光学相干断层扫描对糖尿病患者泪河高度和面积的测量

目的探讨光学相干断层扫描对诊断糖尿病患者干眼症临床应用价值。方法选取2型糖尿病患者96例(192眼),按病程分为A组55例(病程<10年)和B组41例(病程≥10年),按是否合并糖尿病视网膜病变分为NoDR组39例,NPDR组35例,PDR组22例,无糖尿病健康对照组43例(86眼),应用光学相干断层扫描测量下泪河的高度(tear meniscus height,TMH)和面积(TMA,tearmeniscus area),同时进行干眼症状评分(Dry Eye Symptom Score,DESS)、角膜荧光素染色评分(fluorescein,FL)、基础泪液分泌试验(Schirmer I test,SIt)和泪膜破裂时间(break-up time,BUT)测定,采用检验和方差分析对各组数据进行比较,用Spearman相关性分析对TMH和DESS、FL、SIt和BUT进行相关性分析。结果糖尿病组TMH值、TMA值、DESS评分、FL评分、BUT及SIt等各项测量值和对照组相比差异有统计学意义(P<0.05);糖尿病A组TMH值、TMA值、BUT和SIt测量值和B组相比差异具有统计学意义(P<0.05),而DESS评分和FL评分两组比较差异无统计学意义(P>0.05);NoDR、NPDR和PDR三组之间TMH值、TMA值和SIt测量值比较差异有统计学意义(P<0.05),BUT、DESS和FL评分比较差异无统计学意义(P>0.05);TMH测量值与DESS评分呈负相关(rs=-0.612,P<0.05);与FL和SIt弱相关(FL:rs=0.314,P<0.05;SIt:rs=0.363,P<0.05),与BUT呈正相关(rs=0.676,P<0.05)。结论光学相干断层扫描可精确测量泪河高度和面积,可以作为干眼症的客观诊断指标;糖尿病患者泪液分泌减少及泪膜功能的损害随糖尿病的病程和视网膜病变的发展加重。

The Measure of Tear,Meniscus Height and Area by Optical Coherence Tomography in Diabetes Mellitus.

Objeetive To investigate the clinical diagnositic value of optical coherence tomography in diabetes mellitus with dry eye. Methods 96 cases （192 eyes） with II type diabetes mellitus and 43 cases （86 eyes） of healthy people as control group were studied, according to the disease history whom were divided into A group（〈10years） and B group（≥ 10 years）, according to combining the diabetes retinopathy divided into NoDR group（39 cases）, NPDR group（35 cases） and DR group（22 cases）. The height and area of lower tear meniscus（TMH and TMA） was measured with optical coherence tomography. All cases were carried out with Dry Eye Symptom Score （DESS）, fluorescein （FL）, Schirmer I test （Sit） and break-up time （BUT）. The data was analyzed with t-test and variance analysis. The relevance of TMH, DESS, FL, Sit and BUT was proceeded with Spearman analysis. Results The value of TMH, TMA, DESS, FL, Sit and BUT in diabetes mellitus group was significant different with that in control group（P〈0.05）. In diabetes mellitus patients, the value of TMH, TMA, Sit and BUT in A group was significant different with that in B group（P〈0.05）, but the score of DESS and FL no different（P〉0.05）. In the patients of NoDR group, NPDR group and PDR group, the value of TMH, TMA and Sit were significant different（P〈0.05）, but the BUT, DESS and FL were not different（P〉0.05）. The value of TMH was negative correlation with DESS score（rs=-0.612,P〈0.05）, weak correlation with FL and SIt（FL： rs=0.314,P〈0.05;SIt： rs=0.363,P〈0.05）, and positive correlation with BUT（r,=0.676,P〈0.05）respectively. Conclusions The height and area of tear meniscus could be accurately measured by optical coherence tomography, which could be the objective diagnosis index in patients with dry eye. Along with the duration of the diabetes and the aggravating of the DR, the decrease in tear secretion and tear film function damage to gradually increase in diabetes mellitus.