目的：探究干眼症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~2024年6月104例在本院就诊的干眼症患者（疾病组）以及本院体检的100名健康者（对照组），分析研究对象结膜上皮细胞及泪液TLR4、NF-κB的变化，Pearson分析结膜上皮细胞及泪液中TLR4、NF-κB表达的相关性；Logistic分析影响患干眼症的因素；ROC分析结膜上皮细胞及泪液中TLR4、NF-κB表达对干眼症的诊断价值。结果：疾病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（P<0.05）。结膜上皮细胞和泪液中TLR4与NF-κB皆为正相关（r=0.392、0.348，P<0.05）。疾病组与对照组使用滴眼液情况、BUT值、SIT值、TFT、CFS评分差异具有统计学意义（χ2/t=9.525、29.069、38.498、21.722、27.487，P<0.05）。频繁使用滴眼液、CFS评分、TLR4、NF-κB是患干眼症的危险因素（OR=2.153、3.183、1.578、2.452，P<0.05），BUT值、SIT值、TFT是患干眼症的保护因素（OR=0.654、0.755、0.276，P<0.05）。结膜上皮细胞中TLR4联合NF-κB诊断干眼症的敏感性、特异性、AUC分别为86.54%、81.00%、0.889，结膜上皮细胞中TLR4、NF-κB两者联合对干眼症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诊断干眼症的敏感性、特异性、AUC分别为82.69%、70.00%、0.818，泪液中TLR4、NF-κB两者联合对干眼症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：干眼症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与干眼症疾病的发展有关，两者升高增加患干眼症的风险，TLR4联合NF-κB对干眼症有一定诊断意义。

Objective: 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 syndrome. Methods: From January 2023 to June 2024, 104 dry eye patients (disease group) who visited our hospital and 100 healthy individuals (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 syndrome. ROC was applied to analyze the diagnostic value of TLR4 and NF-κB expression in conjunctival epithelial cells and tears for dry eye syndrome. Results: The expression levels of TLR4 and NF-κB in conjunctival epithelial cells and tears in the disease group were obviously higher than those in the control group (P<0.05). There was a positive correlation between TLR4 and NF-κB in conjunctival epithelial cells and tears (r=0.392, 0.348, P<0.05). The differences in the use of eye drops, BUT value, SIT value, TFT, and CFS scores between the disease group and the control group were statistically significant (χ2/t=9.525, 29.069, 38.498, 21.722, 27.487, P<0.05). Frequent use of eye drops, CFS score, TLR4, and NF-κB were risk factors for dry eye syndrome (OR=2.153, 3.183, 1.578, 2.452, P<0.05), while BUT value, SIT value, and TFT value were protective factors for dry eye syndrome (OR=0.654, 0.755, 0.276, 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 in conjunctival epithelial cells had higher diagnostic value for dry eye than alone diagnosis (Z combination - TLR4=3.506, P=0.001, Z combination - NF-κB=3.165, P=0.002). The sensitivity, specificity, and AUC of TLR4 combined with NF-κB in tears for diagnosing dry eye syndrome 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 syndrome than alone diagnosis (Z combination - TLR4=3.117, P=0.002, Z combination - 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 syndrome are elevated. TLR4 and NF-κB are related to the development of dry eye syndrome, and The increase in both can increase the risk of developing dry eye syndrome. The combination of TLR4 and NF-κB has certain diagnostic significance for dry eye syndrome.