Study On Correlation Of Ocular Surface States And Laboratory Examination In Primary Sj(?)gren's Syndrome

【Objective】To investigate the correlation of ocular surface states and laboratory examination in primary sj(O|¨)gren's syndrome.【Methods】The prospective study was carried through in 28 primary sj(O|¨)gren's syndrome cases (56 eyes) and 28 CTD non-pSS cases (56 eyes) and 28 non-CTD controls(56 eyes).The patients with pSS and CTD came from inpatient of rheumatology of our hospital while the controls cases came from inpatient and outpatient of ophthalmology.Each patient was asked to respond to a validated questionnaire on subjective symptoms developed by the Alldrgan in 1995,the OSDI was assessed. Doing comparison in OSDI,Schirmer test examination, tear meniscus high, break up time test,fluorescein staining, conjunctival impression cytology and tear ferning test. Collect the clinical data of patients with primary sj(O|¨)gren's syndrome (age of onset,course of disease,complications)and laboratory test results (autoantibodies, parotid sialography,labial salivary gland biopsy),To analyze the ocular surface coditions and clinical manifestation and to investigate the correlation with laboratory examination in patients with pSS.【Results】The primary sj(O|¨)gren's syndrome group showed significantly higher prevalance rate of dry eye syndrome (51.8%)than that of the CTD group(30.4%)and control group(12.5%).The common symptoms of dry eye syndrome was dry eye 93.1%(27/29). The differences of OSDI score,Schirmer test,tear film break-up time,corneal fluorescein staining score and tear meniscus high of the three groups were statistically significant (P<0.001),each of the indicators of pSS group was worst.The cases of CIC grade concentrated in 2(30) and 3(19), 88% of total,and there is no grade 0 in the pSS group,while the cases of CIC grade concentrated in 1(20) and 2(25), 81% of total,mostly to grade 2 in the CTD group.On the contrary,the cases of CIC grade concentrated in grade 0(25) and 1(23) 89% of total,mostly to grade 0,and there is no grade 3 in the control group.The difference the result of CIC grade between the three group was statisticlly significant(P<0.001),pairwise comparisons among the three groups show statistically significant different(P<0.001).The cases of TFT grade focused onⅢ(30) andⅣ(18),and the cases of gradeⅣaccout for a majority(32%) in the pSS group , while the cases of TFT grade concentrated in gradeⅢ(31) accounted for 55%,the cases of gradeⅡ(13) are of a considerable majorty(23%) in the CTD group. On the contrary , the cases of TFT grade concentrated in gradeⅠ(24) andⅡ(17) 73% of total,mostly to gradeⅠ(43%) in the control group. The difference the result of TFT grade between the three group was statisticlly significant(P<0.001),pairwise compar- isons among the three groups show statistically significant different(P<0.01).There was a considerably positive correlation between the CIC classification and FL and OSDI in patients with pSS,the Spearman correlation coefficient was 0.488 and 0.506 respectively,which was statistically significant(P<0.001).There was a weakly negative correlation between the grade of TFT and SIT,the Spearman correlation coefficient was 0.270 with statistical significance(P<0.05).There was no correlation between the grade of CIC and that of TFT of patients with pSS.(γp =0.091 P>0.05).The BUT of the group whose labial salivary gland biopsy is negative was higher than that of the group whose labial salivary gland biopsy is positive,the difference between the two groups was statistically significant(P<0.01).The value of OSDI of the group whose parotid sialography is positive(26.90±28.56) was higher than that of the group whose parotid sialography is negative with statistically significance(0.00±0.00)(P<0.01).The comparisons of labial salivary gland biopsy and parotid sialography between the CIC classification and TFT classification have no significant difference by statistical analysis(P>0.05).Our study indicated that there was no difference (P > 0.05)in autoantibodies(ANA,SSA,SSB,RF,CRP,RO52) and routine tests of dry eye between the patients with dry eye syndrome and that without dry eye syndrome of pSS. The positive rate of OSDI of patients with dry eye syndrome was statistically significantly higher than that of patients without dry eye syndrome(P<0.05).The OSDI, routine tests of dry eye,CIC grade and TFT grade were poorly correlated with the age of onset and duration of pSS(P>0.05).【Conclusions】The pSS tend to develop ocular glands dysfunction,reduction of tear secretion,changes in tear composition and tear film,decreased stability of tear film, so they are susceptible persons of dry eye,which was severe, of rapid progression and large variation.The routine tests in the diagnosis of dry eye are effective indicators of pSS, can effectively detect patients with eye involvement of pSS ,should become routine tests of ophthalmology in pSS.OSDI score high, labial salivary gland biopsy positive,parotid sialography positive suggest eye involvement,while the sensitivity of autoantibodies predicting eye involvement in pSS is not high.Ocular surface damage of pSS firstly occurs in the conjunctiva. Conjuntival impression cytology has better performance in evaluating the degree of dry eye than the routine tests of dry eye and is valuable to early diagnose the dry eye in pSS.The changes in tear composition is an important factor on the development of dry eye,while TFT test can successfully detect these changes.The CIC test and TFT test contribute to early detect the changes of ocular suface status in patients with pSS.The extent of dry eye syndrome in patients with pSS is poorly correlated with the age of onset and duration of disease.