Correlation Between Tear LTA Level And Conjunctival Goblet Cells Density In Dry Eye Patients

Purpose:To analyse the relationship among tear lymphotoxin-α(LTA)level,conjunctival goblet cell density and other ocular surface related parameters in dry eye patients,and to explore the diagnostic value of LTA level and conjunctival goblet cell density in dry eye disease.Methods:A total of 98 tear samples from 98 dry eye patients and control group were collected to detect LTA concentrations.The confocal microscope was used for measuring conjunctival goblet cell density.And other examination were completed including the Chinese Dry Eye Questionnaire survey,slit lamp microscopy,Keratograph ocular surface comprehensive analyzer and Schirmer I test.Spearson’s test and LTA correlated univariate analysis were used for variables.The GAM model was used to explore the correlation between LTA level and goblet cell density through smooth curve fitting,and then we further performed a multiple piecewise linear regression model to find the best inflection point of the curve.Finally we performed ROC analysis to evaluate diagnostic value of LTA level and conjunctival goblet cell density for predicting dry eye disease.Results:There were significant differences in the Chinese Dry Eye Questionnaire scores,tear film break-up time and corneal staining scores between the control group,mild dry eye group,and moderate-to-severe dry eye group(P<0.05).The goblet cell density in dry eye group(including mild and moderate-to-severe groups)[54.70[24.38-126.50]]was significantly lower than the control group[125.80[72.75-180.00]](P<0.05);The LTA level in dry eye group[0.17[0.05-1.18]]was also lower than the control group[0.30[0.13-1.32]],although there was no significant difference between the two groups.LTA level was positively correlated with BUT(Spearson’s test:r=0.262,p<0.01;univariate analysis:β=0.27,p=0.001);Goblet cell density was curvilinearly related to LTA,when LTA<1.47 ng/ml,the Goblet cell density was positively correlated with LTA(P=0.004);Dry eye diagnostic test:the area under the ROC curve of LTA level was 0.57±0.08,the cutoff was 0.11 ng/ml,and the sensitivity was 41.03%,and the specificity was 80.00%;The area under the ROC curve of conjunctival goblet cell density was 0.70±0.06,the cutoff was 67.90 cells/mm~2,the sensitivity was59.15%,and the specificity was 82.35%;the LTA level in the high goblet cell density group(LTA=0.440[0.135,1.633])was significantly higher than the low goblet cell density group(LTA=0.097[0.040-0.685])(P<0.05).Conclusion:LTA level was significantly positively correlated with goblet cell density.LTA was valuable in the evaluation of tear film stability and dry eye diagnosis,but more evidence was needed.And the value of conjunctival goblet cells in the diagnosis of dry eye was also worthy of attention.