糖尿病患者泪膜功能变化的研究

Evaluation of the tear film function in diabetic patients using the Keratograph 5M

目的探讨糖尿病患者泪膜功能的改变及其相关影响因素。方法病例对照研究。收集2016年4至6月在惠州市中心人民医院内分泌科确诊为糖尿病的患者89例（174只眼），其中男性41例，女性48例，年龄（52．2±10．2）岁。根据荧光素眼底血管造影检查结果是否有DR的眼底改变将患者分为DR组49例（94只眼）和糖尿病组42例（80只眼），另选择健康人38名（52只眼）作为对照组。所有患者均行糖尿病病程、糖化血红蛋白、肌酐、24h尿蛋白、尿微量白蛋白／尿肌酐、肌电图检查，并采用Keratograph5M眼表综合分析仪检测首次泪膜破裂时间（BUT）、平均BUT、中央泪河高度及上下睑板腺缺失情况评分。计量资料（首次BUT、平均BUT、中央泪河高度、SIT结果）3组问比较采用方差分析，两两比较采用SNK—q检验；两组间比较采用独立样本t检验，相关性分析采用Pearson相关性分析。3组间比较采用Kmskal—Wallis抒检验，两组间比较采用Mann—WhitneyU检验，相关性分析采用Spearman秩相关分析。结果DR组、糖尿病组、对照组首次BUT分别为（8．42±4．71）、（10．24±5．32）、（14．2±5．00）s，平均BUT分别为（11．20±5．25）、（12．67±5．52）、（17．64±4．46）S，组间比较差异有统计学意义（F=22．42，26．49；P〈0．01）。3个组中央泪河高度分别为（0．29±0．09）、（0．29±0．11）、（0．26±0．09）rain，组问比较差异无统计学意义（F=2．733，P=0．067）。糖尿病患者中央泪河高度与糖化血红蛋白呈负相关（r=0．212，P=0．006），而与病史、尿微量白蛋白／尿肌酐、肌酐、24h尿蛋白及肌电图暂未见相关性。随病史的延长，糖尿病患者上、下睑板腺缺失评分增加（Z=19．514，15．342；P〈0．05）。肌电图有损伤的糖尿病患者，下睑板腺缺失评分增加（Z=-2．312，P〈0．05）。结论糖尿病合并视网膜病变、糖化血红蛋白高的患者较眼底及糖化血红蛋白正常者更容易出现泪膜完整性的破坏。

Objective To evaluate the tear film function of diabetic patients using the Keratograph 5M and to analyze its related factors. Methods Case-control study. A total of 89 inpatients （174 eyes） diagnosed with diabetes in the Department of Endocrinology at our hospital were recruited. According to the fundus fluorescein angiography results, subjects were divided into two groups, diabetic retinopathy （DR） group and none-DR group. All subjects were examined for duration of diabetes, glycosylated hemoglobin, creatinine, 2d-hour urinary protein, and 24-hour urinary micmalbumin/m-inary creatinine, and by electromyography. The Keratograph JM was used to obtain the first and average tear film break-up time （BUTf and BUTav）, tear meniscus height, the upper and lower meibomian gland loss scores. The data were analyzed by SPSS. Results Compared to the non-DR group, the BUTf and the BUTav in the DR group were shorter [（8.42± 4.71） s vs. （10.24±5.32） s, （11.20±5.25） s vs. （12.67±5,52） s; P=0.000]. There was no significant difference in the tear meniscus height between the three groups （P=0.067）. The tear meniscus height were negatively related with glycosylated hemoglobin, and not related with duration of diabetes, 24-hour urinary microalbumin/urinary creatinine, creatinine, 24-h urinary protein, and eleetromyography results. As the duration of diabetic longer, the upper and lower meibomian gland loss scores added（Z=19.514, 15.342, P〈 0.05）. Patients with EMG abnormal, the lower meibomian gland loss scores added（Z=-2.312, P〈0.05）. Conclusions The Keratograph 5M can directly evaluate the tear film condition of diabetie patients. Diabetic patients with retinopathy and higher glycosylated hemoglobin tend to suffer tear film dysfunction.