【作者】 刘芳；

【导师】 贾卉；

【作者基本信息】 吉林大学 ， 眼科学（专业学位）， 2016， 硕士

【摘要】 目的:观察2型糖尿病患者眼表损害的临床特征,并探讨其与糖尿病病程及糖尿病视网膜病变的相关性。方法:选择2015年8月~12月就诊于吉林大学第一医院眼科门诊的2型糖尿病患者,共83例(166只眼),其中男40例80只眼(48.2%),女43例86只眼(51.8%),年龄范围33岁-77岁,平均年龄55.87±9.89岁,并按糖尿病病程及有无糖尿病视网膜病变进行分组;同时收集年龄、性别相匹配的无糖尿病患者,共40例(80只眼),其中男19例38只眼(47.5%),女21例42只眼(52.5%),年龄范围32岁-77岁,平均年龄55.75±11.28岁。对患者进行非侵入性泪膜破裂时间(BUT)、睑板腺形态、角结膜染色、泪液分泌试验(Schirmer I)、角膜共聚焦显微镜的检查。其结果运用SPSS 18.0软件进行统计分析。结果:糖尿病组干眼患病率95.2%,高于对照组87.5%,差异具有统计学意义(P<0.05)。糖尿病组相比对照组:平均泪膜破裂时间7.18[5.00,9.52]s,低于对照组9.02[5.16,12.8]s(P<0.05);Schirmer I 5.50[5.00,10.25]mm,低于对照组8.50[5.00,15.50]mm(P<0.05);角膜荧光素染色阳性率15.1%,高于对照组12.5%(P>0.05);结膜丽丝胺绿染色阳性率98.2%,高于对照组90.0%(P<0.05);结膜丽丝胺绿染色评分4[3,6],高于对照组3[2,5](P<0.05);Oxford眼表综合评分5[3,6],高于对照组3.5[2,6](P<0.05);睑板腺异常率31.9%,高于对照组17.5%(P<0.05);角膜上皮下神经纤维数量2.64[2.00,3.33]支/幅,低于对照组3.23[2.00,4.00]支/幅(P<0.05);角膜上皮下神经纤维长度478.09[351.28,608.47]um/幅,低于对照组645.70[463.53,888.94]um/幅(P<0.05)。平均泪膜破裂时间、睑板腺异常等级、角膜上皮下神经纤维数量及长度与糖尿病病程及糖尿病视网膜病变程度有关(P<0.05)。结论:相比非糖尿病患者,2型糖尿病患者具有BUT短、泪液分泌少;结膜、睑板腺及角膜神经损伤较重的特点。此外泪膜的稳定性、睑板腺及角膜神经的损伤与糖尿病病程及糖尿病视网膜病变程度有关。更多还原

【Abstract】 Objective: To observe the clinical characteristics of ocular surface damage in type 2diabetes mellitus patients,and to explore its correlation with the duration of diabetes and diabetic retinopathy.Methods: Choose outpatients with 2 type diabetes from August 2015 to December2015 who were visited to Department of Ophthalmology, in the First Hospital of Jilin University, a total of 83 cases(166 eyes), male 40 cases 80 eyes(48.2%), female 43 cases86 eyes(51.8%), aged 33-77 years old, mean age 55.87±9.89 years old, and were grouped according to the duration of diabetes and diabetic retinopathy; patients without diabetes were collected at the same time age and gender matched, a total of 40 cases(80 eyes), male 19 cases 38 eyes(47.5%), female 21 cases 42 eyes(52.5%), aged 32-77 years old, mean age55.75±11.28 years old. All patients were carried out non invasive break-up time(BUT),meibomian gland morphology, corneal and conjunctival staining, Schirmer test(Schirmer I),corneal confocal microscope examination. The results were analyzed and processed by SPSS18.0.Result: Dry eye prevalence rate of Diabetes was 95.2%, higher than 87.5% in the control group, the difference was statistically significant(P<0.05). The diabetic group compared with the control group: The results of the average break-up time was 7.18[5.00,9.52] seconds, was lower than 9.02[ 5.16,12.8]seconds in the control group(P< 0.05);The results of the Schirmer I was 5.50[5.00,10.25]mm, was lower than 8.50 [5.00,15.5]mm in the control group(P<0.05); The positive rate of corneal fluorescein staining was 15.1%,was higher than 12.5% in the control group(P>0.05); The positive rate of conjunctival lissamine green staining was 98.2%, was higher than 90% in the control group(P<0.05); Thescore of conjunctival lissamine green staining was 4[3,6], was higher than 3[2,5] in the control group(P<0.05); The score of Oxford ocular was 5[3,6], was higher than 3.5[2,6] in the control group(P<0.05);The abnormality rate of the meibomian gland was 31.9%,was higher than 17.5% in the control group(P<0.05); The number of subbasal corneal nerve fiber was 2.64 [2.00,3.33] branch/picture, was lower than 3.23[2.00, 4.00]branch/picture in the control group(P<0.05); The length of subbasal corneal nerve fiber was 478.09 [351.28,608.47]um/picture, was lower than 645.70[463.53,888.94]um/picture in the control group(P< 0.05).The average break-up time, the abnormality meibomian gland grading, subbasal corneal nerve fiber number and length were related with duration of diabetes and diabetic retinopathy(P < 0.05).Conclusion: Compared with nondiabetic patients, Diabetes patients with shorter BUT,tear film instability have shorter Schirmer test results, more severe conjunctiva、meibomain glands and corneal nerve damage. In addition, the stability of the tear film, meibomian gland and corneal nerve damage was related with the duration of diabetes and diabetic retinopathy.更多还原