季节性过敏性结膜炎对糖尿病患者眼表影响的临床研究

目的探讨季节性过敏性结膜炎(SAC)对糖尿病患者眼表的影响。 方法选取2019年2月至2019年8月于南京大学医院眼科就诊的糖尿病患者80例(160只眼)。其中，男性49例，女性31例；年龄41~76岁，平均年龄(58.5±8.2)岁。SAC发作期的糖尿病患者40例(80只眼)为观察组；糖尿病常规眼科体检者40例(80只眼)为对照组。观察并记录患者发作时与病情缓解后的眼表疾病指数(OSDI)、泪液分泌量(SⅠt)、泪河线高度(TMH)、泪膜破裂时间(BUT)、角膜荧光素染色(FL)及睑板腺综合评分，并以均数±标准差表示。观察组与对照组患者发作期和缓解期眼表各相关参数的比较，采用单因素方差分析；各参数的相关性，采用Spearman非参数检验。 结果两组患者性别的比较，差异无统计学意义(χ²＝0.891，P>0.05)；两组患者年龄、糖尿病病程、空腹血糖、糖化血红蛋白、最佳矫正视力及眼压的比较，差异无统计学意义(t＝0.925，1.218，0.787，1.014，0.962, 1.231；P>0.05)。观察组发作期患者的OSDI、BUT、FL及睑板腺综合评分分别为(44.79±17.26)、(5.47±2.30)s、(1.45±1.13)及(3.75±2.20)，对照组分别为(28.49±9.18)、(10.39±3.66)s、(0.98±0.80)及(2.83±1.95)，差异有统计学意义(F＝36.387、14.015、4.293，6.011；P<0.05)。与对照组相比，观察组发作期糖尿病患者的OSDI、FL及睑板腺综合评分增高，但BUT缩短。两组患者OSDI、FL、睑板腺综合评分及BUT的比较，差异均有统计学意义(t＝9.386，8.230，5.795，-6.016；P<0.05)。经治疗缓解后，各项相关参数有所改善，OSDI和睑板腺综合评分仍高于对照组，BUT低于对照组。观察组缓解期患者的OSDI、睑板腺综合评分及BUT分别为(35.89±10.76)、(1.10±0.84)及(8.40±3.72)s，差异有统计学意义(t＝4.587，3.840，-6.233；P<0.05)。两组患者SⅠt和TMH的比较，差异无统计学意义(F＝2.185，1.214；P>0.05)。观察组发作期糖尿病患者的OSDI与SⅠt、TMH及BUT呈负相关。经Spearman相关分析，其相关性有统计学意义(r＝-0.652，-0.640，-0.343；P<0.05)。OSDI与FL和睑板腺综合评分呈正相关。经Spearman相关分析，其相关性有统计学意义(r＝0.679，0.817；P<0.05)。SⅠt与TMH呈正相关。经Spearman相关分析，其相关性有统计学意义(r＝0.745，P<0.05)。BUT与FL和睑板腺综合评分呈负相关。经Spearman相关分析，其相关性有统计学意义(r＝-0.521，-0.559；P<0.05)。观察组SAC缓解期糖尿病患者的OSDI与TMH和BUT呈负相关。经Spearman相关分析，其相关性有统计学意义(r＝-0.321，-0.398；P<0.05)。OSDI与睑板腺综合评分呈正相关。经Spearman相关分析，其相关性有统计学意义(r＝0.272，P<0.05)。SⅠt与TMH呈正相关。经Spearman相关分析，其相关性有统计学意义(r＝0.799，P<0.05)。BUT与FL和睑板腺综合评分呈负相关。经Spearman相关分析，其相关性有统计学意义(r＝-0.697，-0.602；P<0.05)。 结论SAC对糖尿病患者眼表的OSDI、FL、BUT及睑板腺综合评分均有影响，但对SⅠt及TMH的影响不大；SAC缓解期患者眼表的OSDI、BUT及睑板腺综合评分恢复较慢；OSDI与SⅠt、TMH、BUT、FL及睑板腺综合评分等眼表相关参数有着良好的一致性。

