Roy Neeta S, Wei Yi, Yu Yinxi, Ying Gui-Shuang, Kuklinski Eric, Barry Brendan, Maguire Maureen G, Dana Reza, Brightwell-Arnold Mary, Asbell Penny A
Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, 930 Madison Avenue, Memphis, TN, USA.
Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 700, Philadelphia, PA, USA.
Transl Vis Sci Technol. 2019 Aug 21;8(4):31. doi: 10.1167/tvst.8.4.31. eCollection 2019 Jul.
Evaluation of dry eye disease (DED) relies on subjective symptoms and signs. We examined HLA-DR expression (HLA-DR%) in conjunctival cells, a minimally invasive biomarker with objective metrics, as an alternative method.
Dry Eye Assessment and Management (DREAM) study participants completed the Ocular Surface Disease Index questionnaire. Clinicians evaluated tear volume, tear breakup time, and corneal and conjunctival staining. Conjunctival impression cytology samples ( = 1049) were assessed for HLA-DR% in total cells (TCs), epithelial cells (ECs), and white blood cells (WBCs). Associations (categorized into <5%, 5%-15%, >15%-25%, and >25%) with symptoms and signs were evaluated.
The HLA-DR% varied markedly across samples. Over 40% had <5 HLA-DR% positive cells in TCs and ECs and under 23% in WBCs. Higher HLA-DR% was associated with higher conjunctival staining for ECs (mean score 2.77 for <5% and 3.28 for >25%, linear trend = 0.009) and TCs (mean score 2.82 for <5% and 3.29 for >25%, linear trend = 0.04) and in TCs was associated with higher corneal staining (mean score 3.59 for <5% and 4.46 for >25%, linear trend = 0.03). HLA-DR% in WBCs did not correlated with signs (all ≥ 0.58), and in TCs, ECs or WBCs were not associated with symptoms ( > 0.06).
The distribution of HLA-DR% in conjunctival cells reflects the heterogeneity of disease in DREAM participants. High percentages of samples with <5% positive cells indicate that HLA-DR% may not be a sensitive marker for DED in all patients.
High HLA-DR% in ECs in association with high conjunctival staining may identify a subgroup of DED patients prone to epithelial disease and possibly need a different approach from current standards of treatment.
干眼疾病（DED）的评估依赖于主观症状和体征。我们检测了结膜细胞中的人类白细胞抗原DR表达（HLA - DR%），这是一种具有客观指标的微创生物标志物，作为一种替代方法。
干眼评估与管理（DREAM）研究的参与者完成了眼表疾病指数问卷。临床医生评估了泪液量、泪膜破裂时间以及角膜和结膜染色情况。对1049份结膜印迹细胞学样本的总细胞（TCs）、上皮细胞（ECs）和白细胞（WBCs）中的HLA - DR%进行了评估。评估了其与症状和体征的关联（分为<5%、5% - 15%、>15% - 25%和>25%）。
样本中HLA - DR%差异显著。超过40%的样本中TCs和ECs的HLA - DR%阳性细胞<5%，WBCs中<23%。较高的HLA - DR%与ECs的结膜染色较高相关（<5%组平均评分为2.77，>25%组为3.28，线性趋势P = 0.009）以及TCs的结膜染色较高相关（<5%组平均评分为2.82，>25%组为3.29，线性趋势P = 0.04），并且TCs中的HLA - DR%与角膜染色较高相关（<5%组平均评分为3.59，>25%组为4.46，线性趋势P = 0.03）。WBCs中的HLA - DR%与体征无相关性（所有P≥0.58），并且TCs、ECs或WBCs中的HLA - DR%与症状无关联（P>0.06）。
结膜细胞中HLA - DR%的分布反映了DREAM研究参与者疾病的异质性。阳性细胞<5%的样本比例较高表明HLA - DR%可能并非所有患者干眼疾病的敏感标志物。
ECs中高HLA - DR%与高结膜染色相关，这可能识别出一组易患上皮疾病的干眼患者亚组，可能需要与当前治疗标准不同的方法。
