Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
J Med Internet Res. 2023 Sep 12;25:e38481. doi: 10.2196/38481.
BACKGROUND: Dry eye (DE) and hay fever (HF) show synergistic exacerbation of each other's pathology through inflammatory pathways. OBJECTIVE: This study aimed to investigate the association between DE and HF comorbidity and the related risk factors. METHODS: A cross-sectional observational study was conducted using crowdsourced multidimensional data from individuals who downloaded the AllerSearch smartphone app in Japan between February 2018 and May 2020. AllerSearch collected the demographics, medical history, lifestyle and residential information, HF status, DE symptoms, and HF-related quality of life. HF symptoms were evaluated using the nasal symptom score (0-15 points) and nonnasal symptom score (0-12 points). HF was defined by the participants' responses to the questionnaire as HF, non-HF, or unknown. Symptomatic DE was defined as an Ocular Surface Disease Index total score (0-100 points), with a threshold score of 13 points. HF-related quality of life was assessed using the Japanese Allergic Conjunctival Disease Standard Quality of Life Questionnaire (0-68 points). We conducted a multivariable linear regression analysis to examine the association between the severity of DE and HF symptoms. We subsequently conducted a multivariable logistic regression analysis to identify the factors associated with symptomatic DE (vs nonsymptomatic DE) among individuals with HF. Dimension reduction via Uniform Manifold Approximation and Projection stratified the comorbid DE and HF symptoms. The symptom profiles in each cluster were identified using hierarchical heat maps. RESULTS: This study included 11,284 participants, classified into experiencing HF (9041 participants), non-HF (720 participants), and unknown (1523 participants) groups. The prevalence of symptomatic DE among individuals with HF was 49.99% (4429/9041). Severe DE symptoms were significantly associated with severe HF symptoms: coefficient 1.33 (95% CI 1.10-1.57; P<.001) for mild DE, coefficient 2.16 (95% CI 1.84-2.48; P<.001) for moderate DE, and coefficient 3.80 (95% CI 3.50-4.11; P<.001) for severe DE. The risk factors for comorbid symptomatic DE among individuals with HF were identified as female sex; lower BMI; medicated hypertension; history of hematologic, collagen, heart, liver, respiratory, or atopic disease; tomato allergy; current and previous mental illness; pet ownership; living room and bedrooms furnished with materials other than hardwood, carpet, tatami, and vinyl; discontinuation of contact lens use during the HF season; current contact lens use; smoking habits; and sleep duration of <6 hours per day. Uniform Manifold Approximation and Projection stratified the heterogeneous comorbid DE and HF symptoms into 14 clusters. In the hierarchical heat map, cluster 9 was comorbid with the most severe HF and DE symptoms, and cluster 1 showed severe HF symptoms with minimal DE-related symptoms. CONCLUSIONS: This crowdsourced study suggested a significant association between severe DE and HF symptoms. Detecting DE among individuals with HF could allow effective prevention and interventions through concurrent treatment for ocular surface management along with HF treatment.
背景:干眼症 (DE) 和花粉热 (HF) 通过炎症途径表现出彼此病理的协同恶化。
目的:本研究旨在探讨 DE 和 HF 共病的相关性及其相关危险因素。
方法:本研究采用横断面观察性研究设计,利用在 2018 年 2 月至 2020 年 5 月期间通过日本 AllerSearch 智能手机应用下载的人群多维数据进行。AllerSearch 收集了人口统计学、病史、生活方式和居住信息、HF 状态、DE 症状以及 HF 相关生活质量信息。HF 症状通过鼻症状评分(0-15 分)和非鼻症状评分(0-12 分)进行评估。HF 是通过参与者对问卷的回答定义的,包括 HF、非 HF 或未知。有症状的 DE 通过眼表面疾病指数总分(0-100 分),以 13 分为阈值来定义。HF 相关生活质量通过日本过敏性结膜炎疾病标准生活质量问卷(0-68 分)进行评估。我们进行了多变量线性回归分析,以研究 DE 症状严重程度与 HF 症状之间的相关性。随后,我们进行了多变量逻辑回归分析,以确定 HF 患者中与有症状 DE(与无症状 DE 相比)相关的因素。统一流形逼近和投影通过维度缩减对共病 DE 和 HF 症状进行分层。在每个聚类中,使用层次热图确定症状特征。
结果:本研究共纳入 11284 名参与者,分为经历 HF(9041 名参与者)、非 HF(720 名参与者)和未知(1523 名参与者)组。HF 患者中出现有症状 DE 的比例为 49.99%(4429/9041)。严重的 DE 症状与严重的 HF 症状显著相关:轻度 DE 的系数为 1.33(95%CI 1.10-1.57;P<.001),中度 DE 的系数为 2.16(95%CI 1.84-2.48;P<.001),重度 DE 的系数为 3.80(95%CI 3.50-4.11;P<.001)。HF 患者共病有症状 DE 的危险因素包括女性;较低的 BMI;服用高血压药物;有血液、胶原、心脏、肝脏、呼吸或特应性疾病史;对番茄过敏;当前和既往精神疾病;养宠物;客厅和卧室采用硬木、地毯、榻榻米和乙烯基以外的材料制成;HF 季节停止使用隐形眼镜;当前使用隐形眼镜;吸烟习惯;以及每天睡眠时间<6 小时。统一流形逼近和投影通过维度缩减将异质共病 DE 和 HF 症状分为 14 个聚类。在层次热图中,聚类 9 与最严重的 HF 和 DE 症状共病,聚类 1 表现出严重的 HF 症状,同时伴有最小的 DE 相关症状。
结论:本项基于人群的研究表明,严重的 DE 和 HF 症状之间存在显著关联。在 HF 患者中检测到 DE 后,可以通过同时进行眼部表面管理和 HF 治疗,进行有效的预防和干预。
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