Li Hai-Yan, Pang Guo-Xiang, Xu Zhuo-Zai
Department of Ophthalmology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2004 Dec;26(6):682-6.
To study the tear film function of patients with type 2 diabetes and to investigate the risk factors of dry eye in these patients.
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.
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).
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.
研究2型糖尿病患者的泪膜功能，并探讨这些患者干眼症的危险因素。
共研究了111例2型糖尿病患者和100例年龄及性别匹配的对照者。通过干眼综合征、泪膜破裂时间（BUT）、角膜荧光素染色、泪液分泌试验（SIt）以及使用泪液镜观察泪膜脂质层来评估泪膜功能。根据这些测试结果计算干眼评分。
与对照组相比，2型糖尿病患者的干眼评分更高（糖尿病患者3.28±1.56，对照组2.31±1.50，P<0.01），BUT更快[糖尿病患者（6.50±4.84）秒，对照组（12.26±7.16）秒，P<0.01]，但SIt相似[糖尿病患者（10.61±6.86）秒，对照组（10.92±7.05）秒，P>0.05]。更多糖尿病患者被诊断为干眼症（糖尿病患者19.8%，对照组8.0%，P<0.05）。根据糖尿病视网膜病变情况，将糖尿病患者分为三组：无糖尿病视网膜病变（DR）、有背景性DR和有增殖性DR。这三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）毫米、（11.71±7.30）毫米和（7.63±5.20）毫米（P>0.05）；BUT分别为（7.53±5.23）秒、（5.88±4.10）秒和（4.47±4.17）秒（P<0.05）。然后将有DR的患者分为两组：接受光凝治疗和未接受光凝治疗。这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）秒和（6.26±4.36）秒（P<0.01）；SIt分别为（7.21±6.51）毫米和（11.33±6.73）毫米（P<0.05）；角膜荧光素染色率分别为50.0%和17.9%（P<0.05）。干眼评分与糖尿病视网膜病变和光凝治疗有良好相关性（P<0.01），但与年龄、性别、胰岛素、糖尿病病程和代谢控制相关性较差（P>0.05）。
2型糖尿病患者容易出现泪膜功能障碍。泪膜数量和质量的紊乱似乎与糖尿病视网膜病变的阶段和光凝治疗有关。
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