Na Kyung-Sun, Yoo Young-Sik, Hwang Kyu-Yeon, Mok Jee-Won, Joo Choun-Ki
Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Laboratory of Visual Science, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Laboratory of Visual Science, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Am J Ophthalmol. 2015 Jul;160(1):143-9.e1. doi: 10.1016/j.ajo.2015.04.002. Epub 2015 Apr 11.
To evaluate the diagnostic value of tear osmolarity and several ocular surface parameters in screening for ocular surface alterations in ocular graft-vs-host disease (GVHD) patients.
Case-control study.
Sixty-three patients with ocular GVHD and 74 healthy participants were screened for ocular surface changes using the Ocular Surface Disease Index (OSDI), tear osmolarity, Schirmer test, tear break-up time (TBUT), and fluorescein corneal staining. The severity of ocular GVHD was diagnosed according to the National Institutes of Health (NIH) grading system. The diagnostic sensitivity and specificity and cutoff values were determined for each ocular parameter using a receiver operating characteristic (ROC) curve and area under the curve (AUC) analysis. Significance was defined at P < .05.
The tear osmolarity, corneal staining score, and OSDI score gradually increased as the severity of ocular GVHD increased, and Schirmer value gradually decreased as the GVHD grade increased in severity. The Schirmer test showed greatest diagnostic sensitivity and specificity for ocular GVHD (92.1% sensitivity, 85.7% specificity, cutoff = 9 mm), followed by the TBUT (87.3% sensitivity, 75.0% specificity, cutoff = 6 s), tear osmolarity (98.4% sensitivity, 60.7% specificity, cutoff = 311 mOsm/L), corneal staining score (66.7% sensitivity, 82.1% specificity, cutoff = 2), and OSDI score (77.8% sensitivity, 66.1% specificity, cutoff = 20.8).
Multiple diagnostic modalities should be used to detect ocular surface changes in GVHD patients. The severity of ocular GVHD can be effectively monitored using tear osmolarity; however, additional studies are required.
评估泪液渗透压及多项眼表参数在筛查眼部移植物抗宿主病（GVHD）患者眼表改变中的诊断价值。
病例对照研究。
采用眼表疾病指数（OSDI）、泪液渗透压、泪液分泌试验、泪膜破裂时间（TBUT）及荧光素角膜染色对63例眼部GVHD患者和74名健康参与者进行眼表变化筛查。根据美国国立卫生研究院（NIH）分级系统诊断眼部GVHD的严重程度。使用受试者工作特征（ROC）曲线和曲线下面积（AUC）分析确定每个眼部参数的诊断敏感性、特异性及临界值。P <.05为有统计学意义。
随着眼部GVHD严重程度增加，泪液渗透压、角膜染色评分及OSDI评分逐渐升高，泪液分泌试验值随GVHD严重程度增加而逐渐降低。泪液分泌试验对眼部GVHD显示出最高的诊断敏感性和特异性（敏感性92.1%，特异性85.7%，临界值 = 9 mm），其次是TBUT（敏感性87.3%，特异性75.0%，临界值 = 6 s）、泪液渗透压（敏感性98.4%，特异性60.7%，临界值 = 311 mOsm/L）、角膜染色评分（敏感性66.7%，特异性82.1%，临界值 = 2）及OSDI评分（敏感性77.8%，特异性66.1%，临界值 = 20.8）。
应采用多种诊断方法检测GVHD患者的眼表变化。泪液渗透压可有效监测眼部GVHD的严重程度；然而，仍需进一步研究。
