糖化血红蛋白(HbA1c)水平对2型糖尿病患者干眼症状及体征的影响

目的探讨糖化血红蛋白(HbA1c)水平对2型糖尿病患者干眼症状及体征的影响。方法选取2016年3月至2018年12月在我院内分泌科确诊的2型糖尿病患者160例160眼,另外选取同时间段在我院就诊的性别、年龄相匹配的非糖尿病正常人共80人80眼。将2型糖尿病患者纳入DM组,非糖尿病正常人纳入对照组。将DM组患者分为3个亚组血糖控制良好组(DM组1,60例),血糖控制一般组(DM组2,50例),血糖控制欠佳组(DM组3,50例)。所有受试者依次进行干眼问卷(OSDI评分)、裂隙灯检查、采用Keratograph 5M进行非侵入式泪膜破裂时间(NIBUT)检查、角膜荧光素染色(fluorescein staining,FL)、无表面麻醉下泪液分泌试验(Schimmer I test,SIt)以及睑板腺红外线成像检查。结果DM组干眼患病率、FL阳性率、睑板腺形态异常率均较对照组高,差异均有统计学意义(均为P<0.05)。DM组患者的OSDI评分较对照组高,NIBUT和SIt值均低于对照组,差异均有统计学意义(均为P<0.01)。DM亚组间比较显示,随着HbA1c水平升高,干眼患病率及睑板腺形态异常率逐渐增加,差异均有统计学意义(均为P<0.05);3组间FL阳性率比较,差异无统计学意义(P=0.45)。DM亚组间比较显示,随着HbA1c水平升高,OSDI评分逐渐增加,NIBUT逐渐降低,差异均有统计学意义(均为P<0.05);然而3组间SIt值差异无统计学意义(P=0.07)。两两比较结果显示,对照组与DM组2、对照组与DM组3、DM组1与DM组3,两两间干眼患病率差异均有统计学意义(均为P<0.05),前者均低于后者。对照组与DM组1、对照组与DM组2、对照组与DM组3、DM组1与DM组3、DM组2与DM组3,两两间睑板腺形态异常率差异均有统计学意义(均为P<0.05),前者均低于后者。对照组与DM组1、对照组与DM组2、对照组与DM组3、DM组1与DM组2、DM组1与DM组3,两两间OSDI评分差异均有统计学意义(均为P<0.05),前者均低于后者。对照组与DM组2、对照组与DM组3、DM组1与DM组3,两两间NIBUT差异均有统计学意义(均为P<0.05),前者均高于后者。结论2型糖尿病患者多存在干眼和睑板腺形态异常,这些异常与其HbA1c控制水平具有一定的相关性。

Effects of HbA1c control level on symptoms and signs of dry eye in patients with type 2 diabetes

Objective　 To investigate effects of glycated hemoglobin (HbA1c) control level on symptoms and signs of dry eye in patients with type 2 diabetes.Methods　A total of 160 type 2 diabetic patients (160 eyes) diagnosed at Endocrinology Department in our hospital from March 2016 to December 2018 were selected. In addition, a total of 80 non-diabetic normal patients who were matched with gender and age, and received treatment in our hospital at the same time were selected. Type 2 diabetic patients were included in the DM group, and non-diabetic normal patients were included in the control group. Patients in DM group were divided into three subgroups: group with good blood glucose control (DM group 1, 60 eyes in 60 patients), group with general blood glucose control (DM group 2, 50 eyes in 50 patients), and group with poor blood glucose control (DM group 3, 50 eyes in 50 patients). All subjects received dry eye questionnaire survey (OSDI score), slit lamp examination, non-invasive tear film rupture time (NIBUT) detection by Keratograph 5M, fluorescent corneal staining, Schimmer I test (SIt) without surface anesthesia, and meibomian gland infrared imaging. Results　 DM group had higher rate of dry eye, FL positive rate, abnormal rate of meibomian gland morphology than those in control group (all P<0.05), higher OSDI score than that in control group, lower NIBUT and SIt value than control group (all P<0.01). Comparison among DM subgroups: Prevalence of dry eye and abnormal rate of meibomian gland morphology gradually increased with HbA1c level (all P<0.05). No statistical differences were observed in FL positive rate among three groups (P=0.45). Comparison among DM subgroups showed that OSDI score gradually increased and NIBUT decreased with HbA1c level, and statistical differences were observed (both P<0.05). There was no difference in SIt value among three groups (P=0.07). Pairwise comparison results showed statistical differences were found in prevalence of dry eye between control group and DM group 1, control group and DM group 3, DM group 1 and DM group 3 (all P<0.05), and the latter group had a lower level than the former group. There were statistical differences in abnormal rate of meibomian gland morphology between control group and DM group 1, control group and DM group 2, control group and DM group 3, DM group 1 and DM group 3, DM group 2 and DM group 3 (all P<0.05), and the latter group had a higher level than the former group. Statistical differences were found in OSDI score between control group and DM group 1, control group and DM group 2, control group and DM group 3, DM group 1 and DM group 2, DM group 1 and DM group 3 (all P<0.05), and the latter group had a higher level than the former group. Statistical differences were found in NIBUT between control group and DM group 2, control group and DM group 3, DM group 1 and DM group 3 (all P<0.05), and the latter group had a lower level than the former group. Conclusion　 Most patients with type 2 diabetes have abnormalities in the morphology of dry eyes and meibomian glands, which are correlated with the control level of HbA1c.