视屏终端工作者泪液中基质金属蛋白酶-9、组织金属蛋白酶抑制剂-1活性研究

目的 观察视屏终端工作者泪液中基质金属蛋白酶-9（matrix metalloproteinase-9，MMP-9）、组织金属蛋白酶抑制剂-1（tissue inhibitors of matrix metalloproteinase-1，TIMP-1）活性变化。设计 横断面研究。研究对象 视屏终端工作者45例（45眼）。方法 按照视频终端工作日平均时间将受试者分为三组：分别为<4小时者17例（17眼）、4~8小时者13例（13眼）、>8小时者15例（15眼）。采用眼表疾病指数问卷（OSDI）对眼部症状问卷调查。泪膜破裂时间（BUT）、基础泪液分泌试验（Schirmer I）、角膜荧光素染色检查。使用双抗体夹心酶联免疫吸附法（ELISA）检测受试者泪液细胞因子MMP-9、TIMP-1的浓度。主要指标 干眼症状评分、BUT、Schirmer I、角膜染色、泪液中MMP-9、TIMP-1的浓度。结果 45例视屏终端工作者中干眼患病率为13.3%，日平均使用时间<4小时组、4~8小时组、>8小时组OSDI得分分别为（16.47±3.28）、（18.77±4.38）、（21.16±3.76）（F=6.11，P=0.005），>8小时组OSDI得分较<4小时组高（P=0.003），而4~8小时组与>8小时组和<4小时组OSDI得分无显著差异（P=0.311，0.319）； BUT、Schirmer I、角膜荧光染色得分三组均无显著性差异（P=0.687、0.122、0.714）。泪液中MMP-9、TIMP-1浓度在>8小时组中分别为（9.579±0.48） ng/ml和（3.174±0.29） ng/ml，明显较<4小时组分别为（2.111±0.17） ng/ml和（0.391±0.06） ng/ml]和4~8小时组高分别为（7.403±0.06） ng/ml和（2.286±0.28） ng/ml]（P值均=0.000）。<4小时组和4~8小时组泪液中MMP-9（P=0.72、0.13）、TIMP-1（P=0.21、0.37）工作前后浓度无显著差异。>8小时组中，工作后MMP-9、TIMP-1浓度均高于工作前水平（P=0.04、0.01）。结论 视屏终端工作者中干眼发生普遍。视屏终端工作日平均使用时间越长，泪液中MMP-9、TIMP-1浓度越高，提示泪液中MMP-9、TIMP-1浓度升高与干眼发病有关。

Concentration of matrix metalloproteinase-9, tissue inhibitors of matrix metalloproteinase-1 in the tear of visual display terminal workers

Objective To investigate the concentrations of matrix metalloproteinase-9(MMP-9) and tissue inhibitors of matrix metalloproteinase-1 (TIMP-1) in the tear of visual display terminal (VDT) users. Design Cross-sectional study. Participants VDT users of 45 cases (45 eyes). Method All the 45 VDT workers were divided into 3 groups according to the average work hours of VDT per day (group 1: VDT work time > 8 hours; group 2: VDT work time was 4~8 hours; group 3: VDT work time < 4 hours). Ocular Surface Disease Index (OSDI) questionnaire was performed. The ocular surface feature, prevalence of dry eye were evaluated by corneal vital staining with fluorescein, tear break-up time (BUT), and Schirmer test. MMP-9 and TIMP-1 concentrations (ng/ml) in tear were quantified with double antibodys and wichenzyme-linked immunosorbentassay (ELISA). Main Outcome Measures Score of the OSDI, BUT, Schirmer I, corneal fluorescein staining, concentration of MMP-9 and TIMP-1 in tear. Results The percentage of dry eye in VDT workers was 13.3%. There was significant difference in OSDI score among 3 groups (F=6.11, P=0.005): group 1 was higher than group 3 (P=0.003); there was no significant difference between group 2 and group 1(P=0.311), group 2 and group 3(P=0.319). There were no significant differences of TBUT, Schirmer I, corneal fluorescein staining in 3 groups (P=0.687, 0.122, 0.714). The mean concentration of MMP-9 and TIMP-1 in tear was significant difference among 3 groups (P =0.000). The concentration of MMP-9 and TIMP-1 in group 1 was 9.579±0.48 ng/ml and 3.174±0.29 ng/ml respectively, which both higher than group 2 (7.403±0.06 ng/ml and 2.286±0.28 ng/ml)(P=0.004, 0.005) and group 3(2.111±0.17 ng/ml and 0.391±0.06 ng/ml)(P=0.000). There were no significant differences in MMP-9 and TIMP-1 between before and after VDT work except in group 1 (P=0.04, 0.01). Conclusion Significant increase of MMP-9 and TIMP-1 concentration in tear in longer VDT work time group may be suggestive of time cumulative effect was contained. MMP-9 and TIMP-1 daily change in VDT workers maybe relate with dry eye.