염증성 건성안 감별진단을 위한 검사법 (Screening Method for Inflammatory Dry Eye)

목적: 눈물검사, 각막염색 및 결막충혈 검사를 통해 염증성 건성안 감별진단을 위한 알고리즘을 제시하고자 하였다.
방법: 안질환이 없는 20~30대 총 81명을 대상으로 염증 생체 표��자인 MMP-9을 이용하여 염증성 건성안을 판별하고, 쉬르머검사, TBUT, OSDI, 각막 염색, 결막 충혈 검사를 실시하였다. 건성안 판단 기준은 Schirmer test 5 mm 미만, 눈물막파괴시간 5초 미만, 건성안 자각증상 점수 12점 이상, 각막스테이닝 및 결막충혈은 CCLRU Grade 1 이상으로 하였다. 각각의 검사왿� MMP-9의 상관성은 카이제곱검정으로 확인보고 염증성 건성안 감별진단의 알고리즘에 대한 민감도(sensitivity)왿� 특이도(specificity) 및 곡선아래면적은 ROC 커브를 이용하였다.
결과: 쉬르머검사왿� TBUT 값은 MMP-9 양성 반응과 상관성이 없었고(p>0.050), OSDI, 각막 염색, 결막 충혈은 MMP-9 양성 반응과 유의한 상관성을 보였다(p<0.050). 염증성 건성안 감별진단에 대한 민감도, 특이도, AUC는 ‘OSDI/각막 염색/결막 충혈’ 모두 반영한 경우 44.00%, 100.00%, 0.720로 나타났으며, ‘OSDI/각막 염색’은 44.00%, 94.59%, 0.693, ‘OSDI/결막 충혈’은 76.80%, 75.68%, 0.762, ‘각막 염색/결막 충혈’은 52.80%, 97.30%, 0.750로 ‘OSDI/결막 충혈’을 반영한 경우가 가장 높은 정확도를 보였다.
결론: ‘OSDI/결막 충혈’ 검사 알고리즘은 MMP-9 검사결과왿� 유사한 높은 정확도를 보여 염증성 건성안의 감별진단에 유용할 것으로 제안한다.

Purpose: To propose an algorithm for screening of inflammatory dry eye using tear tests, corneal staining and conjunctival hyperemiaMethods: A total of 81 patients in 20-30s without ophthalmologic diseases participated. The inflammatory dry eyes were diagnosed using MMP-9 (metalloproteinase-9) test and performed Shirmer test, TBUT (tear break-up time), corneal staining and conjunctival hyperemia. Dry eye refers to the criteria which specifies the OSDI (ocular surface disease index) score of more than 12, TBUT (tear film break-up time) of less 5 seconds, Schirmer test without anesthesia of less than 5mm/5minutes, corneal staining, and conjunctival hyperemia more than grade 1. Chi-square test was used to find out the correlation between tear/ocular surface test and MMP-9 test, and ROC curve was used for the sensitivity, specificity and AUC (area under the curve) for the algorithm of inflammatory dry eye.
Results: Neither of the methods, Schirmer test nor TBUT, showed statistically significant correlation with positive MMP-9 results(p>0.050). And, OSDI, corneal staining, and conjunctival hyperemia were significantly correlated with MMP-9 result(p<0.050). Among the OSDI scores, corneal staining, and conjunctival hyperemia, the sensitivity, specificity, and AUC for screening of inflammatory dry eye were as follows. The sensitivity, specificity, and AUC of ‘OSDI/corneal staining/conjunctival hyperemia’ were 44.00%, 100.00%, 0.720, and ‘OSDI/corneal staining’ were 44.00% 94.59%, 0.693, ‘OSDI/conjunctival hyperemia’ were 76.80%, 75.68%, 0.762, and ‘corneal staining/conjunctival hyperemia were 52.80% 97.30%, 0.750, respectively, showing that ‘OSDI/conjunctival hyperemia’ was highest accuracy.
Conclusion: The algorithm of ‘OSDI/conjunctival hyperemia’ showed high accuracy similar to MMP-9 test. It would be a useful method for screening inflammatory dry eye.