新疆医科大学学报

目的 研究白内障患者术后干眼症与泪液中炎症因子水平表达的相关性。方法 选取2022年2月-2023年8月于中国人民解放军32397部队医院眼科行白内障手术的100例白内障患者为研究对象。术前收集患者泪液，检测泪液中炎症因子[白介素1β(Interleukin-1β,IL-1β)、白介素-20(Interleukin-20,IL-20)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)]水平。术后2周进行复诊，根据是否并发干眼症分为干眼症组、恢复良好组，收集两组临床资料。采用Pearson相关性分析法评估IL-1β、IL-20、TNF-α与干眼症诊断指标[泪膜破裂时间(Tear break-up time, BUT)、角膜上皮荧光素染色(Corneal fluorescein staining, CFL)评分、基础泪液分泌试验(Schirmer I test, SIt)]的相关性，采用Logistic回归分析法筛选影响白内障术后干眼症发生的危险因素，经受试者工作特征曲线(Receiver operating characteristic curve,ROC)评估IL-1β、IL-20、TNF-α对白内障术后干眼症的预测价值。结果 与恢复良好组比较，干眼症组术前泪液IL-1β、IL-20、TNF-α水平较高，BUT和SIt较低，CFL评分较高，差异有统计学意义(P<0.05)。干眼症组患者泪液中IL-1β水平与BUT、SIt均呈负相关(r=-0.564、-0.627,P<0.05),与CFL呈正相关(r=0.542,P<0.05);泪液中IL-20水平与BUT、SIt均呈负相关(r=-0.575、-0.645,P<0.05),与CFL呈正相关(r=0.561,P<0.05);泪液中TNF-α水平与BUT、SIt均呈负相关(r=-0.557、-0.630,P<0.05),与CFL呈正相关(r=0.552,P<0.05)。干眼症组患者合并糖尿病、睑脂粘度分级>2级、结膜松弛度分级3级比例均高于恢复良好组，差异有统计学意义(P<0.05)。Logistic回归分析结果显示，合并糖尿病(OR=1.152)、睑脂粘度分级>2级(OR=1.142)、结膜松弛度分级3级(OR=1.169)、IL-1β(OR=1.224)、IL-20(OR=1.204)、TNF-α(OR=1.242)是影响白内障术后干眼症的独立危险因素(P<0.05)。ROC曲线结果显示，泪液中IL-1β、IL-20、TNF-α水平联合预测白内障术后干眼症的敏感度、AUC分别为91.50%、0.915,均高于IL-1β(83.80%、0.854)、IL-20(84.50%、0.858)、TNF-α(87.20%、0.865)单独预测。结论 白内障患者术后干眼症与泪液中IL-1β、IL-20、TNF-α水平密切相关，且IL-1β、IL-20、TNF-α联合预测白内障术后干眼症的效能良好，为临床早期预防白内障术后干眼症的发生提供了参考依据。

Objective To investigate the correlation between postoperative dry eye and inflammatory factors expression in tears of cataract patients. Methods A total of 100 cataract patients who underwent cataract surgery in the hospital from February 2022 to August 2023 were selected as the study objects. The level of inflammatory factors [interleukin-1β(IL-1β), interleukin-20(IL-20), and tumor necrosis factor-α(TNF-α)] in the tears were collected before the surgery. 2 weeks after the operation, the patients were divided into dry eye group and good recovery group, and the clinical data of the 2 groups were collected. Pearson correlation analysis was used to evaluate the correlation between IL-1β, IL-20, TNF-α and diagnostic indicators of dry eye. The correlation between IL-1β, IL-20, TNF-α and diagnostic indicators [tear break-up time(BUT), corneal fluorescein staining(CFL) and schirmer I test(SIt)] of dry eye was evaluated by Pearson correlation analysis, Logistic regression analysis was used to screen the risk factors affecting the occurrence of postoperative dry eye syndrome, the predictive value of IL-1β, IL-20 and TNF-α for postoperative dry eye was evaluated by receiver operating characteristic curve(ROC). Results Compared with the good recovery group, the levels of IL-1β, IL-20 and TNF-α were higher in the dry eye group before the surgery, BUT and SIt were lower, and CFL score was higher, with statistical significance(P<0.05). The level of IL-1β in tears was negatively correlated with BUT and SIt(r=-0.564,-0.627, P<0.05), and positively correlated with CFL(r=0.542, P<0.05); the level of IL-20 in tears was negatively correlated with BUT and SIt(r=-0.575,-0.645, P<0.05), and positively correlated with CFL(r=0.561, P<0.05); the level of TNF-α in tears was negatively correlated with BUT and SIt(r=-0.557,-0.630, P<0.05), and positively correlated with CFL(r=0.552, P<0.05). The dry eye group combined with diabetes, palpebral fat viscosity grade>2, conjunctival laxity grade 3 proportion were higher than good recovery group, the differences between groups were statistically significant(P<0.05). ROC curve results showed that the combined levels of IL-1β, IL-20 and TNF-α in tears predicted postoperative dry eye sensitivity and AUC were 91.50% and 0.915 respectively, which were higher than those of IL-1β(83.80%, 0.854), IL-20(84.50%, 0.858) and TNF-α(87.20%, 0.865) alone. Conclusion The dry eye after cataract surgery is closely related to the levels of IL-1β, IL-20 and TNF-α in tears, and the combination of IL-1β, IL-20 and TNF-α has a good effect in predicting dry eye after cataract surgery, which provides a reference basis for early prevention of dry eye after cataract surgery.