[1]吕瑛,曾孝宇,李斐,等.糖尿病短泪膜破裂时间型干眼患者的症状和体征分析[J].眼科新进展,2019,39(3):238-242.[doi:10.13389/j.cnki.rao.2019.0053]
　LV Ying,ZENG Xiao-Yu,LI Fei,et al.Symptoms and signs of short tear break-up time dry eye in diabetic patients[J].Recent Advances in Ophthalmology,2019,39(3):238-242.[doi:10.13389/j.cnki.rao.2019.0053]
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糖尿病短泪膜破裂时间型干眼患者的症状和体征分析/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
39卷
期数:
2019年3期
页码:
238-242
栏目:
应用研究
出版日期:
2019-03-05

文章信息/Info

Title:
Symptoms and signs of short tear break-up time dry eye in diabetic patients
作者:
吕瑛; 曾孝宇; 李斐; 赵少贞
300384　天津市，天津医科大学眼科医院、天津医科大学眼科研究所、天津医科大学眼视光学院
Author(s):
LV Ying; ZENG Xiao-Yu; LI Fei; ZHAO Shao-Zhen
Tianjin Medical University Eye Hospital，School of Optometry and Ophthalmology，Tianjin Medical University Eye Institute，Tianjin 300384，China
关键词:
短泪膜破裂时间; 泪膜不稳定; 糖尿病; 干眼; 睑板腺; 脂质层厚度; 眼表干涉仪
Keywords:
short tear break-up time; tear film instability; diabetes; dry eye; meibomian gland; lipid layer thickness; ocular surface interferometry
分类号:
R777.34
DOI:
10.13389/j.cnki.rao.2019.0053
文献标志码:
A
摘要:
目的　探讨糖尿病与非糖尿病患者中短泪膜破裂时间型（short tear break-up time，sBUT）干眼患者之间眼表状况的不同。方法　收集50~80岁的糖尿病患者59例（118眼），非糖尿病患者41例（82眼），排除泪液缺乏型干眼患者，用标准干眼评估问卷（standard patient evaluation of eye dryness，SPEED）评分，泪液分泌量，非侵入性泪膜第一秒破裂（BUT1st）和平均破裂时间（BUTavg），睑板腺拍照评分，脂质层厚度(lipid layer thickness，LLT)，眨眼频率进行统计分析，进一步分为sBUT干眼患者（糖尿病sBUT组、非糖尿病sBUT组）和非sBUT干眼患者（糖尿病非sBUT组、非糖尿病非sBUT组）后再进行统计分析。结果　相比于非糖尿病组，糖尿病组有更高的SPEED评分和睑板腺拍照评分，更薄的LLT，差异均有统计学意义（均为P<0.05）。糖尿病sBUT组的SPEED评分为（7.40±3.24）分，睑板腺拍照评分为（3.2±1.16）分，眨眼频率（6.78±5.10）次，在4组中最高；而Schirmer值［（5.80±4.74）mm］、BUT1st值［（3.44±1.10）s］、BUTavg值［（5.74±3.17）s］和LLT［（66.40±23.34）nm］在4组中最低。在泪液相对不缺乏的干眼人群中，LLT分别与眨眼频率、SPEED评分之间呈负相关（r=-0.168，P<0.05；r=-0.298，P<0.001）；眨眼频率与SPEED评分呈正相关（r=0.268，P<0.001）。结论　糖尿病患者睑板腺的短缩和缺失更严重，使LLT变更薄，从而引起泪膜破裂时间变更短，眨眼频率更高，导致糖尿病患者的干眼症状相比于非糖尿病患者更重。
Abstract:
Objective　To investigate the differences of ocular surface status between diabetic and non-diabetic patients with short tear break-up time (sBUT) dry eye.Methods　Fifty-nine diabetic patients (118 eyes) and 41 non-diabetic patients (82 eyes) aged 50-80 years were enrolled，excluding the patients with tear-sufficient dry eye.The analysis included standard patient evaluation of eye dryness (SPEED) questionnaire，Schirmer I test，fluorescein staining score，non-invasive first tear film break-up time (BUT1st) and average tear film break-up time (BUTavg)，meibography and lipid layer thickness (LLT) and blinking frequency.These data were analyzed further after the patients were divided into sBUT dry eye type (diabetic sBUT group，non-diabetic sBUT group)，non-sBUT dry eye type (diabetic non-sBUT group，non-diabetic non-sBUT group).Results　Compared with non-diabetic patients，there were higher SPEED score，higher meiboscore and thinner LLT in diabetic patients (all P<0.05).The SPEED score (7.40±3.24)，meiboscore (3.20±1.16) and blinking frequency (6.78±5.10) of diabetic sBUT group were the highest in the four groups，while the Schirmer I test value ［(5.80±4.74)mm］，BUT1st ［(3.44±1.10)s］，BUTavg ［(5.74±3.17)s］ and LLT ［(66.40±23.34)nm］ were the lowest in the four groups.In dry eye patients without tear-deficiency，LLT was negatively correlated with blinking frequency and SPEED score (r=-0.168，P<0.05；r=-0.298，P<0.001)，and blinking frequency was positively correlated with SPEED score（r=0.268，P<0.001).Conclusion　The shorten and dropout of meibomian glands in diabetic patients are more serious，which makes LLT thinner and causes tear film break-up time shorter and higher blinking frequency.Thus，the dry eye symptoms in diabetic patients are more severe than those in non-diabetic patients.

