2型糖尿病患者眼表改变的临床分析

目的观察2型糖尿病患者角膜知觉、泪液分泌等眼表改变，及激光共焦显微镜下角膜上皮、神经纤维组织形态学变化，探讨2型糖尿病患者角膜病变的可能机制。方法前瞻性病例对照研究。选取2型糖尿病患者108例，依据眼底情况分为无眼底改变（NDR）组42例（59眼））和增殖性糖尿病性视网膜病变（PDR）组66例（86眼）1；选取无全身及眼部疾病的健康体检者（性别、年龄匹配）33例作为对照组。对所有研究对象均进行角膜敏感度测定、基础泪液分泌试验，泪膜破裂时间（BUT）、泪膜分析、角膜荧光素染色及激光共焦显微镜检查。分别对相关数据进行单因素方差分析、卡方检验、Spearman等级相关分析。结果NDR组除泪膜分析结果（大于等于Ⅲ级者占32％）与对照组（14％）的差异有统计学意义外（p，0．01），其他观察项目均无统计学意义。PDR患者角膜敏感度为（33．0±12．4）mm，低于对照组的（47．2±9．7）mm（P〈0．01）；泪液分泌量为（11．8±4．2）mm，少于对照组的（15．2±4．3）mm（P〈0．011；BUT值为（7．3±2．5）s，低于对照组的（13．7±4．0）s（P〈0．01）；泪膜脂质层光干涉图像为Ⅲ级及以上者占50％，高于对照组的14％（P〈0．01）；角膜荧光染色阳性者占74％，高于对照组的8％（P〈0．01）；角膜上皮细胞密度为（4407±480）个／mm^2，小于对照组的（4736±313）个／mm^2（P〈0．01）；角膜神经纤维密度为（898±153）Ixm／视野。低于对照组的（1231＋176）txm／视野（P〈0．05）。且随糖尿病患病时间的延长，角膜敏感度下降fr=0．657，P=0．020）、角膜荧光素染色增多（rm=-0．460，P=0．012）、角膜神经纤维密度减少（r=-0．473，P=-0．020）。结论NDR患者角膜会出现轻度改变，应引起注意，需定期检查；PDR患者角膜已发生明显改变．应积极诊治。

Clinical analysis of ocular surface abnormalities in type 2 diabetes

Objective To record and analyze the changes in the ocular surface and cornea in diabetic patients using a battery of ophthalmic tests and high resolution laser scanning confocal microscopy. Methods Prospective case control study. One hundred and eight patients with type 2 diabetes and 33 normal people (controls) were enrolled in this study. Based on the classification stages of diabetic retinopathy, patients were divided into 2 groups, those 42 patients (59 eyes) with non-diabetic retinopathy (NDR) and 66 patients (86 eyes) with proliferative diabetic retinopathy (PDR). All patients were examined using corneal sensitivity measurements, Schirmer's I test,non-invasive tear film break-up time (BUT), and corneal fluorescein staining. The testing regime also included DR-1 tear film interferometer camera and corneal confocal microscopy examinations.Parameters among groups were analyzed with a one-way ANOVA, a chi-square test and Spearman's rank correlation analysis. Results There was a significant difference between the NDR group (32％ were equal to or greater than grade Ⅲ) and the control group (14％) in the tear film test (P＜0.01). Corneal sensitivity was significantly lower in the PDR group (33.0±12.4)mm] than in the control group (47.2±9.7)mm] (P＜0.01). Tear secretion was (11.8±4.2)mm in the PDR group, and (15.2 ±4.3)mm in the control group. The difference between the two groups was statistically significant (P＜0.01). Tear film BUT was significantly shorter in the diabetic group (7.3±2.5)s] than in the control group (13.7±4.0)s] (P＜0.01). There was a sgnificant difference between the PDR group (50％ were equal to or gerater than grade Ⅲ) and the control group (14％) in the tear tim test (P＜0.01). Seventy-four percent patients were positive in PDR group in corneal fluorescein staining, much higher than control group (8％) (P＜0.01). Densities of corneal epithelium and corneal nerve fiber were all significantly lower in the PDR group (4407±480)/mm2, (898±153)μm/field] than in the control group (4736±313)/mm2, (1231±176)μm/field], respectively (P＜0.05 in both comparisons). The longer the duration of diabetes, the more serious the decrease in corneal sensitivity (r=-0.657, P=0.020) and the more corneal fluorescein staining (r=0.460, P=0.012) and the less corneal nerve fiber (r=-0.473, P=0.020). Conclusion Ocular surface disorders and retinopathies are common among diabetic patients. The results presented demonstrate significant degrees of corneal damage, especially in the PDR group. The ocular surfaces of PDR patients should be examined regularly to aid in early diagnosis and treatment.