睫毛毛囊蠕形螨感染与睑板腺功能障碍的关系

目的 分析睫毛毛囊蠕形螨感染与睑板腺功能障碍（meibomian gland dysfunction，MGD）发生的相关性。设计 前瞻性病例系列。研究对象 2015年9月至2016年3月北京同仁医院眼科门诊MGD患者60例（60眼），平均年龄（43.10±12.64）岁。方法 根据睑缘充血有无分为有炎症的MGD组（A组，38例）、无炎症的MGD组（B组，22例），再将A组中蠕形螨检出阳性者，根据蠕形螨数量的不同分为3~6只/眼组（a组）、7~10只/眼组（b组）、＞10只/眼组（c组）。对患者的一般情况、睫毛毛囊蠕形螨检出率及各体征评分进行统计分析。主要指标 睫毛毛囊蠕形螨检出率、睑缘体征、睑板腺分泌物性状、分泌难易程度及睑板腺缺失评分。 结果 A组患者蠕形螨检出阳性率为86.84%，高于B组患者（18.18%）（P=0.001）。A组患者睑缘鳞屑、睑板腺分泌物性状、分泌难易程度评分分别为1.76±1.12、1.79±0.47，1.70±0.98，均高于B组（分别为0.52±0.51、1.34±0.53、0.68±0.60）（P=0.001、0.004、0.001）；两组睑板腺缺失比较，无统计学差异（P=0.091）。a、b、c三组间睑缘鳞屑和睑板腺分泌难易程度评分均存在明显统计学差异。在A组蠕形螨检出阳性的33例患者中，蠕形螨检出数量与睑缘鳞屑（r=0.65，P=0.001）及睑板腺分泌物排出难易程度（r=0.64，P=0.001）呈高度正相关，而与睑缘充血、睑板腺分泌物性状及睑板腺缺失无相关性（P=0.197、0.114、0.988）。结论 睫毛毛囊蠕形螨感染可通过导致睑缘炎性反应，引起或加重睑板腺功能障碍。对睑板腺功能障碍伴有睑缘炎的患者应注意排除睫毛毛囊蠕形螨感染的可能。（眼科， 2016， 25： 387-390）

Correlation between infection with demodex folliculorum of eyelid margin and meibomian gland dysfunction

Objective To analyze the correlation between demodex infection and meibomian gland dysfunction(MGD). Design Prospective case series. Participants 60 patients (60 eyes) diagnosed with MGD in Beijing Tongren Hospital between September 2015 and March 2016 were included. The average age was 43.10±12.64 years-old. Methods Patients were divided into MGD with inflammation (group A, 38 cases) and MGD without inflammation (group B, 22 cases) according to congestion of lid margin. According to the number of demodex per eye, the group A patients were divided into 3~6 (group a), 7~10 (group b) and ＞10 (group c). The positive rate of demodex and its correlation with sign scores were analyzed. Main Outcome Measures Positive rate of demodex, manifestation of lid margin and the secretion function of meibomian gland. Results The positive rate of demodex in group A was 86.84%, significantly higher (P=0.001) than that of group B 18.18%. All sign scores of group A were significantly higher than group B(P＜0.01) except meibomian gland dropout (P=0.09). The scores of lid margin scales and meibomian gland secretion were significantly different among group a, b and c. There were significant positive correlations between the number of demodex and lid margin scales, and meibomian gland secretion (P=0.001), while no correlations between the number of demodex and congestion of lid margin, the characters of meibum or meibomian gland dropout (P=0.197; P=0.114; P=0.988). Conclusions Demodex may cause or aggravate the degree of MGD by causing eyelid inflammation. It is noteworthy to detect Demodex for MGD patients with blepharitis. (Ophthalmol CHN, 2016, 25: 387-390)