本文關(guān)鍵詞： 蒸發(fā)過強型干眼 眼表疾病 中醫(yī)辨證 前瞻性研究 相關(guān)性分析　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:蒸發(fā)過強型干眼(evaporative dry eye,EDE)是眼科常見眼表疾病,它是淚液質(zhì)的異常或動力學(xué)異常導(dǎo)致的淚膜穩(wěn)定性下降,并伴有眼部不適,和(或)眼表損害的一類疾病。脂質(zhì)層的異常是該病產(chǎn)生發(fā)展的核心,凡是會引起脂質(zhì)層異常的因素都可能會導(dǎo)致蒸發(fā)過強型干眼的發(fā)生。中醫(yī)學(xué)認(rèn)為本病是由于五臟失于氣血津液的濡養(yǎng)不能上榮于目、目失潤澤而引起。但是,目前僅有干眼的辨證研究分析,而對蒸發(fā)過強型干眼沒有辨證分型研究�；谝陨�,筆者開展這項研究,旨在通過前瞻性研究,探討EDE的中醫(yī)辨證分型,研究年齡、性別、視頻終端使用時間、屈光不正、睡眠時間、角膜屈光手術(shù)、空調(diào)房時間、瞼板腺功能情況等因素與中醫(yī)各證型之間的相關(guān)性,為中西醫(yī)結(jié)合防治EDE提供客觀依據(jù)。方法:以2016年4月到2017年2月在江蘇省中醫(yī)院經(jīng)門診診斷為蒸發(fā)過強型干眼的102例患者為研究對象,記錄其年齡、性別、視頻終端使用時間、屈光不正、睡眠時間、角膜屈光手術(shù)史、空調(diào)房使用時間、淚液分泌試驗(SIt)、淚膜破裂時間(BUT)、角膜熒光素染色(FL)、瞼板腺功能評分,并根據(jù)其局部及全身癥狀,結(jié)合舌苔脈象,四診合參,辨證分型,并分析各證型與各臨床資料之間的相關(guān)性。運用SPSS 20.0進行統(tǒng)計分析。結(jié)果:(1)本病中醫(yī)證型血虛風(fēng)燥證最多,共25例,占24.5%,其次依次為陰虛夾濕證肝腎陰虛證脾胃濕熱證風(fēng)熱外襲證邪熱留戀證,分別為23例、18例、16例、12例、和8例。肺陰不足證無病例。(2)本病女性多發(fā),男性29例,女性73例,男女比例為1:2.52。性別與中醫(yī)證型無關(guān)。(3)本病年齡分布以20～35歲及45～50歲為主。年齡與中醫(yī)證型有統(tǒng)計學(xué)差異,P=0.008(P0.01),脾胃濕熱證、陰虛夾濕證主要集中在壯年組和中年組,而肝腎陰虛證集中在中年組和老年組,血虛風(fēng)燥證和風(fēng)熱外襲證集中在青年組。(4)蒸發(fā)過強型干眼患者的眼部自覺癥狀出現(xiàn)的頻率由高到低依次為是干澀96例(94.1%)、視物疲勞89例(87.3%)、異物感74例(72.5%)、癢68例(66.7%)、畏光56例(54.9%)、上眼皮沉重56例(54.9%)、眼紅55例(53.9%)、刺痛 55 例(53.9%)、流淚 51 例(50.0%)、視力波動 48 例(47.1%)、燒灼45例(44.1%)、雙目頻眨43例(42.2%)、炎性分泌物38例(37.3%)。流淚與證型有統(tǒng)計學(xué)差異,P=0.017(P0.05),肝腎陰虛證中,88.8%的病人無流淚癥狀。眼紅與證型有統(tǒng)計學(xué)差異,P=0.028(P0.05),邪熱留戀證中,87.5%的病人有眼紅癥狀。炎性分泌物與證型有統(tǒng)計學(xué)差異,P=0.042(P0.05),脾胃濕熱證中,68.75%的病人有炎性分泌物。上眼皮沉重與證型有統(tǒng)計學(xué)差異,P=0.003(P0.01),陰虛夾濕證中,82.6%的病人有上眼皮沉重癥狀。其他癥狀無統(tǒng)計學(xué)差異(P0.05)。(5)睡眠時間和中醫(yī)證型有統(tǒng)計學(xué)差異,P=0.002(P0.01),邪熱留戀證患者睡眠時間長,一般大于8.5小時。(6)SIt、BUT、FL與中醫(yī)證型無統(tǒng)計學(xué)差異,P均0.05。(7)灰線位置與中醫(yī)證型有統(tǒng)計學(xué)差異,P=0.003(P0.01),脾胃濕熱證中,灰線位置評分最高,血虛風(fēng)燥證灰線評分最低。瞼板腺分泌物性質(zhì)與中醫(yī)證型有統(tǒng)計學(xué)差異,P=0.000(P0.01),脾胃濕熱證和肝腎陰虛證中,瞼板腺分泌物評分較高,而風(fēng)熱外襲證與血虛風(fēng)燥證評分較低。(8)癥狀分級與中醫(yī)辨證分型無統(tǒng)計學(xué)差異,P=0.410(P0.05)。結(jié)論:蒸發(fā)過強型干眼辨證分型有一定的規(guī)律,主要分為血虛風(fēng)燥證、陰虛夾濕證、肝腎陰虛證、脾胃濕熱證、風(fēng)熱外襲證和邪熱留戀證,病因病機多為陰血不足,風(fēng)濕燥熱上擾,目失濡養(yǎng)而發(fā)病。臟腑累及肝腎脾胃。本病女性多發(fā),性別與中醫(yī)證型無關(guān)。年齡與中醫(yī)分型有關(guān)。流淚、眼紅、炎性分泌物、上眼皮沉重與中醫(yī)分型有關(guān)。睡眠時間與中醫(yī)證型有關(guān)。SIt、BUT、FL與中醫(yī)證型無關(guān)。瞼板腺功能情況與中醫(yī)證型有關(guān)。癥狀分級與中醫(yī)分型無關(guān)。