参考文献/References:

［1］　KAIDO M，KAWASHIMA M，SHIGENO Y，YAMADA Y，TSUBOTA K.Relation of accommodative microfluctuation with dry eye symptoms in short tear break-up time dry eye［J］.PLoS One，2017，12（9）：e0184296.
［2］　CRAIG J P，NICHOLS K K，AKPEK E K，CAFFERY B，DUA H S，JOO C K，et al.TFOS DEWS II definition and classification report［J］.Ocul Surf，2017，15（3）：276-283.
［3］　WHO，Diabetes country profiles，2016.［EB/OL］［2018-09-19］.http：//www.who.int/diabetes/country-profiles/chn_en.pdf?ua=1
［4］　WANG Y，ZHOU Q J，XIE L X.Diabetic keratopathy：new progresses and challenges［J］.Chin J Ophthalmol，2014，50（1）：69-72.
王晔，周庆军，谢立信.糖尿病角膜病变发病机制的研究进展［J］.中华眼科杂志，2014，50 （1）：69-72.
［5］　YU T，SHI W Y，SONG A P，GAO Y，DANG G F，DING G.Changes of meibomian glands in patients with type 2 diabetes mellitus［J］.Int J Ophthalmol，2016，9（12）：1740-1744.
［6］　KAIDO M，KAW A，SHIMA M，ISHIDA R，TSUBOTA K.Relationship of corneal pain sensitivity with dry eye symptoms in dry eye with short tear break-up time［J］.Cornea，2016，57（3）：914-919.
［7］　NGO W，SITU P，KEIR N，KORB D，BLACKIE C，SIMPSON T.Psychometric properties and validation of the standard patient evaluation of eye dryness questionnaire［J］.Cornea，2013，32（9）：1204-1210.
［8］　KORB D R，BLACKIE C A.Debridement-scaling：a new procedure that increases meibomian gland function and reduces dry eye symptoms［J］.Cornea，2013，32（12）：1554-1557.
［9］　MENG Z，SONG J J，YANG L，ZHAO S Z，ZHANG C，YANG R B，et al.Study on correlation of dry eye symptoms and signs in middle-aged and aged people by Lipiview［J］.Rec Adv Ophthalmol，2017，37（2）：143-146.
孟珠，宋建军，杨柳，赵少贞，张琛，杨瑞波，等.Lipiview眼表面干涉仪辅助的中老年人干眼症状与体征的相关性研究［J］.眼科新进展，2017，37（2）：143-146.
［10］　REN B Y，ZHENG Y Z，LIN Y，LIN C.Clinical research on dry eye in diabetics and non-diabetics［J］.Int Eye Sci，2016，16（12）：2345-2347.
任秉仪，郑永征，林颖，林晨.糖尿病与非糖尿病患者干眼症的临床研究［J］.国际眼科杂志，2016，16（12）：2345-2347.
［11］　KAIDO M，KAWASHIMA M，ISHIDA R，TSUBOTA K.Severe symptoms of short tear break-up time dry eye are associated with accommodative microfluctuations［J］.Clin Ophthalmol，2017，11：861-869.
［12］　KAIDO M，UCHINO M，KOJIMA T，DOGRU M，TSUBOTA K.Effects of Diquafosol tetrasodium administration on visual function in short break-up time dry eye［J］.J Ocular Pharmacol Therape，2013，29（6）：595-603.
［13］　KOH S，INOUE Y，SUGMIMOTO T，MAEDA N，NISHIDA K.Effect of rebamipide ophthalmic suspension on optical quality in the short break-up time type of dry eye［J］.Cornea，2013，32（9）：1219-1223.
［14］　ALJAROUSHA M，BADARUDIN N E，CHE AZEMIN M Z.Comparison of dry eye parameters between diabetics and non-diabetics in district of kuantan，pahang［J］.Malay J Med Sci，2016，23（3）：72-77.
［15］　GAO Y，LIU X L，LI X R.Clinical analysis of ocular surface and tear film changes in type 2 diabetes mellitus［J］.Rec Adv Ophthalmol，2011，31（3）：267-270.
