方法：病例对照研究。选取存在泪膜异常的2型糖尿病(T2DM)患者59例59眼，以是否存在DPN分为T2DM组31例31眼和DPN组28例28眼，另选择符合泪膜异常标准且无糖尿病的患者33例33眼作为无T2DM组。对三组患者进行眼表疾病指数(OSDI)量表评分、泪膜破裂时间(BUT)、角结膜荧光素钠染色(FL)评分、泪液分泌试验(SchirmerⅠ)、红外线睑板腺照相。

结果：各组间BUT结果有差异(F=9.43，P<0.01)，无T2DM组、T2DM组和DPN组两两比较均有差异(P<0.05)； 各组间Schirmer Ⅰ及FL阳性率比较无差异(P>0.05)； 各组间睑板腺缺失评分有差异(χ²=8.433，P<0.05)，T2DM组与无T2DM组比较无差异(P>0.05)，DPN组与无T2DM组、T2DM组比较均有差异(P<0.05)； 各组间OSDI量表评分比较有差异(P<0.05)，两两比较，T2DM组与无T2DM组比较无差异(P>0.05)，DPN组与无T2DM组、T2DM组比较均有差异(P<0.05)。

结论：合并DPN的T2DM患者较不伴发DPN的T2DM患者及无T2DM患者BUT更短、睑板腺缺失更重，但干眼症状更不明显，应密切关注和随访DPN患者的眼表异常。

METHODS: Retrospective case-control study was conducted. A total of 59 patients(59 eyes)with tear film abnormalities who were diagnosed with type 2 diabetes mellitus(T2DM)were divided into group T2DM(31 cases, 31 eyes)and group DPN(28 cases, 28 eyes)depending on the presence or absence of diabetic peripheral neuropathy. Patients at the Department of Ophthalmology who met the criteria of tear film abnormalities and without diabetes were selected as the non-T2DM group(33 cases, 33 eyes). All subjects were completed the Ocular Surface Disease Index(OSDI), and underwent fluorescein breakup time test(BUT), fluorescein staining(FL), Schirmer Ⅰ test(SchirmerⅠ)and infrared meibomian gland photography.

RESULTS: A statistically significant difference was observed among the three groups for the BUT values(F=9.43, P<0.01), and differences still existed between any two of the three groups(P<0.05). There were no statistically differences among the three groups for the Schirmer Ⅰ and the positive rates of fluorescein staining(P>0.05). There was statistically difference among the three groups for meibomian gland loss scores(χ²=8.433, P<0.05). Statistically differences only were observed between DPN group with non-T2DM group or T2DM group(P<0.05). Difference of OSDI scores of three groups was statistically significant(P<0.05). There was no significant difference between T2DM group and non-T2DM group(P>0.05), meanwhile between DPN group with non-T2DM group or T2DM group, the differences were statistically significant(P<0.05).

CONCLUSION: T2DM patients with DPN are more likely to have shorter BUT and more meibomian gland loss than T2DM patients without DPN and patients without T2DM, but the symptoms of dry eye are less obvious. Ocular surface abnormalities should be followed up closely in DPN patients.