Effects of seasonal allergic conjunctivitis on ocular surface in diabetes mellitus patients

ObjectiveTo analyze the effects of seasonal allergic conjunctivitis (SAC) on the eye surface of diabetes mellitus patients. Methods80 patients (160 eyes) who visited the Department of Ophthalmology, Nanjing University Hospital from February 2019 to August 2019 were selected. There were 49 males and 31 females, aged 41 to 76 years-old, with average age (58.5±8.2) years-old. 40 diabetic patients (80 eyes) diagnosed with active SAC were included in the observation group; 40 diabetic patients (80 eyes) with routine ophthalmic examination were included in the control group. Ocular surface diseases index (OSDI), Schirmer Ⅰ test (SⅠt), tear meniscus height (TMH), tear break-up time (BUT), fluorescein staining test (FL) and meibomian gland comprehensive score were observed and recorded at onset and after remission. All data was represented by Mean±SD. One-way analysis of variance was used to compare the ocular surface related parameters during onset and remission in the observation group with those in the control group, and Spearman test was used to correlate the parameters of each group. ResultsThere was no significant difference in gender (χ²=0.891, P>0.05)and in age, duration of diabetes, fasting blood glucose, glycosylated hemoglobin, best corrected visual acuity and intraocular pressure between two groups (t=0.925, 1.218, 0.787, 1.014, 0.962, 1.231; P>0.05). The OSDI, BUT, FL and meibomian gland composite scores of diabetic patients in SAC onset period were (44.79±17.26), (5.47±2.30) s, (5.47±2.30), (3.75±2.20), respectively; these dices of control group were (28.49±9.18), (10.39±3.66) s、(0.98±0.80), (2.83±1.95), respectively. After one-way analysis of variance, there were significant differences in OSDI, BUT, FL and meibomian gland composite scores between two groups of patients (F=36.387, 14.015, 4.293, 6.011; P<0.05). Compared with the control group, the OSDI, FL and meibomian gland scores of diabetic patients in SAC onset period were increased, but BUT was decreased with statistical significance difference between two groups (t=9.386, 8.230, 5.795, -6.016; P<0.05). After treatment and remission, various indicators were improved; OSDI and meibomian gland scores were still higher than the control group, but BUT was lower than the control group. OSDI, meibomian gland scores and BUT of patients′were (35.89±10.76), (1.10±0.84) and (8.40±3.72) s, respectively with statistical significance difference between two groups (t=4.587, 3.840, -6.233; P<0.05). There was no significant difference in the comparison of SⅠt and TMH between two groups of patients (F=2.185, 1.214; P>0.05). Spearman correlation analysis showed that in diabetes mellitus patients with SAC in onset in the observation group, OSDI was negatively correlated with SⅠt, TMH and BUT with statistical significance difference (r=-0.652, -0.640, -0.343; P<0.05); positively correlated with FL and meibomian gland scores with statistical significance difference (r= 0.679, 0.817; P<0.05). SⅠt was positively correlated with TMH with statistical significance difference (r= 0.745, P<0.05). BUT was negatively correlated with FL and meibomian gland comprehensive scores with statistical significance difference (r=-0.521, -0.559; P<0.05). In diabetes mellitus patients with SAC in remission in the observation group, OSDI was negatively correlated with TMH and BUT with statistical significance difference (r=-0.321, -0.398; P<0.05); and positively correlated with meibomian gland scores with statistical significance difference (r=0.272, P<0.05). SⅠt was positively correlated with TMH with statistical significance difference (r=0.799, P<0.05). BUT was negatively correlated with FL and meibomian gland comprehensive score with statistical significance difference (r=-0.697, -0.602; P<0.05). ConclusionsSAC had an effect on OSDI, FL, BUT and meibomian gland score in DM patients. but has little effect on SⅠt and TMH. OSDI, BUT and meibomian gland score recover slowly in remission stage of SAC; OSDI was in good agreement with ocular surface parameters such as SⅠt, TMH, BUT, FL and meibomian gland comprehensive score.