陨灶贼允韵责澡贼澡葬造皂燥造熏灾燥造援 5熏晕燥援 3熏 Jun.18, 圆园12 www.IJO.cn 栽藻造押8629原愿圆圆源缘员苑圆 8629-83085628 耘皂葬蚤造押ijopress岳员远猿援糟燥皂 窑ClinicalResearch窑 Comparative study of bacterial status from conjunctivalsacoftheelderQiangminorityand HanpeoplewithdryeyeinSichuan,China Foundation item: SichuanProvincialHealthMinistry sac,orthecompositionofbacteriaspeciesandstrains,orthe ResearchFund,China(No.080302) compositionof betweentwoethnic 1DepartmentofOphthalmology, SichuanAcademyof populations. MedicalSciencesandSichuanProvincialPeople'sHospital, ·CONCLUSION:Therewasnosignificantdifferenceofbacterial Chengdu610072,SichuanProvince,China positiverateinconjunctivalsacfromtheelderofQiang 2 MianyangWanjiangOphthalmologicHospital,Mianyang minorityandHanpeoplewithdryeye,butthespeciesof 621000,SichuanProvince,China bacteriaweredifferent. 3DepartmentofClinicalLaboratory,SichuanAcademyof ·KEYWORDS:conjunctivalsac;bacteria;dryeye MedicalSciencesandSichuanProvincialPeople'sHospital, DOI:10.3980/j.issn.2222-3959.2012.03.18 Chengdu610072,SichuanProvince,China 4 HospitalofTraditionalChineseMedicineAffiliatedto Luzhou Medical College, Luzhou 646000,Sichuan ZhangY,LiuZR,ChenH,DongWJ,FanYC,YuH,WangGJ,Li Province,China YC,CaoK.Comparativestudyofbacterialstatusfromconjunctival sacoftheelderQiangminorityandHanpeoplewithdryeyein 5TheFourthPeople'sHospitalofZigongCity.Zigong Sichuan,China. 2012;5(3):343-347 643000,SichuanProvince,China Correpondenceto: YueZhang.DepartmentofOphthalmo- logy,SichuanAcademyofMedicalSciencesandSichuan INTRODUCTION ryeyeisacommondiseaseinthemiddleageand ProvincialPeople'sHospital,Chengdu610072,Sichuan elderpeople,especiallyintheelderwomenwhois Province,[email protected] D Received:2011-08-23Accepted:2012-05-15 susceptibletotheenvironmentfactors.Therearesome normalfloraexistedintheconjunctivalsac,whichis exposedtotheoutsideandsusceptibletoenvironmental Abstract factors.Fewreportsinchinacanbefoundaboutthe ·AIM:Tocomparethestatusofbacteriaintheconjunctival relationshipbetweendryeyeandconjunctivalsac,andthere sacfromtheelderQiangminorityandHanpeoplewithdry isnoreportonthebacteriastatusfromtheconjunctivalsac eyesinSichuan,China. ofethnicminoritypeopleinChina,neitherfromethnic ·METHODS:Totalof54elderQiangpeoplewithdryeyes Qiangminority(oneofthe55minoritiesinChina).Qiang (108eyes)wereexaminedbyclustersampling.Inthesimilar minoritywithapopulationofabout200000aremainlyin habitationregionofHanpeople,80(160dryeyes)Han theupperreachesofMinjiangRiverinSichuanAbaTibetan peoplewereanalyzedasthecontrolgroup.Thebacteriawas andQiangAutonomousregion(includingPrefectureof separatedfromtheinferiorpalpebralconjunctiva,then Maoxian,Wenchuan,LiCounty,Blackwater,Songpan)and inoculatedonbloodplatefor48hoursandidentified. BeichuanQiangAutonomousCountyinMianyangCity. ·RESULTS:Totally24strainsofbacteriawereculturedin Amongthoseareas,BeichuanQiangAutonomousCountyin eitherQiangminorityorHancpopulationswith3strainsof MianyangCityisthelargestregionfortheQiangminority themexistedinbothethnicgroups.Thecommonestbacteria settlements. inconjunctivalsacintwoethnicgroupswerenon-pathogenic Itisunknownwhetherthedifferentethnicpeoplewithdry bacterium.Thecompositionof inHan eyewillexhibitadifferentbacteriastateintheconjunctival