2型糖尿病患者睑板腺相关指标分析

Analysis of meibomian gland-related indexes in type 2 diabetic patients

目的观察2型糖尿病患者睑板腺相关指标,探讨睑板腺结构和功能异常的因素。方法纳入糖尿病患者130例130眼,正常对照组46例46眼,所有受试者均填写快速干眼评分问卷(standard patient evaluaion of eye dryness,SPEED),进行Lipiview检查并进行睑板腺分泌的评估(meibomian gland evaluator,MGE)。所有糖尿病患者根据病程、糖化血红蛋白(glycosylated hemoglobin level,HbA_(1c))以及有无脂蛋白代谢异常分组,分析不同分组情况下泪膜脂质层厚度(lipid layer thickness,LLT)、泪膜破裂时间(tear break up time,TBUT)、泪液分泌功能(tear secretion function,SIt)、睑板腺缺失率(percentage of partial glands,MGP)、睑板腺开口数量(meibomian gland yielding liquid secretion,MGYLS)、睑板腺分泌物评分(meibomian gland yielding secretion score,MGYSS)。结果糖尿病组HbA_(1c)、SPEED、MGP高于对照组,LLT、BUT、SIt、MGYLS和MGYSS低于对照组(P<0.05)。病程<10年组与病程≥10年组的性别、年龄、HbA_(1c)、SPEED评分以及LLT、BUT、SIt比较差异无统计学意义(P>0.05),病程≥10年组MGP高于病程<10年组,MGYLS、MGYSS低于病程<10年组(P<0.05)。HbA_(1c)≥7%组与HbA_(1c)>7%组性别、年龄、SPEED评分差异无统计学意义(P>0.05),HbA_(1c)≥7%组LLT、BUT、SIt、MGYLS、MGYSS低于HbA_(1c)<7%组,MGP高于HbA_(1c)<7%组(P<0.05)。脂代谢异常组与脂代谢正常组的性别、年龄和SPEED评分比较差异无统计学意义(P>0.05),脂代谢异常组LLT、BUT、SIt、MGYLS、MGYSS低于脂代谢正常组,MGP高于脂代谢正常组(P<0.05)。糖尿病患者睑板腺可见睑板腺腺体缩短、变粗,扭曲变形,部分腺体缺失且排列稀疏;正常对照组的睑板腺可见腺体分布紧凑,腺体长可接近睑板的上端。结论2型糖尿病患者睑板腺结构和功能均出现异常改变,泪膜质量下降,导致各组眼表不适症状,血糖控制欠佳、病程较长的患者的眼表不适及睑板腺异常更重,伴有脂蛋白代谢异常的糖尿病患者泪膜质量及睑板腺功能更差。

Objective To observe the meibomian gland-related indexes in patients with type 2 diabetes mellitus(T2DM)and to explore the influencing factors of abnormal structure and function of meibomian gland.Methods In total,130 patients(130 eyes)with T2DM were selected as experimental group and 46 healthy persons(46 eyes)were selected as control group.All subjects underwent the standard patient evaluation of eye dryness scoring(SPEED),Lipiview examination and meibomian gland evaluator(MGE).The patients were divided into different groups according to duration of T2DM,glycosylated hemoglobin level(HbA_(1c))and blood lipids level and presence of abnormal lipoprotein metabolism.Lipid layer thickness(LLT),tear break up time(TBUT)and tear secretion function[SchirmerⅠtest(SIt)],percentage of partial glands(MGP),meibomian gland yielding liquid secretion(MGYLS),meibomian gland yielding secretion score(MGYSS)were analyzed.Results HbA_(1c),SPEED and MGP in diabetes group were higher than those in control group,while LLT,BUT,SIt,MGYLS and MGYSS were lower than those in control group(P<0.05).There was no statistically significant difference in gender,age,HbA_(1c),SPEED score,LLT,BUT,and SIt between the group with a disease course of<10 years and the group with a disease course of≥10 years(P>0.05).MGP in the group with a disease course of≥10 years was higher than that in the group with a disease course of<10 years,while MGYLS and MGYSS were lower than those in the group with a disease course of<10 years(P<0.05).There was no statistically significant difference in gender,age,and SPEED scores between the HbA_(1c)<7%group and the HbA_(1c)≥7%group(P>0.05).The LLT,BUT,SIt,MGYLS,and MGYSS of the HbA_(1c)≥7%group were lower than those of the HbA_(1c)<7%group,and MGP was higher than those of the HbA_(1c)<7%group(P<0.05).There was no significant difference in gender,age,and SPEED scores between the abnormal lipid metabolism group and the normal lipid metabolism group(P>0.05).The LLT,BUT,SIt,MGYLS,and MGYSS in the abnormal lipid metabolism group were lower than those in the normal lipid metabolism group,while MGP was higher than those in the normal lipid group(P<0.05).In the meibomian gland of T2DM patients,the meibomian gland were shortened,thickened,distorted,and some glands were missing and sparsely arranged.The meibomian glands in the normal control group are densely distributed,with glandular lengths approaching the upper end of the meibomian plate.Conclusion The structure and function of meibomian gland are abnormal in T2DM patients,and the quality of tear film is decreased,which result in ocular surface discomfort in all groups,and the ocular surface discomfort and meibomian gland abnormality are more serious in patients with poor control of blood sugar and longer course of disease.Diabetic patients with abnormal lipoprotein metabolism have worse tear film quality and meibomian gland function.