翼状胬肉合并糖尿病对患者泪膜功能的影响

Tear film functions of diabetes mellitus with pterygium

目的研究手术前后翼状胬肉合并糖尿病对患者泪膜功能的影响。方法选取单侧翼状胬肉患者90例，其中单纯翼状胬肉患者（治疗组A）30例、翼状胬肉合并1型糖尿病患者（治疗组B）30例、翼状胬肉合并2型糖尿病患者（治疗组C）30例；另选取90例非翼状胬肉者作为对照，其中健康人（对照组A）30例、单纯1型糖尿病患者（对照组B）30例、单纯2型糖尿病患者（对照组C）30例。观察各组术前3周（术前）泪膜功能差异，观察治疗组B和治疗组C术后3个月（术后）与术前泪膜功能的差异。结果术前各组泪液分泌试验比较差异无统计学意义（P〉0．05）；除对照组A外，各组泪膜破裂时间（BUT）均异常；角膜荧光素染色（CFS）评分治疗组B[（9．08±0．48）分]与对照组B[（3．43±0．51）分]比较差异有统计学意义（P〈0．05），治疗组C[（10．31±0．94）分]与对照组C[（7．91±0．51）分]比较差异有统计学意义（P〈0．05）；泪液羊齿状物试验（MFT）治疗组B与对照组B比较差异有统计学意义（P〈0．05）；术前泪液清除率（TCR）除对照组A外均异常。治疗组B和治疗组C术后与术前比较，泪液分泌试验差异无统计学意义（P〉0．05）；BUT、CFS评分及MFT与术前比较差异均有统计学意义（P〈0．05或〈0．01）；TCR正常。结论翼状胬肉合并糖尿病加重患者泪膜功能损伤，行翼状胬肉切除联合角膜缘干细胞移植术治疗后泪膜功能得到修复。

Objective To study tear film functions of diabetes mellitus with pterygium before and after surgery. Methods Ninety patients with single side pterygium were divided into 3 groups with 30 cases each： simple pterygium （treatment group A）, pterygium combination with type 1 diabetes mellitus （treatment group B） and pterygium combination with type 2 diabetes mellitus （treatment group C）. Ninety patients without pterygium were divided into 3 groups with 30 cases each：normal （control group A）,type 1 diabetes mellitus （control group B） and type 2 diabetes mellitus （control group C）. Tear film functions were compared in each group before surgery,while tear film functions in treatment group B and C were compared between before and after surgery. Results Before surgery, there was no significant difference among each group in lacrimal secretion test. Every group＇s tear film break-up time （BUT） was abnormal except control group A. Cornea fluorescein staining （ CFS ） score in treatment group B compared with control group B, and treatment group C compared with control group C were significant differences [ （9.08 ± 0.48） scores vs. （3.43 ± 0.51 ） scores and （10.31 ± 0.94） scores vs. （7.91 ± 0.51 ） scores,P 〈 0.05 ]. There was significant difference in mucus fern test （MFT） between treatment group B and control group B （P 〈 0.05）. Tear clearance rate （TCR） were all abnormal except control group A. Before surgery compared with after surgery between treatment group B and treatment group C, there was no significant difference in lacrimal secretion test （P 〉 0.05 ）, but there were significant differences in BUT, CFS score and MFI＇, the TCR were normal. Conclusion Diabetes mellitus with pterygium will aggravate damage in tear film functions,and these damaged functions could be recovered through pterygium surgery with conjunctival limbal autograft.