갑상샘눈병증에서 마이봄샘 구조 변화에 미치는 요인 분석
Risk Factors for Structural Changes in Meibomian Gland in Thyroid Eye Disease
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목적: 갑상샘눈병증 환자에서 질병활성도(clinical activity score, CAS)와 thyroid stimulating hormone receptor autoantibody (TSHR autoantibody)가 마이봄샘 구조 변화에 미치는 영향을 알아보고자 한다. 대상과 방법: 2015년 3월부터 2016년 2월까지 본원에서 갑상눈병증으로 진단된 환자들을 대상으로 후향적, 단면조사 연구를 시행하였다. 갑상샘 기능과 TSHR autoantibody (thyrotropin-binding inhibitor immunoglobulin [TBII] assay) 상태, 갑상샘눈병증 유병 기간, CAS를 조사하였으며, Lipiview inferometer® (TearScience Inc., Morrisville, NC, USA)를 이용하여 마이봄샘 구조를 분석하였다. 세극등현미경검사를 통해 마이봄샘 발현(meibum expression, ME) 정도와 눈물막파괴 시간을 평가하였다. 결과: 총 37명(남: 13명, 여: 24명)의 갑상샘눈병증 환자들이 연구에 포함되었으며, 평균 나이는 43.8 ± 13.3세였다. 연구 포함 당시갑상샘 기능은 항진 24명(64.9%), 저하 5명(13.5%), 정상 8명(21.6%)이었다. 평균 CAS는 1.86 ± 1.74 (0-7)였고, CAS 3점 이상의 활동군은 9명(24.3%), CAS 3점 미만의 비활동군은 28명(75.7%)이었다. 마이봄샘점수(meiboscore)는 위눈꺼풀 1.05 ± 0.82, 아래눈꺼풀 0.76 ± 0.76이었으며, 위눈꺼풀에서 유의하게 더 높게 나타났다(p=0.001). TBII의 평균값은 6.11 ± 11.35 IU/L였고 TBII가 정상1.5보다 높은 경우는 16명(43.2%), 정상인 경우는 21명(56.8%)이었다. TBII가 정상보다 높은 군에서 정상인 군보다 위눈꺼풀의 마이봄샘점수가 유의하게 더 높았다(p=0.045). 위눈꺼풀의 마이봄점수와 유의한 연관성을 갖는 요인은 CAS (r=0.356, p=0.030), ME (r=0.379, p=0.021), TBII (r=0.334, p=0.044)였다. 다중회귀분석에서 위눈꺼풀 마이봄점수에 영향을 미치는 요인은 CAS (p=0.010)와 TBII (p=0.011)였으며, 아래눈꺼풀 마이봄점수에 영향을 미치는 요인 또한 CAS (p=0.015), TBII (p=0.038)였다. 결론: 갑상샘눈병증 환자에서 마이봄샘의 구조적 소실은 아래눈꺼풀보다 위눈꺼풀에서 큰 양상을 보였으며, CAS와 TSHR autoantibody가 마이봄샘 구조 소실에 영향 미침을 확인할 수 있었다.
Abstract
Purpose: To investigate the effect of clinical activity score (CAS) and thyroid stimulating hormone receptor autoantibody (TSHR autoantibody) on structural changes in Meibomian gland in patients with thyroid eye disease (TED). Methods: From March 2015 to February 2016, retrospective and cross-sectional studies were performed on patients diagnosed with TED. We investigated thyroid function, TSHR autoantibody (thyrotopin-binding inhibitor immunoglobulin [TBII] assay) status, duration of TED, CAS, and analyzed the Meibomian gland structure using a Lipiview inferometer® (TearScience Inc., Morrisville, NC, USA). We evaluated the degree of meibum expression (ME) and the tear film breakdown time by slit lamp microscopy. Results: A total of 37 patients (13 males and 24 females) with TED were included in the study, and the mean age was 43.8 ± 13.3 years. At the time of the study, 24 patients (64.9%) had hyperthyroidism, five patients (13.5%) had hypothyroidism, and eight patients (21.6%) had normal functioning. The mean CAS was 1.86 ± 1.74 (0-7), nine patients (24.3%) were in the active group with ≥3 points of CAS, and 28 patients (75.7%) were in the inactive group with <3 points of CAS. The meiboscore was 1.05 ± 0.82 in the upper eyelid, and 0.76 ± 0.76 in the lower eyelid, with a significantly higher upper eyelid (p = 0.001). The mean value of the TBII was 6.11 ± 11.35 IU/L. Sixteen patients (43.2%) had TBII above the normal 1.5 value, and 21 patients (56.8%) had a normal TBII. The meiboscore of the upper eyelid was significantly higher when the TBII was higher than normal (p = 0.045). CAS (r = 0.356, p = 0.030), ME (r = 0.379, p = 0.021), and TBII (r = 0.334, p = 0.044) were significantly associated with the meiboscore in the upper eyelid. Using multiple regression analyses, CAS (p = 0.010) and TBII (p = 0.011) were factors affecting the upper eyelid meiboscore, and CAS (p = 0.015) and TBII (p = 0.038) were factors affecting the lower eyelid meiboscore. Conclusions: The structural loss of Meibomian glands in patients with TED was greater in the upper eyelid than lower eyelid, and CAS and TSHR autoantibody had an effect on the structural loss of the Meibomian gland.
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