2型糖尿病周围神经病变与干眼的相关性研究

张瑞杰; 秦鹏; 杜志鹏; 程庆丰; 张琪

doi:10.16016/j.2097-0927.202201202

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2型糖尿病周围神经病变与干眼的相关性研究

临床医学 | 更新时间：2026-01-09

- 2型糖尿病周围神经病变与干眼的相关性研究
- Correlation of peripheral neuropathy with dry eye disease in type 2 diabetic patients
- 陆军军医大学学报 2022年44卷第14期页码：1466-1471
- 作者机构：
  
  1.400016 重庆，重庆医科大学附属第一医院：眼科
  2.400016 重庆，重庆医科大学附属第一医院：内分泌科
- 作者简介：
  
  [张琪，E-mail：cqzqwxm@163.comZHANG Qi, E-mail: cqzqwxm@163.com
- 基金信息：
  
  国家自然科学基金面上项目(82070935)
- DOI：10.16016/j.2097-0927.202201202
  中图分类号： R587.2;R745;R777.34
- 收稿：2022-01-22，
  
  修回：2022-03-23，
  
  纸质出版：2022-07-30
- 稿件说明：
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张瑞杰, 秦鹏, 杜志鹏, 等. 2型糖尿病周围神经病变与干眼的相关性研究[J]. 陆军军医大学学报, 2022,44(14):1466-1471.

Ruijie ZHANG, Peng QIN, Zhipeng DU, et al. Correlation of peripheral neuropathy with dry eye disease in type 2 diabetic patients[J]. Journal of Army Medical University, 2022, 44(14): 1466-1471.
张瑞杰, 秦鹏, 杜志鹏, 等. 2型糖尿病周围神经病变与干眼的相关性研究[J]. 陆军军医大学学报, 2022,44(14):1466-1471. DOI： 10.16016/j.2097-0927.202201202.

Ruijie ZHANG, Peng QIN, Zhipeng DU, et al. Correlation of peripheral neuropathy with dry eye disease in type 2 diabetic patients[J]. Journal of Army Medical University, 2022, 44(14): 1466-1471. DOI： 10.16016/j.2097-0927.202201202.

摘要

目的

研究2型糖尿病患者周围神经病变(diabetic peripheral neuropathy，DPN)严重程度与干眼的相关性。

方法

采用横断面研究设计，纳入2020年7月至2021年7月在重庆医科大学附属第一医院内分泌科住院的2型糖尿病患者120例(240眼)，根据神经缺陷评分(neuropathy disability score，NDS)分为无DPN组、轻度DPN组以及中重度DPN组各40例。对各组患者进行干眼检查，包括眼表疾病指数(ocular surface disease index，OSDI)量表、泪膜破裂时间(break up time，BUT)、泪液分泌试验(schirmer Ⅰ test，SⅠt)、角膜荧光素钠染色(corneal fluorescein staining，CFS)评分，并利用角膜共聚焦显微镜观察角膜神经参数，包括角膜神经纤维密度(corneal nerve fiber density，CNFD)、角膜神经分支密度(corneal nerve branch density，CNBD)、角膜神经纤维长度(corneal nerve fiber length，CNFL)、角膜神经弯曲度(corneal nerve tortuosity，CNT)。比较各组患者角膜神经参数、干眼患病率以及干眼指标的差异，分析NDS、角膜神经参数与泪液质量的相关性。

结果

DPN严重程度越重，CNFD、CNBD、CNFL越低(

0.05)，中重度DPN组和轻度DPN组CNT较无DPN组明显升高(

0.05)。中重度DPN组患者干眼患病率(62.5%)较无DPN组(27.5%)和轻度DPN组(30.0%)均明显升高(

0.05)。中重度DPN组OSDI评分较无DPN组和轻度DPN组均明显升高(

=0.004，

=0.023)，中重度DPN组SⅠt较无DPN组明显降低(

=0.010)，CFS评分较无DPN组明显升高(

=0.008)。NDS越高，泪液分泌量越低(

=-0.316，

=0.001)。角膜神经弯曲度越大，泪膜稳定性越低(

=-0.261，

=0.004)；角膜神经纤维密度越低、角膜神经分支密度越低、角膜神经纤维长度越短、角膜神经弯曲度越大，泪液分泌量越低(

=0.202，

=0.021；

=0.224，

=0.014；

=0.262，

=0.004；

=-0.193，

=0.034)。

结论

中重度DPN患者干眼患病率高，OSDI评分升高。DPN严重程度评分(NDS)越高的患者，其泪液分泌量越低。

Abstract

Objective

To investigate the correlation between the severity of diabetic peripheral neuropathy (DPN) and dry eye disease in patients with type 2 diabetes mellitus (T2DM).

Methods

A cross-sectional study was conducted on 120 T2DM patients (240 eyes) admitted in our hospital from July 2020 to July 2021. According to the neuropathy disability score (NDS)

the subjects were divided into non-DPN group (

=40)

mild DPN group (

=40)

and moderate to severe DPN group (

=40). Dry eye disease examinations were subsequently performed

including ocular surface disease index (OSDI) scale

tear film break up time (BUT)

Schirmer Ⅰ test (SⅠt)

and corneal fluorescein staining (CFS) scoring. In addition

corneal nerve parameters

such as corneal nerve fiber density (CNFD)

corneal nerve branch density (CNBD)

corneal nerve fiber length (CNFL) and corneal nerve tortuosity (CNT) were measured by corneal confocal microscopy. The corneal nerve parameters

as well as prevalence and indicators of dry eye disease were compared among all the groups

and the correlation of NDS with corneal nerve parameters and tear quality were analyzed.

Results

Exa

mination results showed that the more serious DPN was

the lower the CNFD

CNBD and CNFL were (

0.05)

and CNT in the moderate to severe DPN and mild DPN groups was significantly higher than that in the non-DPN group (

0.05). The prevalence of dry eye was greatly increased in the moderate to severe DPN group (62.5%)

as compared with the non-DPN group (27.5%) and mild DPN group (30.0%) (

0.05). OSDI score was also notably elevated in the moderate to severe DPN group in comparison with the other 2 groups (

=0.004

=0.023). Moreover

the moderate to severe DPN group had lower SⅠt (

=0.010) while higher CFS score (

=0.008) than the non-DPN group. It was found that the higher the NDS was

the lower volume of tear secreted (

=-0.316

=0.001); and the greater the CNT was

the less stable tear film became (

=-0.261

=0.004). In addition

the tear production was reduced with the lower CNFD

the less CNBD

the shorter CNFL

and the higher CNT

respectively (

=0.202

=0.021;

=0.224

=0.014;

=0.262

=0.004;

=-0.193

=0.034).

Conclusion

Patients with moderate and severe DPN have a high prevalence of dry eye disease and an increased OSDI score. Patients with higher DPN severity score (NDS) have lower tear secretion.

关键词

Keywords

references

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