.59%）, foreign body sensation（18.08%）, frequent blinking（14.49%）and uncomfortable in windy conditions（20.90%）are the most common symptoms in VKC children.（2）The score of slit-lamp examination in VKC children was significantly higher than that in the normal group（Z = -9.902, P < 0.01）.（3）The BUT was significantly shorter in VKC children（7.06±3.51）than in normal children（13.34±4.82）（Z = -6.729 P < 0.01）. FL score（1.82±1.69）was significantly higher than that of normal children（0.23±0.46）（Z = -6.355 P < 0.01）. The score of LWE（1.03±1.00）was significantly higher than that of normal children（0.31±0.50）（Z = -4.463 P < 0.01）.（4）For VKC children, the severity of dry eye symptoms is correlated with slit-lamp checking scores（ r = 0.259 P < 0.05）; FL scores are also correlated with slit-lamp checking scores（r = 0.269 P < 0.05）; these children's BUT scores are correlated with FL（ r = -0.283 P < 0.05）and LWE（ r = -0.252 P < 0.05）scores; FL scores are correlated with LWE scores（ r = 0.307 P < 0.05）. Conclusion Dry eyes do exist in VKC children. The severity of dry eye is correlated with the severity of VKC inflammation. This study provides a basis for further study on pathophysiology of dry eye in VKC children, as well as a reason for the use of artificial tears in acute stage of VKC. -
Key words:
- Vernal keratoconjunctivitis /
- Dry eye /
- Lid-wiper epitheliopathy
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表 1 观察组与对照组症状评分、体征评分、BUT、FL及LWE评分之间的比较[中位数（四分位数）]
Table 1. Comparison of scores in dry eye symptoms，signs，BUT，FL and LWE between observation group and control group [（QR（P25，P75）]
项目 观察组 对照组 Z P 症状评分 27.50（17.50，40.00） 6.50（4.25，9.75） −8.589 < 0.001 体征评分 6.00（5.00，8.00） 1.00（0.00，1.00） −9.902 < 0.001 BUT（s） 6.33（4.33，9.33） 14.00（9.67，17.17） −6.729 < 0.001 FL评分 1.00（0.00，3.00） 0.00（0.00，0.00） −6.355 < 0.001 LWE评分 1.00（0.00，1.75） 0.00（0.00，0.50） −4.463 < 0.001 
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表 2 观察组与对照组角膜荧光素着染（FL）情况（%）
Table 2. Comparison of FL situation in observation group and control group（%）
分组 阳性 阴性 χ2 P 观察组 70.77 29.23 31.695 < 0.001 对照组 21.54 78.46
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表 3 观察组与对照组LWE阳性率及不同级别LWE分布情况（%）
Table 3. Proportion of Patients With LWE in observation group and control group（%）
组别 LWE总阳性率 LWE1级 LWE2级 LWE3级 无LWE 观察组 63.08 21.54 27.69 13.85 36.92 对照组 32.31 27.69 4.62 0 67.69 χ2 12.334 P 0.000
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表 4 观察组中存在相关性的观察值
Table 4. Relationship between symptom，sign，BUT，FL and LWE in observation group
相关性 rs P 症状评分与体征评分 0.259 0.037* 体征评分与 FL 0.269 0.030* BUT 与 FL −0.283 0.030* BUT 与 LWE −0.252 0.043* FL 与 LWE 0.307 0.013* * P < 0.05。
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[1] Vazquez Nava F,Salas Ralningz E,MogicaMogicaJdeD,et al. Prevalence and risk factors for allergic conjunctivitis in children. Comparative study in two communities[J]. Rev Alerg Mex,2002,49(2):33-41. [2] Lobefalo L D,Antonio E,Colangelo L,et al. Dry eye in allergic conjunctivitis:Role of inflammatory infiltrate[J]. Int J Immunopathol Pharmacol,1999,12(3):133-137. [3] Kramer J H,Mannis M J. Seborrhea and meibomian gland dysfunction[J]. Cornea,2004,38(5):485-491. [4] 洛非,邹留河. 儿童干眼症的初步研究[J].眼科,2006,15(6):411-413. doi: 10.3969/j.issn.1004-4469.2006.06.015 [5] Ozcura F,Aydin S,Helvaci M R. Ocular surface disease index for the diagnosis of dry eye syndrome[J]. Ocul Iimmunol Iinflamm,2007,15(5):389-393. doi: 10.1080/09273940701486803 [6] 晏晓明,刘爽,李海丽. 眼睑刷上皮病变与干眼相关性的初步观察[J].中华眼科杂志,2008,44(5):436-441. doi: 10.3321/j.issn:0412-4081.2008.05.012 [7] Donald R Korb,John P Herman,Jack V Greiner,et al. Lid Wiper Epitheliopathy and Dry Eye Symptoms[J]. Eye & Contact Lens,2005,31(1):2-8. [8] Donald R Korb,John P Herman,Caroline A Blackie,et al. Prevalence of lid wiper epitheliopathy in subjects with dry eye signs and symptoms[J]. Cornea,2010,29(4):377-383. doi: 10.1097/ICO.0b013e3181ba0cb2 [9] Efron N,Brennan N A,Morgan P B,et al. Lid wiper epitheliopathy[J]. Prog Retin Eye Res,2016,53(7):140-174. [10] Wing Li,Thao N Yeh,Tiana Leung,et al. The relationship of lid wiper epitheliopathy to ocularsurface signs and symptoms[J]. Invest Ophthalmol Vis Sci,2018,59(5):1878-1887. doi: 10.1167/iovs.17-23639 -
