Department of Twin Research & Genetic Epidemiology, King's College London, St. Thomas' Hospital, Waterloo, London, United Kingdom; Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Ophthalmology, King's College London, St. Thomas' Hospital, Waterloo, London, United Kingdom.
Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Ophthalmology. 2017 Mar;124(3):280-286. doi: 10.1016/j.ophtha.2016.11.008. Epub 2016 Dec 23.
To investigate predictors of discordance between symptoms and signs in dry eye disease (DED).
Cross-sectional association study.
A total of 648 patients with dry eye from the Groningen LOngitudinal Sicca StudY (GLOSSY), a tertiary dry eye clinic patient cohort from the Netherlands.
Patient symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire. Dry eye signs were assessed by tear osmolarity, Schirmer test, tear breakup time, corneal and conjunctival staining, and meibomian gland dysfunction, all in both eyes, and a composite dry eye signs severity score was calculated from these 6 tests for each patient. Linear regression analysis was used to test the association of discordance between symptoms and signs with a wide range of independent variables (demographic and environmental variables, systemic diseases, ocular traits, and medications).
Predictors of discordance between symptoms and signs in DED, defined by the difference between the rank score of the OSDI and the rank score of the dry eye signs severity score.
Of the 648 subjects in this cohort, 536 (82.7%) were female and the mean age was 55.8 years (standard deviation, 15.6 years). Significant predictors of greater symptoms than signs were the presence of a chronic pain syndrome, atopic diseases, a known allergy, the use of antihistamines (all P < 0.001), depression (P = 0.003), osteoarthritis (P = 0.008), and the use of antidepressants (P = 0.02). Predictors of lesser symptoms than signs were increased age (P < 0.001) and the presence of Sjögren's disease (P < 0.001) (primary Sjögren's disease, P < 0.001) more than secondary Sjögren's disease (P = 0.08), and graft-versus-host disease (P = 0.04). Furthermore, greater symptoms compared with signs were highly associated with lower self-perceived health (P < 0.001).
This large clinical study has shown that discordance between symptoms and signs in DED is an indicator of self-perceived health. The study found important predictors of greater symptoms to signs but also predictors of lesser symptoms to signs. Awareness of these predictors is helpful in assessing patients with dry eye in clinical practice.
研究干眼症（DED）中症状与体征不一致的预测因素。
横断面关联研究。
共纳入 648 名来自荷兰格罗宁根纵向干燥研究（GLOSSY）干眼症三级临床患者队列的干眼患者。
采用眼表疾病指数（OSDI）问卷评估患者的症状。使用泪液渗透压、泪液分泌试验、泪膜破裂时间、角膜和结膜染色以及睑板腺功能障碍评估干眼体征，所有这些检查均在双眼进行，每位患者根据这 6 项检查计算综合干眼体征严重程度评分。线性回归分析用于检验症状与体征不一致与多种自变量（人口统计学和环境变量、系统性疾病、眼特征和药物）之间的关联。
DED 中症状与体征不一致的预测因素，定义为 OSDI 秩评分与干眼体征严重程度评分秩评分之间的差异。
在本队列的 648 名受试者中，536 名（82.7%）为女性，平均年龄为 55.8 岁（标准差为 15.6 岁）。症状比体征更明显的显著预测因素包括慢性疼痛综合征、特应性疾病、已知过敏、使用抗组胺药（均 P < 0.001）、抑郁症（P = 0.003）、骨关节炎（P = 0.008）和使用抗抑郁药（P = 0.02）。症状比体征更轻的预测因素包括年龄增加（P < 0.001）和干燥综合征的存在（P < 0.001）（原发性干燥综合征，P < 0.001）多于继发性干燥综合征（P = 0.08）和移植物抗宿主病（P = 0.04）。此外，与体征相比，症状更明显与自我感知健康状况较差高度相关（P < 0.001）。
这项大型临床研究表明，DED 中症状与体征的不一致是自我感知健康的一个指标。该研究发现了症状比体征更明显的重要预测因素，也发现了症状比体征更不明显的预测因素。了解这些预测因素有助于在临床实践中评估干眼症患者。
