摘要
目的:探讨合并甲状腺功能减退(hypothyroidism,HT)对原发性干燥综合征相关性干眼(primary Sjogren’s syndrome related dry eye,pSS-DED)患者眼表状态的影响。方法:采用横断面研究,选择2020年12月—2021年6月在北京大学第三医院眼科干眼门诊就诊的pSS-DED患者36例,其中合并HT的pSS-DED患者12例,并纳入同时期就诊的单纯干眼症(dry eye disease,DED)患者24例作为对照组。所有患者填写眼表疾病指数(ocular surface disease index,OSDI)问卷,并进行泪膜破裂时间(tear film break-up time,BUT)、泪液分泌Schirmer试验、泪河高度、角/结膜荧光素染色、睑板腺分泌能力、睑酯性状评估,以及共聚焦显微镜检查。结果:(1)较pSS-DED及单纯DED患者,合并HT后pSS-DED患者的平均BUT[(2.7±0.8)s]、Schirmer试验结果[(4.9±4.8)mm]以及泪河高度[(0.13±0.03)mm]更低,差异具有统计学意义(F=12.43,P<0.01;F=6.96,P<0.01;F=3.31,P<0.05)。(2)合并HT后pSS-DED患者的睑板腺分泌能力与睑酯性状评分较DED与pSS-DED患者多集中于高分区,3组患者的睑板腺分泌能力(χ^(2)=10.72,P<0.05)及睑酯性状评估分数分布(χ^(2)=8.34,P<0.05)差异具有统计学意义。(3)pSS-DED+HT患者血清总甲状腺素、血清游离甲状腺素水平与其BUT(r=0.60;0.60)、Schirmer试验(r=0.64;0.66),以及泪河高度(r=0.61;0.62)正相关(P<0.05;P<0.05),与睑板腺分泌能力无关;未发现促甲状腺激素、抗甲状腺球蛋白抗体、甲状腺过氧化物酶抗体与眼表状态存在明显相关性。(4)相较pSS-DED,合并HT后患者基底下神经丛纤维密度降低(t=2.06,P<0.05),曲率评分增加(t=2.13,P<0.05)。结论:合并HT的pSS-DED患者较pSS-DED以及DED患者的眼表状况更差,主要表现为泪液分泌减少、泪膜稳定性下降、睑板腺分泌功能降低、睑酯性状变差、基底下神经丛纤维密度降低与曲率增加,其机制可能与甲状腺激素分泌减少有关。
Objective:To explore the effect of hypothyroidism(HT)on the ocular surface status of patients with primary Sjogren’s syndrome-related dry eye(pSS-DED).Methods:The cross-sectional study included 36 patients with pSS-DED who were treated at the dry eye clinic of Peking University Third Hospital from December 2020 to June 2021,of whom 12 were pSS-DED patients combined with HT.In the same period,24 patients with simple dry eye disease(DED)were served as a control group.All the patients filled out the Ocular Surface Disease Index(OSDI)questionnaire,and performed tear film break-up time(BUT),Schirmer test,tear meniscus height,corneal/conjunctival fluorescein staining,meibomian gland secretion capacity,meibum evaluation and confocal microscope examination.Results:(1)Compared with pSS-DED and simple DED patients,pSS-DED+HT patients had lower average BUT[(2.7±0.8)s],Schirmer test[(4.9±4.8)mm]and tear meniscus height[(0.13±0.03)mm],and the difference was statistically significant(F=12.43,P<0.01;F=6.96,P<0.01;F=3.31,P<0.05).(2)Compared with DED and pSS-DED patients,the meibomian gland secretion capacity and meibomian trait scores of pSS-DED+HT patients were mainly distributed in the high division.There were statistically significant differences in the distribution of secretion capacity of meibomian glands(χ^(2)=10.72,P<0.05)and meibomian trait assessment scores(χ^(2)=8.34,P<0.05)among the three groups.(3)Serum total thyroxine and serum free thyroxine levels in the pSS-DED+HT patients showed positive correlation(P<0.05,P<0.05)with their BUT(r=0.60,0.60),Schirmer’s test(r=0.64,0.66)and tear river height(r=0.61,0.62),independent of lid gland secretory capacity;no significant correlation was found between thyroid-stimulating hormone,anti-thyroglobulin antibody and lid gland secretory capacity.Thyroid hormone,anti-thyroglobulin antibody,and thyroid peroxidase antibody were not found to be significantly correlated with ocular surface status.(4)Compared with pSS-DED,the fiber density of the subbasal nerve plexus in pSS-DE
作者
于昊哲
曾唯珍
吴文雨
姚中强
冯云
YU Hao-zhe;ZENG Wei-zhen;WU Wen-yu;YAO Zhong-qiang;FENG Yun(Department of Ophthalmology,Peking University Third Hospital,Beijing 100191,China;Department of Rheumatology and Immunology,Peking University Third Hospital,Beijing 100191,China)
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2022年第4期705-711,共7页
Journal of Peking University:Health Sciences
基金
国家自然科学基金(81700799、82070926)。
