目的:确定手持式脂质层检查仪测量的非侵入性泪膜破裂时间(NIBUT)的诊断准确性。
方法:108例患者被纳入本横断面研究,分为两组:干眼症患者(n=57),根据Schein问卷获得的干眼症状和最少一个客观干眼症(泪膜破裂时间<10s或角膜,结膜和眼睑边缘荧光素染色),和健康受试者(n=51)。
结果:干眼受试者的NIBUT明显短于健康受试者(6svs20s,p<0.001)。Logistic回归分析显示,NIBUT值较短是干眼症的优良指标(p<0.001),具有一致性,测量之间没有显著差异,即使在对年龄和性别的结果进行标准化之后。区分干眼与健康受试者的NIBUT切点为12s(灵敏度90.2%,特异性88.5%,PPV92.5%,净现值85.2%,LR+7.82,LR-0.11,DOR70.92,DE89.6%)。很好,但在10s的截止值下观察到较低的精度(灵敏度为87.8%,特异性88.5%,PPV92.3%,净现值82.1%,LR+7.61,LR-0.14,DOR55.2,DE88.1%)。0.944的ROC曲线下面积(AUC)将NIBUT分类为具有非常高准确性的诊断测试。
结论:这项研究显示了通过手持式脂质层检查仪器测量的NIBUT的高诊断准确性。这个简单的,可靠,客观和可用的工具可能会定期进行,标准的干眼诊断,几乎每个眼科专家都可以使用。
OBJECTIVE: To determine the diagnostic accuracy of non-invasive tear film break-up time (NIBUT) measured by the handheld lipid layer examination instrument.
METHODS: 108 patients were enrolled in this cross-sectional study and divided into two groups: patients with dry eye (n = 57) categorized by the presence of dry eye symptoms obtained by Schein Questionnaire and minimally-one objective dry eye sign (tear film break-up time <10 s or corneal, conjunctival and lid margin fluorescein staining), and healthy subjects (n = 51).
RESULTS: Dry eye subjects had significantly shorter NIBUT than healthy subjects (6 s vs 20 s, p < 0.001). Logistic regression analysis showed that shorter NIBUT values were excellent indicators of dry eye disease (p < 0.001), with consistency and no significant difference between measurements, even after standardizing the results for age and sex. NIBUT cut-off point to distinguish dry eye from healthy subjects was 12 s (sensitivity 90.2 %, specificity 88.5 %, PPV 92.5 %, NPV 85.2 %, LR +7.82, LR- 0.11, DOR 70.92, DE 89.6 %). Good, but lower accuracy was observed at cut-off value of 10 s (sensitivity 87.8 %, specificity 88.5 %, PPV 92.3 %, NPV 82.1 %, LR+ 7.61, LR- 0.14, DOR 55.2, DE 88.1 %). The area under the ROC curve (AUC) of 0.944 classified NIBUT as a diagnostic test with very high accuracy.
CONCLUSIONS: This study showed a high diagnostic accuracy of NIBUT measured by the handheld lipid layer examination instrument. This simple, reliable, objective and available instrument might regularly take place in routine, standard dry eye diagnostic and can be used by almost every eye specialist.