2型糖尿病对眼部自主神经功能的影响

Type 2 diabetes affects the autonomic nervous system function of the eye

目的通过比较2型糖尿病患者与正常人在自然状态下及药物散瞳后的瞳孔直径、双眼最大调节幅度，分析2型糖尿病患者眼部自主神经功能病变的意义。方法前瞻性队列研究。选取北京大学深圳医院内分泌科确诊为2型糖尿病患者，根据眼底荧光素血管造影结果分为临床前期组及非增殖期组．随机数字表法各抽取40例。选取同期在北京大学深圳医院做健康体检的相应年龄段正常人30例。作为正常对照组。综合验光仪下测双眼最大调节幅度，使用角膜地形图测量仪分别测量双眼自然状态下及散瞳后的瞳孔直径并计算瞳孔散大率，将所得数据进行单因素方差分析。结果正常对照组、临床前期组和非增生期组自然状态下瞳孑L直径双眼相等，3组双眼瞳孔直径平均值分别为（2．92±0．47）、（3．14±0．65）、（3．24±0．58）mm，组间差异无统计学意义（F=2．637，P〉0．05）。药物散瞳后瞳孔直径为：右眼（7．28±0．64）、（6．66±0．95）、（6．42±1．32）mm，组间差异有统计学意义（F=6．008，P〈0．05）；左眼（7．37±0．63）、（6．50±1．21）、（6．51±1．04）mm，组间差异有统计学意义（F=7．737，P〈0．05）。瞳孔散大率3组右眼分别为（1．56±0．47）％、（1．16±0．32）％、（0．98±0．32）％，组间差异有统计学意义（F=21．620，P〈0．05），左眼分别为（1．59±0．47）％、（1．11±0．36）％、（1．04±0．32）％，组间差异有统计学意义（F=20．289，P〈0．05）。双眼最大调节幅度分别为（＋4．87±2．53）、（＋3．01±1．66）、（＋2．38~1．53）D，组间差异有统计学意义（F=15．478，P〈0．05）。正常对照组的左右眼瞳孔直径、瞳孔散大率和双眼最大调节幅度均大于临床前期组和非增生期组（P〈0．05）。各组内左右眼瞳孔散大率比较差异均无统计学意义。结论2型糖尿病患者早期即可出现眼部交感神经功能病变及双眼对称性副交感神经功能病变。

Objective To evaluate autonomic nervous function lesions in eyes with type 2 diabetes mellitus by investigating pupil diameters under the natural state and drug-induced dilated conditions and maximum binocular amplitude adjustment. Methods In this prospective cohert study, 80 type 2 diabetic patients from Peking University Shenzhen Hospital were divided into two groups based on the results of fundus fluoreseene angiography （FFA）, a preclinical group and a non-proliferative group with 40 patients in each group. Thirty age-matched healthy people were selected as controls. Maximum binocular amplitude adjustment was tested with a comprehensive refractometer, pupil diameters under the natural state and drug-induced dilated conditions were measured with corneal topography. A one-way ANOVA was used for data analysis. Results The mean pupil diameters of the two eyes under the natural state in the control group, preclinical group and non-proliferative group were the same, 2.92±0.47 mm, 3.14±0.65 mm, and 3.24±0.58 mm, respectively. The differences between the groups were not statistically significant （F=2.637, P〉0.05）. For the right eyes, the mean pupil diameters under the drug-induced dilated conditions were 728±0.64 mm, 6.66±0.95 mm, and 6.42±1.32 mm, respectively. The differences between the groups were not statistically significant （F=6.008, P〈0.05）. The mean diameters for the left eyes were 7.37±0.63 mm, 6.50±1.21 mm, and 6.51±1.04 mm, respectively. The differences between the groups were statistically significant （F=7.737, P〈0.05）. For the right eyes,the mean dilation ratios were 1.56%±0.47%, 1.16%±0.32%, and 0.98%±0.32%, respectively. The differences between the groups were statistically significant （F=21.620, P〈0.05）. The ratios for the left eyes were 1.59%±0.47%, 1.11%±0.36%, and 1.04%±0.32%, respectively. The differences between the groups were significant （F=20.289, P〈0.05）. The mean maximum binocular amplitude adjustments were ＋4.87±2.53 D, ＋3.01±1.66 D, and ＋2.38±1.53 D, respectively. The differences between the groups were significant （F=15.478, P〈0.05）. Further comparison showed that the drug-induced pupil diameter, dilation ratio and maximum binocular amplitude adjustment in the control group were higher than in the preclinical and non-proliferative groups （P〈0.05）. Conclusion eye sympathetic nerve lesions and eyes symmetry parasympathetic nerve functional lesion occurs early in type 2 diabetes.