糖尿病视网膜病变患者干眼发生率及原因探讨

目的 观察糖尿病视网膜病变患者发生干眼的情况,并探讨造成干眼的原因.方法 收集2016年1月1日至10月1日在广州军区广州总医院内分泌科确诊为2型糖尿病患者共72例144眼.根据视网膜造影评估的糖尿病视网膜病变程度分组,A组:增殖期糖尿病视网膜病变40例,B组:非增殖期糖尿病视网膜病变32例;另以同期健康体检者36例为对照组(C组).对比各组间主观症状、Schirmer I test(S I T)、非侵入性泪膜破裂时间(non-invasive break-up time,NIBUT)、脂质层分级、印迹细胞的差异.结果 糖尿病患者干眼发生率为61.1％,非增殖期糖尿病视网膜病变患者干眼的发生率为50.0％,增殖期糖尿病视网膜病变患者干眼的发生率为70.0％,非增殖期糖尿病视网膜病与干眼发生有相关性(OR=17.00),而增殖期糖尿病视网膜病变患者与于眼发生呈明显正相关(OR=57.29);眼表疾病指数(ocular surface disease index,OSDI)问卷得分A组为(64.32±1.00),B组为(28.45 ±1.10),C组为(13.54 ±0.90),各组两两比较差异有统计学意义(P ＜0.001).A组NIBUT为(5.90 ±2.28)s,B组为(7.58±2.15)s,C组为(11.55 ±2.25)s,各组两两比较差异有统计学意义(P＜0.001);A组SIT为(7.75 ±2.03) mm,B组为(8.75±1.98)mm,C组为(10.78±2.21)mm,A、B两组与C组相比差异有统计学意义(P=0.016,P＜0.001);A组杯状细胞数为(59.00±5.18)个,B组为(67.50±3.93)个,C组为(80.94±8.87)个,各组两两比较差异有统计学意义(P＜0.001).结论 糖尿病患者较正常人易发生干眼,增殖期糖尿病视网膜病变患者较非增殖期糖尿病视网膜病变干眼症状明显,泪膜功能稳定性下降,容易造成眼部干涩异物感.

Incidence and etiological analysis of dry eye in diabetic retinopathy patients

Objective To observe the incidence and clinical presentation of dry eye in patients with diabetic retinopathy, and analyze the possible causes.Methods A total of 72 patients (144 eyes) with type 2 diabetes mellitus admitted in the endocrinological department of the General Hospital of Guangzhou Military Command from January 1 to October 1,2016 were recruited in this study.According to the severity of diabetic retinopathy by retinography, they were divided into proliferative diabetic retinopathy group (PDR, n =40)and non-proliferative diabetic retinopathy group (NPDR, n =32), and another 36 health individuals served as normal control.Subjective symptoms, results of Schirmer I test (S I T), non-invasive tear film break-up time (NIBUT), lipid layer classification and impression cytology were compared among the 3 groups.Results Among the 72 diabetic patients, the total incidence rate of dry eye was 61.1％, and the incidence was 50.0％ for the NPDR group and 70.0％ for the PDR.Dry eye was associated with NPDR (OR =17.00), and positively correlated with PDR (OR =57.29).The score of ocular surface disease index (OSDI) questionnaire was 64.32 ± 1.00, 28.45 ± 1.10 and 13.54 ± 0.90, respectively, for the PDR group, NPDR group and healthy subjects, with significant difference between any 2 groups (P ＜ 0.001).NIBUT was 5.90 ± 2.28, 7.58 ±2.15 and 11.55 ±2.25 s, respectively in the above 3 groups (P ＜0.001).The results of S I T was 7.75 ±2.03, 8.75 ± 1.98 and 10.78 ± 2.21 mm, respectively, with significant differences in PDR group and NPDR group with the control group (P =0.016, P ＜ 0.001).The number of goblet cells were 59.00 ± 5.18, 67.50 ± 3.93 and 80.94 ± 8.87, respectively (P ＜ 0.001).Conclusion The diabetic patients are prone to dry eye than healthy individual.The PDR patients have more obvious dry eye symptoms than the NPDR patients, with declined stability of tear film and thus susceptible to eye dryness and foreign body sensation.