건성안 환자에서 쇼그렌증후군의 빈도 및 임상양상
Prevalence and Clinical Aspects of Sjögren Syndrome in Dry Eye Patients
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목적: 국내에서 건성안으로 진단받은 환자들 중에서 쇼그렌증후군 환자들의 비율 및 임상양상을 알아보고자 하였다. 대상과 방법: 2008년 3월부터 2010년 3월까지 전남대학교병원에서 건성안으로 진단받은 환자 중 3개월 이상 경과 관찰한 자를 대상으로 의무기록을 후향적으로 분석하였다. 결과: 건성안 환자는 모두 206명으로 그 중 58명(28%)의 환자에서 쇼그렌증후군을 보였고, 39명(19%)명의 환자에서 일차성 쇼그렌증후군을 나타냈다. 안구표면장애 측정표를 통한 증상점수, 눈물막파괴시간, 쉬르머검사 및 Oxford scheme에 의한 각결막표면염색검사에서 쇼그렌증후군 환자가 비쇼그렌증후군에 비해 유의하게 더 심한 양상을 보였다(p＜0.05). 일차성 쇼그렌증후군 환자 중 혈청 내자가항체(anti-SSA/Ro, anti-SSB/La) 양성은 27명(69%), 음성은 12명이었으며, 두 군 사이의 건성안의 증상 및 눈물검사 지표에 유의한 차이는 없었다. 결론: 건성안 환자 중 쇼그렌증후군 환자는 약 28%였으며 중증 건성안 환자에서는 약 2/3으로 많았으며 비쇼그렌증후군 환자에 비해더 심한 임상양상을 보였다. 따라서 중증 건성안 환자들에 대해 전신적인 검사를 통한 쇼그렌증후군의 선별이 중요할 것으로 생각한다.
Abstract
Purpose: To investigate the prevalence and clinical aspects of Sjögren syndrome in patients who were diagnosed with dry eye syndrome in Korea. Methods: The medical records of patients who were diagnosed with dry eye syndrome in a dry eye clinic during a 2-year period (March 2008 to March 2010) and were followed up for more than 3 months were reviewed retrospectively. Results: A total of 206 patients were included in the present study. Fifty-eight patients (28%) had Sjögren syndrome and 39 patients (19%) showed primary Sjögren syndrome. Sjögren syndrome patients showed poorer results than non-Sjögren syndrome patients in ocular surface disease index score (OSDI), tear break up time, Schirmer test score, and ocular surface staining score using the Oxford scheme (p < 0.05). Among the patients with primary Sjögren syndrome, 27patients were SSA (anti-Ro antibodies) or SSB (anti-La antibodies) positive and 12 patients were sero-negative. There were no statistically significant differences in objective or subjective parameters between the sero-positive and sero-negative groups. Conclusions: Sjögren syndrome was observed in 28% of all dry eye patients, in two-thirds of severe dry eye patients. Sjögren syndrome patients showed more severe clinical aspects than dry eye patients with non-Sjögren syndrome. Diagnosing Sjögren syndrome through systemic evaluation is necessary in the patients with severe dry eye.
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