Predictors of Discordance between Symptoms and Signs in Dry Eye Disease
Predictors of Discordance between Symptoms and Signs in Dry Eye Disease
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DOI：
10.1016/j.ophtha.2016.11.008
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发表时间：
2017-03-01
期刊：
影响因子：
13.7
通讯作者：
Hammond, Christopher J.
中科院分区：
文献类型：
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作者：
Vehof, Jelle;Smitt-Kamminga, Nicole Sillevis;Hammond, Christopher J.
目的：目的：探讨干眼症（DED）症状和体征之间不一致的预测因素。设计：横断面相关研究。参与者：来自荷兰格罗宁根LONGLESS SICCA研究（GLOSSY）的648例干眼症患者，该研究是一个三级干眼症门诊患者队列。方法：使用眼表疾病指数（OSDI）问卷对患者症状进行评估。通过泪液渗透压、Schirmer试验、泪液破裂时间、角膜和结膜染色以及睑板腺功能障碍（全部在双眼中）评估干眼体征，并根据这6项试验计算每例患者的复合干眼体征严重程度评分。线性回归分析用于检验症状和体征之间的不一致性与广泛的自变量之间的关联（人口统计学和环境变量、全身性疾病、眼部特征和药物治疗）。主要结果测量：DED中症状和体征之间不一致的预测因子，由OSDI的等级评分和干眼症体征严重程度评分的等级评分之间的差异定义。在该队列的648例受试者中，536例（82.7%）为女性，平均年龄为55.8岁（标准差，15.6岁）。症状大于体征的重要预测因素是慢性疼痛综合征、特应性疾病、已知过敏、抗组胺药的使用（P均< 0.001）、抑郁（P = 0.003）、骨关节炎（P = 0.008）和抗抑郁药的使用（P = 0.02）。症状轻于体征的预测因素是年龄增加（P < 0.001）和干燥病（P < 0.001）（原发性干燥病，P < 0.001）多于继发性干燥病（P = 0.08）和移植物抗宿主病（P = 0.04）。此外，更大的症状相比，体征是高度相关的较低的自我感知的健康（P < 0.001）。结论：这项大型临床研究表明，症状和体征之间的不一致，在DED是一个指标的自我感知的健康。该研究发现了症状与体征之间的重要预测因素，但也发现了症状与体征之间的重要预测因素。了解这些预测因子有助于在临床实践中评估干眼症患者。(C)2016年美国眼科学会
Purpose: To investigate predictors of discordance between symptoms and signs in dry eye disease (DED).Design: Cross-sectional association study.Participants: A total of 648 patients with dry eye from the Groningen LOngitudinal Sicca StudY (GLOSSY), a tertiary dry eye clinic patient cohort from the Netherlands.Methods: Patient symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire. Dry eye signs were assessed by tear osmolarity, Schirmer test, tear breakup time, corneal and conjunctival staining, and meibomian gland dysfunction, all in both eyes, and a composite dry eye signs severity score was calculated from these 6 tests for each patient. Linear regression analysis was used to test the association of discordance between symptoms and signs with a wide range of independent variables (demographic and environmental variables, systemic diseases, ocular traits, and medications).Main Outcome Measures: Predictors of discordance between symptoms and signs in DED, defined by the difference between the rank score of the OSDI and the rank score of the dry eye signs severity score.Results: Of the 648 subjects in this cohort, 536 (82.7%) were female and the mean age was 55.8 years (standard deviation, 15.6 years). Significant predictors of greater symptoms than signs were the presence of a chronic pain syndrome, atopic diseases, a known allergy, the use of antihistamines (all P < 0.001), depression (P = 0.003), osteoarthritis (P = 0.008), and the use of antidepressants (P = 0.02). Predictors of lesser symptoms than signs were increased age (P < 0.001) and the presence of Sjogren's disease (P < 0.001) (primary Sjogren's disease, P < 0.001) more than secondary Sjogren's disease (P = 0.08), and graft-versus-host disease (P = 0.04). Furthermore, greater symptoms compared with signs were highly associated with lower self-perceived health (P < 0.001).Conclusions: This large clinical study has shown that discordance between symptoms and signs in DED is an indicator of self-perceived health. The study found important predictors of greater symptoms to signs but also predictors of lesser symptoms to signs. Awareness of these predictors is helpful in assessing patients with dry eye in clinical practice. (C) 2016 by the American Academy of Ophthalmology