2型糖尿病患者的泪膜功能

目的评价2型糖尿病患者泪膜功能并探讨其影响因素.方法对111例2型糖尿病患者和100例健康对照者进行泪膜功能评价.2型糖尿病患者分别按年龄、糖尿病病程、血糖控制情况、眼底病变进行分组.分别进行眼干症状询问、泪膜破裂时间(BUT)测定、角膜荧光素染色、基础泪液分泌试验(Schirmer Ⅰ试验,SIt)和泪膜脂质层形态观察.根据上述检查结果进行干眼评分.结果2型糖尿病组的干眼评分(3.28±1.56)高于对照组(2.31±1.50,P＜0.01);BUT(6.50±4.84)s低于对照组(12.26±7.16)s(P＜0.01);SIt(10.61±6.86)mm与对照组(10.92±7.05)mm差异无显著性(P＞0.05).2型糖尿病组的干眼症患病率为19.8%,高于对照组8.0%(P＜0.05).对2型糖尿病患者按照眼底分为3组:无糖尿病性视网膜病变组、背景性糖尿病性视网膜病变组、增殖性糖尿病性视网膜病变组,3组的干眼评分分别为:2.95±1.50、3.38±1.48和4.11±1.60(P＜0.01);SIt分别为(10.95±6.89)mm、(11.71±7.30)mm和(7.63±5.20)mm(P＞0.05);BUT分别为(7.53±5.23)s、(5.88±4.10)s和(4.47±4.17)s(P＜0.05);对有眼底病变者分为已行激光治疗组和未行激光治疗组,两组的干眼评分分别为4.71±1.14和3.26±1.15(P＜0.01);BUT分别为(2.93±2.06)s和(6.26±4.36)s(P＜0.01);SIt分别为(7.21±6.51)mm和(11.33±6.73)mm(P＜0.05);出现角膜染色的比率分别为50.0%和17.9%(P＜0.05).干眼评分与眼底病变程度和是否行激光治疗有显著相关性(P＜0.01),与年龄、性别、胰岛素治疗、病程、血糖控制分组均无相关性(P＞0.05).结论2型糖尿病患者容易出现泪膜功能异常,其泪膜功能改变与糖尿病性视网膜病变和眼底激光治疗有相关性.

Tear film function of patients with type 2 diabetes

OBJECTIVE: To study the tear film function of patients with type 2 diabetes and to investigate the risk factors of dry eye in these patients. METHODS: Totally 111 patients with type 2 diabetes and 100 age- and sex-matched control subjects were studied. Tear film function was evaluated by dry eye syndrome, tear breaking up time (BUT), corneal fluorescein staining, Schirmer I test (SIt), and tear film lipid layer observation with tear scope. Dye eye score was calculated with the results of these tests. RESULTS: When compared with the controls, patients with type 2 diabetes showed higher dry eye score (diabetics 3.28 +/- 1.56, control 2.31 +/- 1.50, P < 0.01) and faster BUT diabetics (6.50 +/- 4.84) s, control (12.26 +/- 7.16) s, P < 0.01], but similar SIt diabetics (10.61 +/- 6.86) s, control (10.92 +/- 7.05) s, P > 0.05]. More diabetic patients were diagnosed as dry eye(diabetics 19.8%, control 8.0%, P < 0.05). According to their retinopathy, the diabetic patients were divided into three groups: without diabetic retinopathy (DR), with background DR, and with proliferative DR. For these three groups, the dry eye scores were 2.95 +/- 1.50, 3.38 +/- 1.48 and 4.11 +/- 1.60, respectively (P < 0.01); the SIt were (10.95 +/- 6.89) mm, (11.71 +/- 7.30) mm and (7.63 +/- 5.20) mm, respectively (P > 0.05); the BUT were (7.53 +/- 5.23) s, (5.88 +/- 4.10) s and (4.47 +/- 4.17) s (P < 0.05). Patients with DR were then devided into two groups: with photocoagulation and without photocoagulation. For these two groups, the dry eye scores were 4.71 +/- 1.14 and 3.26 +/- 1.15, respectively (P < 0.01); the BUT were (2.93 +/- 2.06) s and (6.26 +/- 4.36) s, respectively (P < 0.01); the SIt were (7.21 +/- 6.51) mm and (11.33 +/- 6.73) mm, respectively (P < 0.05); the rates of corneal fluorescein staining were 50.0% and 17.9%, respectively (P < 0.05). Dry eye score had a good correlation with diabetic retinopathy and photocoagulation (P < 0.01), but was poorly correlaed with age, gender, insulin, duration of diabetes mellitus, and metabolic control (P > 0.05). CONCLUSIONS: Patients with type 2 diabetes tend to develop tear film dysfunction. The disorders of tear film quantity and quality seem relevant to the stage of diabetic retinopathy and photocoagulation.