高研，刘新玲，李筱荣.糖尿病患者眼表及泪液蛋白改变的临床分析［J］.眼科新进展，2011，31（3）：267-270.
［16］　DOGRU M，KATAKAMI C，INOUE M.Tear function and ocular surface changes in noninsulin-dependent diabetes mellitus［J］.Ophthalmology，2000，108（3）：586-592.
［17］　ZOU X，LU L，XU Y，ZHU J，HE J，ZHANG B，et al.Prevalence and clinical characteristics of dry eye disease in community-based type 2 diabetic patients：the Beixinjing eye study［J］.BMC Ophthalmol，2018，18（1）：117.
［18］　OZDEMIR M，BUYUKBESE M A，CETINKAYA A，OZDEMIR G.Risk factors for ocular surface disorders in patients with diabetes mellitus［J］.Diabetes Res Clin Pr，2003，59（3）：195-199.
［19］　NAJAFI L，MALEK M，VALOJERDI A E，AGHILI R，KHAMSEH M E，FALLAH A E，et al.Dry eye and its correlation to diabetes microvascular complications in people with type 2 diabetes mellitus［J］.J Diabetes Compl，2013，27（5）：459-462.
［20］　MA A，MAK M S，SHIH K C，TSUI C K，CHEUNG R K，LEE S H，et al.Association of long-term glycaemic control on tear break-up times and dry eye symptoms in Chinese patients with type 2 diabetes［J］.Clin Exp Ophthalmol，2018，46（6）：608-615.
［21］　YU L，CHEN X，QIN G，XIE H，LV P.Tear film function in type 2 diabetic patients with retinopathy［J］.Ophthalmologica，2008，222（4）：284-291.
［22］　COUSEN P，CACKETT P，BENNETT H，SWA K，DHILLON B.Tear production and corneal sensitivity in diabetes［J］.J Diabetes Compl，2007，21（6）：371-373.
［23］　LIN X，XU B，ZHENG Y，COURSEY T G，ZHAO Y，LI J，et al.Meibomian gland dysfunction in type 2 diabetic patients［J］.J Ophthalmol，2017，2017：3047867.
［24］　SUN L G，MA Z X，MA L，LIU Y X，GAO Y.Dynamic assessment of tear-film stability-associated objective vision in mild or moderate dry eyes based on Optical Quality Analysis System parameters［J］.Chin J Exp Ophthalmol，2017，35（4）：344-348.
孙龙格，马忠旭，马林，刘艳霞，高原.基于OQAS-Ⅱ视觉质量参数对轻中度干眼泪膜稳定性动态变化的评估［J］.中华实验眼科杂志，2017，35（4）：344-348.
［25］　SEIRAFI H，FARSINEJAD K，FIROOZ A，DAVOUDI S M，ROBATI R M，HOSEINIM S，et al.Biophysical character istics of skin in diabetes：a controlled study［J］.J Eur Acad Dermatol Venereol，2009，23：146-149.
［26］　AKIR BK，KATIRCIO G ˇ LU Y，NL N，DUMAN S，STN H.Ocular surface changes in patients treated with oral antidiabetic drugs or insulin［J］.Eur J Ophthalmol，2015，26（4）：303-306.
［27］　BURNHAM J M，SAKHALKAR M，LANGFORD M P，LIANG C，REDENS T B，JAIN S K.Diabetic and non-diabetic human cornea and tear γ-glutamyl transpeptidase activity［J］.Clin Ophthalmol，2013，7：99-107.
［28］　KIM H J，KIM P K，YOO H S，KIM C W.Comparison of tear proteins between healthy and early diabetic retinopathy patients［J］.Clin Biochem，2012，45（1-2）：60-67.
［29］　GHOSH S，GHOSH S，AZHARUDDIN M，BERA S，DATTA H，DASGUPTA A.Change in tear protein profile in diabetic retinopathy with duration of diabetes［J］.Diabetes Metab Syndr，2014，8（4）：233-235.

备注/Memo

备注/Memo:
国家自然科学基金项目（编号：81770890）
更新日期/Last Update: 2019-03-15