people(54.1%)wassignificantlyhigherthanthatinQiang minority(27.4%)( 2=11.6721, =0.0006).Thepercentage sacornot.Thepurposeofthestudyistocomparethe of inQiangpeoplewashigher bacteriaintheconjunctivalsacbetweentheelderQiang thanthatinHanpeople( 2=18.6442, =0.0000).However, minorityandHanpopulationwithdryeyeinMianyangcity, therewasnosignificantdifferencebetweenQiangminority Sichuan,China.However,asinQiangminorityareathe andHanpeopleeitherinbacterialpositiverateinconjunctival proportionofHanpeopleisquitelow,wehavetoselectthe 343 BacterialstatusfromconjunctivalsacofQiangminorityandHanpeople HanpeopleinFuchengdistrictofMianyangcity,foritis Theparticipantsunderwenteyeexaminations,which thenearestareatoBeichuanQiangAutonomousCountyand includedmeasurementofbest-correctedvisualacuity, showsasimilargeographicandenvironmentconditionto observationforsignsofdryeyes,slit-lampassessmentof Beichuan.Inthisstudy,thebacteriaintheconjunctivalsac anteriorsegmentandlens,andfundusevaluation. fromtheelderpeopleofQiangminorityandHanwere Ophthalmologistsconductedtheeyeexaminationsaccording compared. toastandardizedprotocol.Thedryeyeexaminations MATERIALSANDMETHODS includedBUT,FSS,Schirmertest(ST)andslit-lamp Subjects IntheearlyNovember,2009,theclusterrandom assessmentofanterior segment.Theophthalmologists samplingmethodwasusedinBeichuanQiangAutonomous performingtheeyeexaminationsweremaskedastodryeye CountyandMianyangFuchengDistrict.TheelderQiang informationfromthequestionnaire.Allthesurveyed minority(over40yearsold) in BeichuanQiang participantshadnohistoryoftopicaluseofantibioticseye AutonomousCounty,Mianyangcitywassurveyedand dropswithinthreedays. comparedwiththeelderHanpeoplewithdryeyein Schirmer test A5mm 35mmfilterstrip(Tianjin 玉 伊 FuchengDistrict,Mianyangcity. JingmingNewTechnologicalDevelopmentCo.,Ltd., Methods Tianjin,China,rangeofwettingwasfrom0-30mm)was Samplingmethods Beforethesurvey,wegotthefull thenplacedtemporallyinbotheyesfor5minutes.The supportsfrom localgovernments andcorrelated participantwasencouragedtoclosehis/hereyesbutallowed constitutions.Thestandardtrainingwasgivenforoneweek toblinknormally.After5minutes,thestripwasremoved, totheteamhowtocarryonthesaccusconjunctivasecretion andtheamountofwettingwasrecorded.Tearsoakedfilter selectionvaccinationbythespecialistfromlaboratory paperwetlength<10mm,suspectedpositivefordryeye; medicinedepartment.Thepilotstudywasconductedoutside <5mmispositive. thestudyarea.Totally216individualsfromanothercounty BUT BUTwasmeasuredbyapplyingaslightlymoistened nearbywereexaminedandtheresultswereexcludedfrom fluorescentstriptotheinferiorfornixwhiletheparticipant thisstudy.Pilottestingshowedthatthequestionnairewas lookedup.Theparticipantwasaskedtoblinkseveraltimes easilyadministered,understandable,andculturallyacceptable. andthenholdtheeyesopen.Thetearfilmwasthen Ateamofophthalmologists,administrativepersonnel,and examinedwiththeaidofthecobaltbluefilterontheslit enumeratorsfromthevillagesandthemedicalworkersof lampwhiletheparticipantrefrainsfromblinking.Thetime thetownshipclinics(theyalsoactedastranslators) thatelapsesbeforethefirstdryspotorlineappearsinthe performedthedatacollection.Theteamwasequippedwith