糖尿病患者眼表情况的临床观察

发布时间：2018-03-16 02:28

本文选题：糖尿病　切入点：泪膜　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景和目的:正常的眼表结构与功能是获取清晰视觉的保证。眼表的健康依赖于泪膜的稳定性和眼表上皮的完整性。任何原因引起的泪液质或量的异常,均可引起泪膜稳定性下降和眼表组织的损害,从而导致眼部出现异物感、干涩感、视物模糊等多种不适症状。糖尿病可以引起眼睑、结膜、角膜等眼表组织的多种病变。本研究通过对糖尿病患者与健康志愿者眼表相关指标进行检查、比较,观察糖尿病患者的眼表情况,探讨糖尿病对眼表组织的影响。方法:选取在我院内分泌科就诊的糖尿病患者(符合1999年世界卫生组织制定的糖尿病诊断标准)30例作为糖尿病组;自愿接受检查的健康志愿者30例作为对照组。分别进行以下检查:裂隙灯显微镜检查眼睑、结膜、角膜等眼表组织;眼表疾病指数(Ocular Surface Disease Index,OSDI)问卷调查表评估眼部症状;Keratograph眼表综合分析仪进行泪河高度、泪膜破裂时间(Tear Break-up Time,TBUT)、角膜荧光素染色(Corneal Fluorescein Staining,CFS)及睑板腺检查;角膜地形图仪检测自然睁眼状态时及持续睁眼10秒(second,s)后角膜表面规则指数(Surface Regular Index,SRI);泪液分泌试验 I(Schirmer I Test,SIt)检查泪液分泌情况;记录检查结果并进行统计学分析。所有研究对象均自愿接受以上检查并签署知情同意书,同一检查均由同一位检查者在相同条件下进行。结果:糖尿病患者存在不同程度的眼部烧灼感、异物感、干涩感、刺激感及视力下降等不适症状,健康志愿者出现上述症状的情况较少、不适症状的程度较轻,糖尿病组OSDI分值较对照组高,两组差异有统计学意义(P0.01);糖尿病组泪液分泌的质和量均存在不同程度异常,与对照组相比,糖尿病患者的泪河高度、TBUT、SIt均有不同程度下降,两组结果相比,均有统计学差异(均P0.01);糖尿病组角膜上皮受损程度、角膜荧光素染色阳性率及着染程度均较对照组明显,CFS评分及角膜SRI(自然睁眼状态时及持续睁眼10s后)较对照组高,两组结果差异有统计学意义(均P0.05);糖尿病组与对照组的睑板腺缺失情况无统计学差异(P0.05)。结论:糖尿病可引起泪液质和量的异常,导致泪膜稳定性下降及眼表上皮损伤,从而引起烧灼感、异物感、干涩感、视疲劳等多种眼部不适症状。
[Abstract]:Background and objective: normal ocular surface structure and function are the guarantee of clear vision. The health of eye surface depends on the stability of tear film and the integrity of ocular surface epithelium. Can cause tear film stability decline and ocular surface tissue damage, resulting in the eyes of foreign body feeling, dry sense, blurred vision and other symptoms. Diabetes can cause eyelid, conjunctiva, In this study, the ocular surface of diabetic patients and healthy volunteers were examined and compared to observe the ocular surface of diabetic patients. Methods: 30 patients with diabetes mellitus (in accordance with the diabetes diagnostic criteria established by the World Health Organization in 1999) were selected as the diabetic group. 30 healthy volunteers who volunteered to be examined as control group were examined as follows: slit-lamp microscope was used to examine eyelid, conjunctiva, cornea and other ocular surface tissues; The ocular symptom was evaluated by Keratograph synthetic analyzer. The tear film rupture time (Tear Break-up time), cornea fluorescein staining (Corneal Fluorescein Stainingus) and tarsal gland were examined. The corneal surface rule index (Regular index) and tear secretion test (I) were detected by corneal topography when the eyes opened naturally and when the eyes were opened at 10 seconds. The results were recorded and statistically analyzed. All the subjects voluntarily accepted the above examination and signed the informed consent form. The same examination was carried out by the same examiner under the same conditions. Results: the diabetic patients had different degrees of eye burning, foreign body sensation, dry feeling, irritating feeling and decreased visual acuity, etc. The OSDI score of the diabetic group was higher than that of the control group, the difference between the two groups was statistically significant (P 0.01), the quality and quantity of tear secretion in the diabetic group were abnormal in different degrees. Compared with the control group, the level of TBUTSIt in diabetic patients decreased in varying degrees, and there were significant differences between the two groups (all P 0.01), and the degree of corneal epithelium damage in the diabetic group was significantly higher than that in the control group. The positive rate and staining degree of fluorescein staining in cornea were significantly higher than those in the control group, and the corneal SRI (when the eyes opened naturally and after 10 seconds of continuous opening) were higher than those in the control group. There was significant difference between the two groups (P 0.05), but there was no significant difference between the diabetic group and the control group. Conclusion: diabetes can cause the abnormality of tear quality and quantity, the decrease of tear film stability and the injury of ocular surface epithelium. Thus causing burning, foreign body sensation, dry sense, visual fatigue and other eye discomfort symptoms.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R771.3

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