눈물 지질층 두께와 안구표면임상인자 간의 상관관계 분석
Correlation Analysis of Tear Film Lipid Layer Thickness and Ocular Surface Disease Index
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목적: LipiView IIⓇ 간섭계(LipiViewⓇ Ocular Surface Interferometer, TearScienceⓇ, Morrisville, NC, USA)를 이용하여 측정한 눈물지질층 두께(tear film lipid layer thickness, tear film LLT)를 임상적으로 이용되는 안구 표면 질환의 지표들과 비교하여 상관관계를 분석하고자 한다. 대상과 방법: 건성안을 진단받은 환자 49명을 대상으로 전향적 연구를 시행하였다. 환자들은 안구표면질환지표(ocular surface disease index, OSDI) 설문조사를 받았다. 세극등 현미경 검사, 눈물막 파괴 시간(tear film break-up time, tBUT) 측정, 쉬르머 검사(Schirmer test), 각막 및 결막 형광 염색, 마이봄샘기능부전에 대한 평가를 시행하였다. LipiView IIⓇ 간섭계를 통한 눈물 지질층 두께, 동적 투과조명 마이봄샘 촬영 및 눈 깜박임 횟수를 측정하였다. 결측값을 보정하기 위해 다중대체 방법을 사용하여 4개의 결측값 대체 모델을 만들어 Pearson 상관 분석을 시행하였다. 눈물 지질층 두께에 따라 환자들을 두 군으로 구분(LLT <60 nm, LLT ≥60 nm)하여 카이제곱 교차 분석을 시행하였다. 결과: 안구 표면 질환의 지표 중 눈물막 파괴 시간이 눈물 지질층 두께의 평균, 최댓값과 유의한 상관관계를 보였으며(average LLT; p=0.008, 0.035, 0.006, 0.049, maximum LLT; p=0.006, 0.042, 0.020, 0.049, Pearson correlation analysis with multiple imputation) 최솟값과는 유의한 관계가 없었다(minimum LLT; p=0.048, 0.090, 0.079, 0.039). 평균 및 최대 눈물 지질층 두께가 상대적으로 얇게 측정된 환자군(LLT <60 nm)에서는 각각 80%와 88%의 환자에서 tBUT가 10초 미만인 값을 보였고 이와 대조적으로 상대적으로 눈물 지질층 두께가 두껍게 측정된 환자군(LLT ≥60 nm)에서는 각각 39%, 47%의 환자에서 tBUT가 10초 미만으로 나타났다. 결론: 건성안 환자에서 눈물 지질층 두께의 평균 및 최댓값은 눈물막 파괴시간과 유의한 상관관계를 보였고 평균, 최대 눈물 지질층두께가 상대적으로 얇은 환자에서 눈물막 파괴 시간이 단축된 경향을 보였다. 이는 눈물막 증발 건성안 환자에서 LipiView IIⓇ 간섭계를 이용한 평균 눈물 지질층 두께를 측정하는 것이 진단 및 경과관찰에 도움을 줄 수 있음을 보여준다.
Abstract
Purpose: To analyze the relationship between ocular surface disease index and tear film lipid layer thickness (LLT) using a LipiView II® (LipiView® Ocular Surface Interferometer, TearScience®, Morrisville, NC, USA) interferometer. Methods: Forty-nine patients diagnosed with dry eye syndrome were recruited for this prospective study. Patients completed ocular surface disease index questionnaires. We performed slit lamp examination, Schirmer test, corneal and conjunctival fluorescein staining, measured tear film break-up time, and graded meibomian gland dysfunction. Tear LLT, blinking time, and dynamic meibomian imaging were analyzed using a LipiView II® ocular interferometer. To control for missing data, we analyzed four sets of imputated data via the multiple imputation method and performed Pearson correlation analysis. Patients were assigned to one of two LLT categories (LLT < 60 or LLT ≥ 60) and Chi-square test was performed. Results: Among ocular surface disease parameters, tear film break-up time (tBUT) had a statistically significant correlation with average and maximum LLT (average LLT; p = 0.008, 0.035, 0.006, 0.049, maximum LLT; p = 0.006, 0.042, 0.020, 0.049, Pearson correlation analysis with multiple imputation) but there was no significant correlation with minimum LLT (minimum LLT; p = 0.048, 0.090, 0.079, 0.039). Of the patients with a relatively thick average LLT or maximum LLT (LLT ≥ 60 nm), 80% and 88% had a tBUT < 10, respectively. Conversely, 39% and 47% of patients with relatively thin average LLT (LLT < 60 nm) had a tBUT < 10 (average LLT; p = 0.013, maximum LLT; p = 0.039). Conclusions: Average LLT and maximum LLT were significantly correlated with tBUT. Patients with a relatively thin average or maximum LLT tended to have a shorter tBUT. Based on these results, measuring tear film LLT using a LipiView II® interferometer may be useful in the diagnosis and follow-up of patients with evaporative dry eye.
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