[Abstract]:Objective: evaporative dry eye (evaporative dry, eye, EDE) is a common eye ocular surface disease, it is falling tears or abnormal tear film stability dynamics caused by abnormal, and accompanied by eye discomfort, and (or) a disease of ocular surface damage. The lipid layer is the disease caused abnormal development the core, usually caused by abnormal lipid layer factors may lead to evaporative dry eye. Traditional Chinese medicine believes that this disease is due to loss of blood and body fluid in five Ruyang not on the wing in the head, the eye loses moisture and cause. However, the only dry eye syndrome research and analysis, and to evaporative dry eye syndrome differentiation type no research. Based on the above, this study aims to carry out the prospective study to explore TCM EDE type, age, gender, time use video terminal, ametropia, sleep time, corneal refractive surgery, air conditioning room Time, the correlation between meibomian gland function and other factors and TCM syndrome type, provide an objective basis for the combination of TCM and Western medicine prevention and treatment of EDE. Methods: from April 2016 to February 2017 in Jiangsu Province Traditional Chinese Medicine Hospital, 102 cases diagnosed as evaporative dry eye patients as the research object, recording the age, sex, the use of video terminal time. Ametropia, sleep time, corneal refractive surgery, the use of air conditioning in real time, Schirmer test (SIt), tear break-up time (BUT), corneal fluorescein staining (FL), meibomian gland function score, and according to the local and systemic symptoms, tongue and pulse combination, four diagnostic methods, syndrome differentiation, and analysis the correlation between the syndrome and the clinical data. The use of SPSS 20 for statistical analysis. Results: (1) the TCM syndrome type of blood deficiency and wind dryness, at most, a total of 25 cases, accounting for 24.5%, the secondary are yin deficiency with dampness syndrome of liver and kidney yin deficiency syndrome of spleen and stomach 婀跨儹璇侀鐑琚瘉閭儹鐣欐亱璇，

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