| 类风湿关节炎患者干眼特征与其活动度相关性研究 |
| 投稿时间：2017-11-04 修订日期：2017-11-14 点此下载全文 |
| 引用本文：郝晓琳,刘坚,朱婧,宿梦苍,丁秋玲,张仲臣.类风湿关节炎患者干眼特征与其活动度相关性研究[J].医学研究杂志,2018,47(8):48-53 |
| DOI：
10.11969/j.issn.1673-548X.2018.08.012 |
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| 基金项目:国家自然科学基金资助项目（81400370） |
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| 中文摘要:目的 本研究探讨类风湿关节炎患者干眼的发病特点，并对干眼的严重程度与类风湿关节炎疾病活动度的相关性进行研究，以期对类风湿关节炎干眼的发病机制能有进一步的了解，进而对类风湿关节炎干眼提供诊疗帮助。方法 收集笔者医院风湿免疫科经临床确诊的2014年3月~2016年12月住院类风湿关节炎合并干眼患者48例，同期就诊于眼科门诊的非类风湿关节炎干眼患者（单纯干眼组）50例和正常志愿者50例。对所有研究对象行眼表疾病指数（ocular surface disease index，OSDI）问卷评分、泪液分泌试验Ⅰ（schirmer Ⅰ test，S Ⅰ t）、泪膜破裂时间（tear break-up time，BUT）、角膜荧光染色（corneal fluorescein staining，FL）干眼相关指标进行统计，并同时采集红细胞沉降率（ESR）、C反应蛋白（CRP）、类风湿因子（RF）等类风湿活动度相关的指标。依据干眼BUT、S Ⅰ t、FL客观检测指标，对干眼严重程度分级，对类风湿关节炎疾病活动强度分级采用DAS28积分方法。对研究对象间类风湿性关节炎疾病活动度指标、干眼指标、类风湿性关节炎疾病活动度强度与干眼严重程度的相关性进行统计学分析。结果 3组间OSDI、S Ⅰ t、BUT、FL的检查结果比较，类风湿关节炎干眼组、单纯干眼组S Ⅰ t、BUT低于正常对照组，OSDI、FL高于正常对照组，总体比较差异有统计学意义（P<0.05）。类风湿关节炎干眼组与单纯干眼组比较，BUT低于单纯干眼组，差异有统计学意义（P<0.05）；FL高于单纯干眼，差异有统计学意义（P<0.05）；OSDI、S Ⅰ t类风湿关节炎干眼组与单纯干眼组比较，差异无统计学意义（P>0.05）；3组间风湿活动性指标ESR、CRP、RF检查结果比较，单纯干眼组、正常对照组ESR、CRP、RF低于类风湿关节炎干眼组，总体差异有统计学意义（P<0.05）；单纯干眼组与正常对照组间差异无统计学意义（P>0.05）；类风湿关节炎干眼组中BUT与ESR、CRP、RF均呈负相关（P<0.05），FL与ESR、CRP、RF均呈正相关（P<0.05），S Ⅰ t、OSDI与ESR、CRP、RF无相关性（P>0.05）；类风湿关节炎组疾病活动度强度与干眼指标BUT呈负相关（P<0.05），与FL呈正相关（P<0.05），与S Ⅰ t、OSDI无相关性（P>0.05）；类风湿关节炎组干眼的严重程度与类风湿活动指标ESR、CRP、RF呈正相关（P<0.05）。结论 类风湿关节炎干眼患者较单纯干眼患者干眼症状重，推断类风湿关节炎干眼与单纯干眼可能存在不同的致病机制；类风湿关节炎疾病活动度越高，干眼的症状越重，推测类风湿关节炎疾病活动度可能影响干眼的严重程度。类风湿关节炎的疾病活动度与干眼症状的严重程度之间存在相关性，推测通过对类风湿关节炎患者干眼症状检查，可以评价类风湿关节炎疾病活动度与病情。 |
| 中文关键词:类风湿关节炎 干眼 发病特点 活动度 相关性 |
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| Characteristics of Dry Eye in Rheumatoid Arthritis Patients and Correlation between Rheumatoid Arthritis Activity |
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| Abstract:Objective To investigate the characteristics of dry eye in patients with rheumatoid arthritis,and the correlation between dry eye and rheumatoid arthritis activity.In order to have further understanding of the pathogenesis of dry eye in rheumatoid arthritis patients,and to provide help for diagnosis and treatment of rheumatoid arthritis associated dry eye. Methods Forty eight patients with rheumatoid arthritis and dry eye were selected from March 2014 to December 2016, and 50 dry eye patients without rheumatoid arthritis (simple dry eye group) and 50 normal volunteers. All the subjects underwent ocular surface disease index (OSDI), tear secretion test Ⅰ (S Ⅰ t), tear break-up time (BUT), corneal fluorescein staining (FL). The rheumatoid arthritis activity was evaluated by erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF). The grading of dry eye severity was recorded according to the objective indexes of BUT, S Ⅰ t and FL,and DAS28 integral was used for the intensity grading of rheumatoid arthritis activity. The characteristics of dry eye, the correlation between dry eye and rheumatoid arthritis activity were analyzed. Results The results of OSDI,S Ⅰ t,BUT and FL in the three groups:S Ⅰ t, BUT in rheumatoid arthritis (RA) dry eye group, simple dry eye group were lower than that in the normal control group. The OSDI, FL were higher than that in the normal control group, the overall differences were statistically significant (P<0.05). BUT in rheumatoid arthritis dry eye group was lower than that in simple dry eye group, FL was higher than that in simple dry eye group, the differences were statistically significant (P<0.05). The differences in OSDI, S Ⅰ t between rheumatoid arthritis dry eye group and simple dry eye group were not statistically significant (P>0.05).The results of ESR, CRP and RF in the three groups:ESR, CRP, RF in simple dry eye group and normal control group were lower than that in rheumatoid arthritis dry eye group, the differences were statistically significant (P<0.05).There were no significant differences between simple dry eye group and normal control group in rheumatic activity indexes (P>0.05).Negative correlations between BUT and ESR,CRP,RF in the rheumatoid arthritis dry eye group were observed (P<0.05).Positive correlations between FL and ESR, CRP, RF in the rheumatoid arthritis dry eye group were observed (P<0.05). No correlations between S Ⅰ t, OSDI and ESR, CRP, RF were observed in the rheumatoid arthritis dry eye group (P>0.05).The degree of rheumatoid arthritis activity was negatively correlated with BUT (P<0.05), and was positively correlated with FL(P<0.05), while no correlations in S Ⅰ t,OSDI were observed (P>0.05).The severity of dry eye was positively correlated with ESR, CRP and RF (P<0.05). Conclusion The symptoms of rheumatoid arthritis dry eye group were more serious than those of simple dry eye group, and possibly there were different pathogenic mechanisms in the two groups. The higher the degree of rheumatoid arthritis activity was, more serious the dry eye symptoms were, showing that rheumatoid arthritis activity might affect the severity of dry eye.There was a correlation between rheumatoid arthritis activity and severity of dry eye, suggesting that the severity of dry eye might indicate the degree of rheumatoid arthritis activity. |
| keywords:Rheumatoid arthritis Dry eye Characteristics of disease Degree of rheumatoid arthritis activity Correlation |
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