- 學位論文
臺灣早發性乾眼症之危險因子分析
Risk factors analysis of early-onset Dry eye disease in Taiwan
摘要
目的 近年來，乾眼症的發病人數日趨增加，發病的年齡也有年輕化的趨勢。目前尚未有全面性的研究針對早發性乾眼症做討論，因此本研究目的為調查及分析臺灣早發性乾眼症的危險因子。 方法 本研究對象的收納年齡為18至55歲的青壯年人，研究場所在台中澄清醫院眼科執行。研究對象須先填寫問卷（包含基本資料、眼表指數及焦慮量表），接著進行眼科檢查，項目包含電腦驗光、自覺式驗光、眼壓、眼軸長、淚液試紙、淚膜鏡、視網膜斷層掃描及眼科醫師看診，加上身體總和抗氧化血液分析，如血漿抗氧化指數 （Total Anti-oxidative Capacity, TAC）、C-反應蛋白（C-Reactive Protein, CRP）、以及細胞抗氧化指數（Glutathione peroxidase, GPx）。本研究將研究對象分成三組，分別為正常對照組、早發性乾眼症組以及合併組（合併早發性乾眼症與白內障，簡稱合併組）進行統計分析。 結論 本研究共招募113人，其中正常組41名（36.3％）、早發性乾眼症組48名（42.5％）、以及合併組24名（21.2％）。研究結果顯示，相較於正常組，早發性乾眼症組以及合併組在BMI ( χ2=9.24, p=0.01)、教育程度 ( χ2=13.36, p=0.04)、長期在冷氣房工作( χ2=5.39, p=0.036)、飲酒習慣（χ2=5.94, p=0.05）、長時間使用3C產品（χ2=12.52, p=0.05）、曾經接受雷射手術( χ2=5.48, p=0.036)與視網膜疾病( χ2=7.02, p=0.03)等變項，在統計上達顯著差異。 此外，三組研究對象在家族中有罹患高血壓（χ2=5.88, p=0.05）與免疫系統疾病（χ2=9.19, p=0.01）、研究對象本身有高血壓（χ2=13.24, p=0.00）、糖尿病（χ2=11.03, p=0.00）；服用降血壓藥物（χ2=10.08, p=0.01）、葉黃素（χ2=6.23, p=0.04）、口服抗氧化補充品（χ2=4.89, p=0.05）；白內障藥水（χ2=19.40, p=0.00）及人工淚液（χ2=11.53, p=0.00）的使用等，在統計結果上亦達顯著差異。 再者，研究對象在OSDI問卷分數（F=7.52, p=0.00）及眼科檢查中雙眼視力值（F=2.63, p=0.04）、Schirmer's test（F=5.04, p=0.01）、淚液破裂時間（F=6.22, p=0.00）等分析上皆達統計上的顯著差異；且身體總和抗氧化血液分析中僅在CRP指數（F=3.13, p=0.05）達顯著差異，血液分析中的GPX指數（F=0.19, p=0.83）和TAC指數（F=1.46, p=0.24）則未達到顯著差異。 討論 根據本研究結果，早發性乾眼症可能因BMI、教育程度、工作環境、生活習慣、身體或眼睛疾病、家族病史、藥物藥水的使用及保健食品的補充而所影響。藉著身體總和抗氧化血液分析來了解身體健康狀態，並研究乾眼症之間的關聯，如何預防或延緩早發性乾眼症的發病，將會是未來值得進一步發展的課題。
並列摘要
Purpose There are more and more dry eye patients in recent years; meanwhile, the dry eye cases increasing with a trend toward young age. At this stage, there has not been any comprehensive quantitative study conducted to examine early-onset dry eye. Therefore, this study attempts to investigate and analyze the risk factors of early-onset DED in Taiwan. Methods There were a total of 113 patients ages 18 to 55 who were diagnosed in medical center. Participants were divided into three groups as follows: control group, early-onset DED group and combined group. Eye examination ( VA measure, IOP measure, subjective refraction, axial Length measure, Schirmer test, tearscope measure , and OCT measure) and ROS analysis (including Total Anti-oxidative Capacity (TAC), C-Reactive protein (CRP), Glutathione peroxidase (GPx) were performed. In addition, questionnaire about patient’s basic information, past history, habit, family history, Ocular Surface Disease Index (OSDI) and Depression Anxiety Stress Scales (DASS) were completed before examination. Results There were 41 non-DED (36.3%), 48 early-onset DED (42.5%) and 24(21.2%) combined group patients participated in the study. Comparing with control group, body mass index (χ2=9.24, p=0.01), education level (χ2=13.36, p=0.04), working in air-conditioned room (χ2=5.39,p=0.036), drinking habit (χ2=5.94,p=0.05), electronic devices use (χ2=12.52,p=0.05), experienced LASIK surgery (χ2=5.48, p=0.036) and participants who had retinal disease (χ2=7.02, p=0.03) were significantly between the three groups. In addition, participants who had family history of hypertension (χ2=5.88, p=0.05), immune system problems (χ2=9.19, p=0.01); participants themselves who had hypertension (χ2=13.24, p=0.00), diabetes (χ2=11.03, p=0.00); taking anti-hypertensive drugs (χ2=10.08, p=0.01), lutein (χ2=6.23, p=0.04), antioxidant supplement (χ2=4.89, p=0.05); using cataract eye drops (χ2=19.40, p=0.00) and artificial tears (χ2=11.53, p=0.00) were significantly different between the three groups. Furthermore, OSDI scores (F=7.52, p=0.00), VA (F=2.63, p=0.04), Schirmer's test (F=5.04, p=0.01), NIBUT (F=6.22, p=0.00) were also significantly different between the three groups. Similar results were found in CRP index (F=3.13, p=0.05) but not in GPX (F=0.19, p=0.83) and TAC (F=1.46, p=0.24). Discussion According to the results, early onset DED may be associated by BMI, education level, working environment, habits, physical or eye disease, family history, drugs or drops use and nutritional supplement. To prevent or defer early-onset dry eye disease, monitoring eye anatomy or antioxidant blood analysis may be worth taking into consideration in the further.