| 目的 评价2型糖尿病患者泪膜功能并探讨其影响因素。 方法 前瞻性研究111例2型糖尿病患者和100例健康对照者进行泪膜功能评价。分别进行眼干症状询问、泪膜破裂时间（TBUT）测定、角膜荧光素染色、基础泪液分泌试验和泪膜脂质层形态观察。根据上述检查结果进行干眼评分。结果 病例组的干眼评分高于对照组（病例组3.28±1.556，对照组2.31±1.502， U ＝3686.5， P <0.01），泪膜破裂时间低于对照组（病例组 6.50±4.84s，对照组12.26±7.16s，t ＝6.899， P <0.01），Schirmer试验结果比较，差异无显著意义（病例组 10.61±6.86mm，对照组10.92±7.05mm,t ＝0.321，P >0.05）。病例组诊断为干眼症的比率高于对照组（病例组47.7%，对照组27.0%，χ2＝9.620，P ＝0.003， P <0.01)。在病例组中，不同眼底分组的TBUT结果比较P < 0.05，出现角膜染色出现比率比较P < 0.05，组间结果差异具有显著性。有眼底病变者共53例，已行激光治疗组和未行激光治疗组比较，TBUT结果比较， t ＝3.744，P <0.01，结果之间差异有显著性； SIt结果比较，t ＝1.980， P <0.05，结果之间差异有显著性。干眼评分比较， U ＝124.5， P <0.01，结果差异有显著意义。对干眼评分与不同分组行Kendall等级相关性分析，干眼评分与眼底分组和激光治疗与否有明显相关性（P <0.01），与年龄分组、性别、胰岛素治疗、病程分组、血糖控制分组均无明显相关性（P >0.05）。 结论 2型糖尿病患者容易出现泪膜功能异常，其泪膜功能改变与糖尿病性视网膜病变和眼底激光治疗有相关性。应该对糖尿病患者常规进行泪膜功能检查。
Tear Film Function of Patients with Type 2 Diabetes
LI Hai-yan# PANG Guo-xiang Xu Zhuo-zai
(Department of Ophthalmology,Peking Union Medical College Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences.Beijing 100730,China)
Objective To study the tear film function of patients with type 2 diabetes and to investigate the risk factors of dry eye in patients with type 2 diabetes. Methods 111 patients with type 2 diabetes and 100 age- and sex-matched control subjects were studied prospectively. Tear film function was evaluated by dry eye syndrome, tear break-up time (TBUT),corneal fluorescein staining,SchirmerI test (SIt) and tear film lipid layer observation with tear scope. Dye eye score was calculated using the results of these tests. Results When compared with the controls,diabetics showed higher Dry eye score（diabetics 3.28±1.556，control 2.31±1.502，P <0.01） and faster TBUT（diabetics 6.50±4.84s，control 12.26±7.16s，P <0.01）,but similar SIt（diabetics 10.61±6.86s，control10.92±7.05s, P >0.05）.More diabetics patients were diagnosed as dry eye (diabetics 47.7%，control 27.0%, P <0.01). Patients with different diabetic retinopathy had different Dry eye scores,TBUT values and rates of corneal fluorescein staining(P < 0.05).Patients after laser treatment showed higher dry eye scores(P <0.01) , faster TBUT (P < 0.01)and lower SIt results (P < 0.05) than those without laser treatment. Dry eye score had a good correlation with diabetic retinopathy and laser treatment (P <0.01),but a poor correlation with age,gender,insulin,duration of diabetes mellitus and metabolic control（P>0.05）. Conclusions Patients with type 2 diabetes tend to develop tear film dysfunction.The disorders of tear quantity and quality seem relevant to the stage of diabetic retinopathy.Examination of tear film should be an integral part of the assessment of diabetic eye disease.
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