目的：探究干眼患者结膜上皮细胞及泪液中Toll样受体4(TLR4)、核因子κB(NF-κB)的表达情况及临床诊断价值。方法：选择2023年1月至2024年6月在本院就诊的干眼患者(干眼组，104例104眼)以及本院体检的健康者(对照组，100名100眼)，分析参与者结膜上皮细胞及泪液中TLR4、NF-κB的变化，Pearson分析结膜上皮细胞及泪液中TLR4与NF-κB表达的相关性； Logistic分析影响干眼患病的因素； ROC分析结膜上皮细胞及泪液中TLR4、NF-κB表达对干眼的诊断价值。结果：干眼组与对照组使用滴眼液情况、泪膜破裂时间(BUT)、泪液分泌试验(SⅠt)、泪膜厚度(TFT)、角膜荧光素染色(CFS)评分具有差异(均P<0.01)。干眼组结膜上皮细胞及泪液中TLR4、NF-κB表达水平皆显著高于对照组(均P<0.01)。干眼组结膜上皮细胞和泪液中TLR4与NF-κB均正相关(r=0.392、0.348，均P<0.05)。频繁使用滴眼液、CFS评分、TLR4、NF-κB是患干眼的危险因素(OR=2.153、3.183、1.578、2.452，均P<0.05)，BUT值、SⅠt值、TFT是患干眼的保护因素(OR=0.654、0.755、0.276，均P<0.05)。结膜上皮细胞中TLR4联合NF-κB诊断干眼的敏感性、特异性、AUC分别为86.54%、81.00%、0.889，TLR4、NF-κB两者联合对干眼的诊断比单独诊断价值高(Z两者联合-TLR4=3.506，P=0.001； Z两者联合-NF-κB=3.165，P=0.002)。泪液中TLR4联合NF-κB诊断干眼的敏感性、特异性、AUC分别为82.69%、70.00%、0.818，TLR4、NF-κB两者联合对干眼的诊断比单独诊断价值高(Z两者联合-TLR4=3.117，P=0.002； Z两者联合-NF-κB=2.363，P=0.018)。结论：干眼患者结膜上皮细胞及泪液中TLR4、NF-κB表达水平升高，TLR4与NF-κB与干眼疾病的发展有关，两者升高与干眼患病风险增加有关，TLR4联合NF-κB对干眼有一定诊断意义。

AIM: To investigate the expression and clinical diagnostic value of toll-like receptor 4(TLR4)and nuclear factor-κB(NF-κB)in conjunctival epithelial cells and tears of patients with dry eye.METHODS: From January 2023 to June 2024, 104 dry eye patients(104 eyes, disease group)who visited our hospital and 100 healthy individuals(100 eyes, control group)who underwent physical examination were selected. The changes of TLR4 and NF-κB in conjunctival epithelial cells and tears were analyzed. Pearson analysis was applied to analyze the correlation between TLR4 and NF-κB expression in conjunctival epithelial cells and tears. Logistic analysis was applied to analyze the factors that affected dry eye. ROC was applied to analyze the diagnostic value of TLR4 and NF-κB expression in conjunctival epithelial cells and tears for dry eye.RESULTS: The differences in the use of eye drops, tear film break-up time(BUT), Schirmer's test(SⅠt), tear film thickness(TFT), and corneal fluorescein staining(CFS)scores between the disease group and the control group were statistically significant(all P<0.01). The expression levels of TLR4 and NF-κB in conjunctival epithelial cells and tears in the disease group were significantly higher than those in the control group(all P<0.01). There was a positive correlation between TLR4 and NF-κB in conjunctival epithelial cells and tears(r=0.392, 0.348, all P<0.05). Frequent use of eye drops, CFS score, TLR4, and NF-κB were risk factors for dry eye(OR=2.153, 3.183, 1.578, 2.452, all P<0.05), while BUT, SⅠt, and TFT were protective factors for dry eye(OR=0.654, 0.755, 0.276, all P<0.05). The sensitivity, specificity, and AUC of TLR4 combined with NF-κB in conjunctival epithelial cells in the diagnosis of dry eye were 86.54%, 81.00%, and 0.889, respectively. The combination of TLR4 and NF-κB had higher diagnostic value for dry eye than uncombined diagnosis(Zcombination-TLR4=3.506, P=0.001; Zcombination-NF-κB=3.165, P=0.002). The sensitivity, specificity, and AUC of TLR4 combined with NF-κB in tears for diagnosing dry eye were 82.69%, 70.00%, and 0.818, respectively. The combination of TLR4 and NF-κB in tears had higher diagnostic value for dry eye than uncombined diagnosis(Zcombination-TLR4=3.117, P=0.002; Zcombination-NF-κB=2.363, P=0.018).CONCLUSION: The expression levels of TLR4 and NF-κB in conjunctival epithelial cells and tears of patients with dry eye are elevated. TLR4 and NF-κB are related to the development of dry eye, and that elevated levels of both are associated with an increased risk of dry eye disease. The combination of TLR4 and NF-κB has a certain diagnostic significance for dry eye.