在评估干眼疾病患者对治疗的反应时，纳入泪液渗透压测量的价值是什么？
What is the value of incorporating tear osmolarity measurement in assessing patient response to therapy in dry eye disease?
机构信息
Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Brigham and Women's Hospital, Division of Preventive Medicine, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
出版信息
Am J Ophthalmol. 2014 Jan;157(1):69-77.e2. doi: 10.1016/j.ajo.2013.07.019. Epub 2013 Sep 21.
PURPOSE
To evaluate the correlation between changes in tear osmolarity, symptoms, and corneal fluorescein staining in patients with dry eye disease (DED).
DESIGN
Retrospective, clinic-based cohort study.
METHODS
In this single-institution study, we reviewed the charts of 186 patients with DED from whom we had data on tear osmolarity, symptoms, and corneal fluorescein staining from 2 separate visits. Main outcomes included the correlation of the changes between the 2 visits for tear osmolarity (TearLab system), symptoms (Ocular Surface Disease Index), and corneal fluorescein staining (modified Oxford scheme). For tear osmolarity and corneal fluorescein staining the scores from the eye with highest readings were analyzed. The correlations were repeated on subgroups based on proposed cutoffs for DED severity and on patients' treatment.
RESULTS
We found a modest, though statistically significant, correlation between changes in corneal fluorescein staining and symptoms of DED (R = 0.31; P < .001). However, there was no correlation between the recorded change in tear osmolarity and symptoms (R = -0.091; P = .38) or between changes in tear osmolarity and corneal fluorescein staining (R = -0.02; P = .80). This lack of correlation was consistent in all the subgroups studied. A multivariate analysis revealed that changes in corneal fluorescein staining had predictive value on symptom changes, whereas tear osmolarity changes did not.
CONCLUSIONS
Changes in tear osmolarity do not correlate significantly with changes in patient symptoms or corneal fluorescein staining in dry eye disease.
目的
评估干眼症（DED）患者的泪液渗透压变化与症状和角膜荧光素染色之间的相关性。
设计
回顾性、基于临床的队列研究。
方法
在这项单中心研究中，我们回顾了 186 例 DED 患者的图表，这些患者在两次就诊时都有泪液渗透压、症状和角膜荧光素染色的数据。主要结局包括两次就诊时泪液渗透压（TearLab 系统）、症状（眼表面疾病指数）和角膜荧光素染色（改良牛津方案）变化之间的相关性。对于泪液渗透压和角膜荧光素染色，分析了读数最高的眼睛的评分。根据DED 严重程度的建议临界值和患者治疗情况，对亚组进行了重复相关性分析。
结果
我们发现，角膜荧光素染色与 DED 症状之间存在适度但具有统计学意义的相关性（R = 0.31；P <.001）。然而，泪液渗透压的记录变化与症状之间没有相关性（R = -0.091；P =.38），或与角膜荧光素染色的变化之间没有相关性（R = -0.02；P =.80）。这种缺乏相关性在所有研究的亚组中都是一致的。多变量分析显示，角膜荧光素染色的变化对症状变化具有预测价值，而泪液渗透压的变化则没有。
结论
在干眼症中，泪液渗透压的变化与患者症状或角膜荧光素染色的变化无显著相关性。
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