cornealfluorescentlayeristhetearfilmbreakuptime.BUT twovehicles,SnellenEchart,twoslitlampmicroscopes(66 wasrepeatedthreetimesforeacheye,andtheaveragetime Vision-TechCo.,Suzhou,YZ-5E,Crane,China),a wasrecorded. binocularindirectophthalmoscope(Keeler,Windsor,UK) FSS Thefluorescentsodiumpaperwasplacedinthe withaVolk20Dlens,aPerkinshand-heldtonometer conjunctivalsacandthecornealstainingsituationwas (Clement-Clarke Ltd.,Essex, UK),andtwopower examinedundertheslit-lamp.Thegradingmethodwas generatorsforlocationswithoutelectricity. stipulatedas0:nostaining;1:1-5spotsstaining;2:5-10 ThequestionnaireofLü [1] wasusedinthisstudy.A spotsstaining;3:morethan10spotsstainingineach doortodoorvisitwasmadebytheteamandaquestionnaire quadrant.Andeachquadrantstainingwasclassified wascompletedaboutdemographicdata(name,age,gender, moderate,mediumandsevere3level. locality,economicsituation,medicalhistory,and Withthe education),lifestyle (smoking,alcoholintake),anddryeye Conjunctivalsecretioncollectionandculture symptoms.Thequestionsregardingdry-eyesymptoms platinumwireloops,theconjunctivalsecretionwastakento consistedofsixitems:(1)Didyoureyeseverfeeldry?(2) inoculateonthebloodagarculturemedium(AnTulv Didyoueverfeelagrittyorsandysensationinyoureyes? Bio-engineeringLimitedCompany,Zhengzhou,China).The (3)Didyoureyeseveryhaveaburningsensation?(4)Were secretionwasculturedat35℃ for48hours.Ifthe youreyeseverred?(5)Didyounoticemuchcrustingon microorganismwasfoundfromtheculture,thenitwas yourlashes?(6)Didyoureyesevergetstuckshut? furthervaccinatedandseparatedbybloodagarculture Participantswhoreportedoneormoreofthesixdryeye medium.Thedetectionandidentificationofmicroorganism symptomsoftenorallthetimewereidentified. wasdoneinthelabdepartmentofSichuanProvincial Dryeyecriteriaandeyeexamination Criterionofdry People'sHospitalthroughVITEK2-compactautomatic eye [2] includes:Patient'ssymptomofdryeye,positive microorganismanalyzer,ontheEgyptianAPIappraisal SchirmerItest(5mm/5min)；positivetear-filmbreakuptime board. test(BUT) (<10s)曰positivecornealfluorescentstaining StatisticalAnalysis Thecollecteddatawereenteredintoa score(FSS)(score>1).Thepatientwasdiagnosedasdryeye computerprocessingsystembydesignatedprofessionals withanyoftheabovesymptoms,twopositivetestsand performingthesametaskstoensureconsistency.SPSS medicalhistory. Version15.0 (StatisticalPackageforSocialSciences,Inc, 344 陨灶贼允韵责澡贼澡葬造皂燥造熏灾燥造援 5熏晕燥援 3熏 Jun.18, 圆园12 www.IJO.cn 栽藻造押8629原愿圆圆源缘员苑圆 8629-83085628 耘皂葬蚤造押ijopress岳员远猿援糟燥皂 Chicago,Illinois,USA)wasusedforstatisticalanalysis. < Table 1 Percentage of bacterial positive culture from 0.05wasconsideredtobestatisticallysignificant.The conjunctiva in Qiang and Han people with dry eye Groups n Positive Negative Positive rate % positiverateandthecompositionwerecomparedby Qiang 108 62 46 57.4 Chi-squaretest.Thekindsofbacteriawereanalyzedby Han 160 98 62 61.2 Wilcoxonranksumtest. Total 268 160 108 59.7 RESULTS 2 DemographicInformation Dryeyewasdiagnosedin54 X = 0.396, P =0.529. patients （108eyes）outof210Qiangminoritypersons Table 2 Composition of single bacteria and multi-bacteria in surveyedinthisstudyandconjunctivalsecretionwas the saccus conjunctival from Qiang and Han with