目的：分析2型糖尿病(T2DM)患者的眼表改变及危险因素。

方法：纳入2017-05/2018-05收治的118例236眼T2DM患者为研究对象，另选取100例200眼非T2DM患者为对照组，进行常规眼科检查、基础泪液分泌试验(SⅠt)、泪膜破裂试验(BUT)、角膜荧光素染色试验(FL)及结膜印记细胞学检查，并收集患者病例资料进行单因素及Logistic多因素回归分析T2DM患者眼表改变的独立危险因素。

结果：T2DM组眼表改变发生率22.5%显著高于对照组7.5%，差异有统计学意义(P<0.05)； T2DM组SⅠt、BUT、结膜杯状细胞计数均显著低于对照组，FL及结膜鳞状上皮化生程度均显著高于对照组，差异有统计学意义(P<0.05)； 单因素分析结果提示，发生眼表改变的T2DM患者与未发生眼表改变的T2DM患者在年龄、病程、空腹血糖(FPG)、血浆总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1c)、尿素(Urea)、肌酐(Cr)、肾小球滤过率(GRF)、24h尿蛋白(24h UP)水平比较差异有统计学意义(P<0.05)； 多因素Logistic回归分析显示年龄、病程、TC、TG、LDL-C、HbA1c、Cr是影响T2DM患者眼表改变的独立危险因素。

结论：T2DM患者眼表改变较正常人明显，是眼表改变的高发人群，应积极纠正T2DM患者血脂代谢紊乱，早期预防，降低眼表改变风险。

METHODS: Totally 118 cases of T2DM patients(236 eyes)admitted from May 2017 to May 2018 were selected as T2DM group, and 100 non-T2DM patients(200 eyes)were selected as control group. The patients were given routine ophthalmic testing, Schirmer Ⅰ test(SⅠt), tear film break-up test(BUT), corneal fluorescein staining test(FL)and conjunctive impression cytology. The cases data were collected for univariate and multivariate Logistic regression analysis so as to analyze the independent risk factors for ocular surface changes in T2DM patients.

RESULTS: The incidence rate of ocular surface changes in T2DM group was significantly higher than that in control group(22.5% vs 7.5%, P<0.05). The SⅠt, BUT and conjunctival goblet cell count in T2DM group were significantly lower than those in control group while the FL and conjunctival squamous metaplasia degree were significantly higher than those in control group(P<0.05). Univariate analysis results suggested that there were significantly differences between T2DM patients with ocular surface changes and T2DM patients without ocular surface changes in terms of age, disease duration, fasting plasma glucose(FPG), plasma total cholesterol(TC), triglycerides(TG), low-density lipoprotein cholesterol(LDL-C), glycosylated hemoglobin(HbA1c), urea, creatinine(Cr), glomerular filtration rate(GFR)and 24h urinary protein(24h UP)(P<0.05). Multivariate Logistic regression analysis showed age, disease duration, TC, TG, LDL-C, HbA1c and Cr were independent risk factors for ocular surface changes in T2DM patients.

CONCLUSION: Ocular surface changes of T2DM patients are more obvious than those of normal people, and T2DM patients have high incidence of ocular surface changes, thus it is necessary to actively correct lipid metabolism disorder and given early prevention for T2DM patients so as to reduce the risk of ocular surface changes.