目的：探讨2型糖尿病病程、血糖水平、血清C肽与干眼的关系及糖尿病发生干眼的危险因素。

方法：收集江苏省中医院内分泌科确诊的2型糖尿病患者51例102眼的临床资料，其中明确诊断为干眼的患者44例88眼。检测糖化血红蛋白(HbA1c)、空腹血糖(FBG)、餐后2h血糖(2h PBG)、空腹及餐后1h血清胰岛素及C肽。记录患者的视力、瞬目次数、角膜荧光素染色(fluorescein，FL)评分、泪膜破裂时间(break up time，BUT)、基础泪液分泌(SchirmerⅠtest，SⅠt)情况。比较生化指标与眼表指标的关系，采用Logistic回归分析2型糖尿病患干眼的危险因素。

结果：不同糖尿病病程患者的BUT和SⅠt检查结果、瞬目次数、视力、FL和干眼症状评分差异均无统计学意义(P>0.05)。HbA1c值与FL显著相关(P<0.05)，8.1%P<0.01)。空腹血糖水平与FL评分、瞬目次数显著相关(P<0.05)，餐后2h血糖与泪液分泌量和视力显著相关(P<0.05)。血清C肽水平与BUT有显著相关性(P<0.05)，3.3ng/mL≤餐后1h血清C肽≤5.5ng/mL患者的BUT与其它水平相比有显著差异(P<0.05)。空腹血糖及血清C肽水平均是糖尿病患者发生干眼的危险因素(P<0.05)。

结论：胰岛素分泌功能差和血糖控制不佳是糖尿病患者发生干眼的危险因素，二者均可导致泪膜稳定性下降，高血糖状态易导致泪液分泌减少，视力损伤及角膜上皮缺损。

METHODS: The clinical data of 51 patients(102 eyes)with type 2 diabetes diagnosed by the Department of Endocrinology, Jiangsu Provincial Hospital of Traditional Chinese Medicine was collected, in that 44 cases(88 eyes)of patients diagnosed with dry eye. Those patients were detected for the levels of glycosylated hemoglobin A1c(HbA1c), fasting blood-glucose(FBG), postprandial 2h blood-glucose(2h PBG), fasting plasma C-peptide and insulin, 1h C-peptide and insulin. Corneal fluorescein staining(FL), tear break-up time(BUT)and Schirmer Ⅰ test(SⅠt)were collected from all subjects. Compared biochemistry index and ocular surface index. The multiple Logistic regression was used to analyze the risk factors for dry eye in patients with T2DM.

RESULTS: There was no significant differences between the patients with different diabetic duration, on BUT, SⅠt, winking frequency, vision, FL and the scores of dry eye symptoms(P>0.05). HbA1c was significantly correlated with FL(P<0.05). There were significant differences in FL among patients with HbA1c in 8.1% to 11.8%(P<0.01). FBG was significantly correlated with FL and winking frequency(P<0.05). The 2h PBG was significantly correlated with tear secretion and vision(P<0.05). Plasma C-peptide was significantly correlated with BUT(P<0.05). There were significant differences in BUT among patients with 1h C-peptide in 3.3-5.5ng/mL(P<0.05). FBG and plasma C-peptide in T2DM patients were risk factors for occurrence of dry eye(P<0.05).

CONCLUSION: Poor function of insulin secretion and poor control of blood glucose in T2DM patients are risk factors for dry eye. Both of them can decline tear film stability. High blood glucose levels easily lead to decrease of tear secretion, vision and corneal epithelial defect.