Messmer EM, von LV, Garbe A, et al.
基质 蛋白酶 眼病
目的：旨在比较干眼病患者与对照者泪膜中基质金属蛋白酶9（MMP-9）并与临床表现相关联。设计：在一项前瞻性研究中，101例患者和对照接受了泪膜MMP- 9检测。然后，评价受试者的DED症状和体征。研究对象：纳入的患者符合以下4个干眼症标准中的3个：眼表面疾病指数（OSDI）评分大于12，泪膜破裂时间（TBUT ）10秒以内，无麻醉下Schirmer试验结果小于10mm / 5分钟，角膜染色结果1以上。本研究包括54只健康眼和符合各种严重程度DED诊断标准的47只眼。方法：通过一种市售检测法（InflammaDry; 快速病原体筛查，Sarasota公司，FL）（可检测大于40ng / ml的MMP-9水平）分析泪膜中的MMP。使用OSDI问卷，TBUT，结膜和角膜染色，无麻醉下Schirmer试验结果和睑板腺检查来评价DED的症状和体征。将这些结果与泪液MMP-9检测结果进行关联。结果：47例干眼症患者中的19例（40.4％），54例对照中3例（5.6％）MMP-9结果为阳性。差异具有统计学意义（P <0.001）。因此，MMP-9结果提示40％的干眼患者中有临床明显的炎症。阳性结果与通过OSDI（P = 0.001），TBUT小于5秒（P <0.013），Schirmer检测结果（P <0.001），结膜染色（P <0.001）和角膜染色评估的DED主观症状存在良好相关（P = 0.007）。此外，MMP-9结果与阻塞的睑板腺管数量（P = 0.005）和病理性睑板腺分泌（P = 0.001）相关。 女性（P <0.001）和自身免疫性疾病患者（P = 0.005），特别是Sjgren综合征（P = 0.001）和甲状腺疾病（P = 0.012）患者的MMP-9水平明显升高。结论：DED基质金属蛋白酶9检测是一个有价值的新型诊断工具。它与其他干眼检测和已确诊的40％干眼患者中存在眼表面炎症相关良好。这种工具可能对于确诊患有眼表面炎症和自身免疫疾病的患者特别有帮助，并且可以促进对这些患者进行抗炎治疗的决定。
PURPOSE:To measure matrix metalloproteinase 9 (MMP-9) in the tear film of patients with dry eye disease (DED) compared with controls and to correlate clinical findings.DESIGN:In a prospective study, 101 patients and controls underwent MMP-9 testing of the tear film. Thereafter, they were evaluated for symptoms and signs of DED.PARTICIPANTS:Included patients were those who showed 3 of the following 4 dry eye criteria: ocular surface disease index (OSDI) score of more than 12, tear film break-up time (TBUT) of 10 seconds or less, Schirmer test results without anesthesia of less than 10 mm/5 minutes, and corneal staining results of 1 or more. Fifty-four healthy eyes and 47 eyes fulfilling diagnostic criteria for DED of various levels of severity were included in this study.METHODS:The tear film was analyzed for MMP-9 by a commercially available test (InflammaDry; Rapid Pathogen Screening, Inc, Sarasota, FL) detecting MMP-9 levels of more than 40 ng/ml. Symptoms and signs of DED were evaluated using the OSDI questionnaire, TBUT, conjunctival and corneal staining, Schirmer test results without anesthesia, and meibomian gland examination. These findings were correlated to results of the MMP-9 test in tears.MAIN OUTCOME MEASURES:Positive MMP-9 results in tears.RESULTS:In 19 of 47 patients confirmed with dry eye (40.4%) and in 3 of 54 controls (5.6%), the MMP-9 results were positive. This difference was statistically significant (P < 0.001). Thus, the MMP-9 results indicated a clinically significant inflammation in 40% of dry eye patients. Positive results correlated well with subjective symptoms of DED evaluated by OSDI (P= 0.001), TBUT of less than 5 seconds (P < 0.013), Schirmer test results (P < 0.001), conjunctival staining (P < 0.001), and corneal staining (P= 0.007). Moreover, MMP-9 results correlated with the number of obstructed meibomian ducts (P= 0.005) and a pathologic meibomian gland secretion (P= 0.001). The MMP-9 results were increased significantly in women (P < 0.001) and in patients with autoimmune disease (P= 0.005), especially Sjgren's syndrome (P= 0.001) and thyroid disease (P= 0.012).CONCLUSIONS:Matrix metalloproteinase 9 testing in DED is a valuable new diagnostic tool. It correlated well with other dry eye tests and identified the presence of ocular surface inflammation in 40% of confirmed dry eyepatients. It may be especially helpful to identify patients with ocular surface inflammation and autoimmune disease and may facilitate the decision to institute anti-inflammatory treatment in these patients.