건성안 환자에서 마이봄샘 소실의 위험 요인 분석
Risk Factors of Meibomian Gland Loss in Dry Eye Disease
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목적: 건성안 환자에서 심한 마이봄샘 소실의 위험 요인을 분석하고자 하였다. 대상과 방법: 2020년부터 2021년까지 건성안으로 치료받은 환자 중 마이봄샘 촬영술을 시행한 229명의 환자를 대상으로 마이봄샘소실 정도에 따라 4개의 군으로 나누어 안검연의 혈관확장, 불규칙성, 안구표면질환지수, 비침습적 눈물막파괴시간, 눈물막 지질층두께, 눈물띠높이를 비교하였다. 대상군의 나이, 성별, 아이라인 문신 여부, 고혈압, 당뇨, 이상지질혈증, 항암 치료, 두경부의 방사선치료, 폐경기 호르몬 대체 치료, 자가면역 질환 등의 과거력을 조사하여 심한 마이봄샘 소실 정도와의 상관관계를 분석하였다. 결막면적의 75% 이상 마이봄샘이 소실된 경우 심한 마이봄샘 소실로 정의하고 로지스틱 회귀분석을 이용하여 위험 요인을 평가하였다. 결과: 마이봄샘 소실 정도에 따라 나눈 4개의 군에서 마이봄샘 소실 정도가 심한 군에서 나이가 더 많고(p=0.001) 눈물 지질층 두께가낮았으며(p<0.001) 아이라인 문신 빈도가 높았다(p=<0.001). 고지혈증(p<0.001)과 항암 치료력(p=0.001)의 비율도 마이봄샘 소실이심한 군에서 높았다. 다중 로지스틱 회귀분석 결과 나이, 아이라인 문신, 고지혈증, 항암 치료의 과거력은 심한 마이봄샘 소실과 유의한 영향을 주는 변수였다(p<0.05). 결론: 건성안 환자에서 나이, 아이라인 문신, 고지혈증, 항암 치료의 과거력은 심한 마이봄샘 소실을 유발하는 유의한 변수이다.
Abstract
Purpose: To determine the risk factors of meibomian gland loss in dry eye disease. Methods: The medical charts of 229 dry eye disease patients who had a meibography were retrospectively reviewed. They were divided into 4 groups according to the degree of meibomian gland loss. Telangiectasia and irregularity of eyelid margin, Ocular Surface Disease Index (OSDI), non invasive breakup time (NIBUT), lipid layer thickness (LLT) and tear meniscus height (TMH) were compared. Age, gender, history of eyeline tattoo, history of hypertension, diabetes, dyslipidemia, chemotherapy, radiation therapy, hormone therapy and autoimmune diseases were also investigated to analyze the correlation with the severe meibomian gland loss. Severe meibomian gland loss was defined as loss of more than 75% of the conjunctival area, and risk factors were evaluated using logistic regression analysis. Results: Comparing the four groups divided according to the degree of meibomian gland loss, the group with severe meibomian gland loss was older (p = 0.001), had lower LLT (p < 0.001), had a higher frequency of eyeline tattoos. The ratio of hyperlipidemia (p < 0.001) and chemotherapy (p < 0.001) was also high in the group with severe meibomian gland loss. As a result of multiple logistic regression analysis, age, eyeline tattoo, hyperlipidemia, and chemotherapy were variables that had a significant effect on sever meibomian gland loss. (p < 0.05) Conclusions: Age and history of eyeline tattoo, hyperlipidemia, and chemotherapy are significant variables that cause severe meibomian gland loss in dry eye disease patients.
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