Association between systemic activity ındex and dry eye severity in patients with primary Sjögren syndrome

ABSTRACT Purpose: The aim of the present study was to compare the severity of ocular and systemic findings among patients with primary Sjögren syndrome. Methods: The study followed a prospective controlled design and comprised two groups; the test group included 58 eyes of 58 patients newly diagnosed with primary Sjögren syndrome with poor dry eye test findings and the control group included 45 right eyes of 45 healthy age- and sex-matched individuals. The ocular surface disease index score, tear osmolarity, Schirmer I test without anesthesia, fluorescein tear breakup time, and cornea-conjunctiva staining with lissamine green (van Bijsterveld scoring) were used to examine tear function in the patients via a complete ophthalmological examination. The results were graded and classified on the basis of a Dry Eye WorkShop report and results of the corneal and conjunctival staining test, Schirmer’s test, and fluorescein tear breakup time test. Discomfort, severity and frequency of symptoms, visual symptoms, conjunctival injection, eyelid-meibomian gland findings, and corneal-tear signs were interpreted. Disease activity was scored per the EULAR Sjögren’s syndrome disease activity index (ESSDAI) via systemic examination and laboratory evaluations, and the EULAR Sjögren’s syndrome patient-reported index (ESSPRI) assessed via a survey of patient responses. Results: Mean patient age was 48.15 ± 16.34 years in the primary Sjögren syndrome group and 44.06 ± 9.15 years in the control group. Mean fluorescein tear breakup time was 4.51 ± 2.89s in the primary Sjögren syndrome group and 10.20 ± 2.39 s in the control group. Mean Schirmer I test result was 3.51 ± 3.18 mm/5 min in the primary Sjögren syndrome group and 9.77±2.30 mm/5 min in the control group. Mean ocular surface disease index score was 18.56 ± 16.09 in the primary Sjögren syndrome group, and 19.92 ± 7.16 in the control group. Mean osmolarity was 306.48 ± 19.35 in the primary Sjögren syndrome group, and 292.54 ± 10.67 in the control group. Mean lissamine green staining score was 2.17 ± 2.76 in the primary Sjögren syndrome group, and 0.00 in the control group. Statistically significant differences were found berween the primary Sjögren syndrome group and control group in terms of fluorescein tear breakup time, Schirmer’s test, lissamine green staining, and osmolarity tests (p=0.036, p=0.041, p=0.001, and p=0.001 respectively). The Dry Eye WorkShop score was 2.15 ± 0.98, the EULAR Sjögren’s syndrome disease activity index score was 11.18 ± 4.05, and the EULAR Sjögren’s syndrome patient-reported index score was 5.20±2.63. When potential associations of the Dry Eye Workshop Study scores and osmolarity scores with the Eular Sjögren’s syndrome disease activity index scores were evaluated, the results were found to be statistically significant (p=0.001, p=0.001 respectively). Conclusion: The results showed an association between dry eye severity and systemic activity index in primary Sjögren syndrome patients.

摘要
研究目的：本研究旨在比较原发性干燥综合征（primary Sjögren syndrome）患者眼部与全身表现的严重程度。
方法：本研究采用前瞻性对照设计，分为两组；试验组纳入58例初诊原发性干燥综合征且干眼检查结果异常的患者，共58只眼；对照组纳入45名年龄、性别匹配的健康个体，各取其右眼，共45只眼。通过完整眼科检查，采用眼表疾病指数评分、泪液渗透压、无麻醉Schirmer I试验、荧光素泪膜破裂时间以及丽丝胺绿角膜结膜染色（van Bijsterveld评分法）评估患者的泪液功能。检测结果依据干眼工作组（Dry Eye WorkShop）报告、角膜结膜染色试验、Schirmer试验及荧光素泪膜破裂时间试验的结果进行分级与分类。随后对不适症状、症状严重程度与发作频率、视觉症状、结膜充血、睑板腺表现以及角膜泪膜体征进行解读。通过全身检查与实验室评估，采用欧洲抗风湿病联盟干燥综合征疾病活动指数（EULAR Sjögren’s syndrome disease activity index, ESSDAI）对疾病活动度进行评分；采用欧洲抗风湿病联盟干燥综合征患者报告指数（EULAR Sjögren’s syndrome patient-reported index, ESSPRI）通过患者问卷调查完成评估。
结果：原发性干燥综合征组患者的平均年龄为48.15±16.34岁，对照组为44.06±9.15岁。原发性干燥综合征组的平均荧光素泪膜破裂时间为4.51±2.89秒，对照组为10.20±2.39秒。原发性干燥综合征组的平均Schirmer I试验结果为3.51±3.18 mm/5 min，对照组为9.77±2.30 mm/5 min。原发性干燥综合征组的平均眼表疾病指数评分为18.56±16.09，对照组为19.92±7.16。原发性干燥综合征组的平均泪液渗透压为306.48±19.35，对照组为292.54±10.67。原发性干燥综合征组的平均丽丝胺绿染色评分为2.17±2.76，对照组为0.00。两组在荧光素泪膜破裂时间、Schirmer试验、丽丝胺绿染色及泪液渗透压检测方面均存在统计学显著差异（分别对应p=0.036、p=0.041、p=0.001及p=0.001）。原发性干燥综合征组的干眼工作组评分为2.15±0.98，ESSDAI评分为11.18±4.05，ESSPRI评分为5.20±2.63。当评估干眼工作组评分与泪液渗透压评分和ESSDAI评分之间的潜在关联时，结果显示二者均存在统计学显著性（分别对应p=0.001、p=0.001）。
结论：本研究结果显示，原发性干燥综合征患者的干眼严重程度与全身疾病活动指数存在关联。