目的：探讨糖尿病视网膜病变(DR)严重程度与角膜上皮基底神经丛(SNP)变化间的相关性。

方法：研究纳入我院2018-01/2021-05收治2型糖尿病(T2DM)患者132例132眼和年龄相关性白内障患者80例80眼，其中T2DM患者中包括非DR(NDR)患者52例52眼，非增生性DR(NPDR)患者40例40眼及增生性DR(PDR)患者40例40眼，分析一般资料和角膜激光扫描共焦显微镜检查资料，采用Spearman秩相关分析评价DR临床分期与神经纤维长度间相关性。

结果：四组性别和年龄比较均无差异(P>0.05)； PDR组糖尿病病程显著长于NPDR组、NDR组(P<0.05)； NPDR组糖尿病病程显著长于NDR组(P<0.05)； 年龄相关性白内障组空腹血糖和糖化血红蛋白水平均显著低于其他三组(P<0.05)； PDR组最佳矫正视力显著低于NPDR组、NDR组(均P<0.05)； NPDR组最佳矫正视力显著低于NDR组(P<0.05)； 年龄相关性白内障组神经纤维长度值均显著大于NDR组、NPDR组及PDR组(P<0.05)； PDR组神经纤维长度值显著小于NPDR组(P<0.05)； Spearman秩相关分析结果显示，DR分期与神经纤维长度间呈负相关(r_s=-0.347，P<0.001)。

结论：DR病情严重程度与角膜上皮基底神经丛变化间具有相关性，PDR患者神经纤维长度较NPDR显著缩短； PDR和NPDR均存在神经结构缺失，T2DM眼底病变治疗时注意对眼表病变情况评估及处理。

METHODS: There were 132 patients with 132 eyes in type 2 diabetes(T2DM)and 80 patients with 80 eyes in age-related cataract selected in our hospital from January 2018 to May 2021, among them, there were 52 non-diabetic retinopathy(NDR)patients with 52 eyes, 40 non proliferative diabetic retinopathy(NPDR)patients with 40 eyes and 40 proliferative diabetic retinopathy(PDR)patients with 40 eyes in T2DM. The general data and corneal laser scanning confocal microscopy were analyzed. Spearman rank correlation analysis was used to evaluate the correlation between DR clinical stage and nerve fiber length.

RESULTS: There were no differences in gender and age comparisons among 4 groups(P>0.05). The diabetes duration in PDR group was significantly longer than NPDR group and NDR group(P<0.05). The diabetes duration in NPDR group was significantly longer than NDR group(P<0.05). The levels of fasting blood glucose and glycosylated hemoglobin in age-related cataract group were significantly lower than other three groups(P<0.05). The best corrected visual acuity in PDR group was significantly lower than NPDR group and NDR group(P<0.05). The best corrected visual acuity in NPDR group was significantly lower than NDR group(P<0.05). The length of nerve fibers in age-related cataract group was significantly higher than NDR group, NPDR group and PDR group(P<0.05). The length of nerve fibers in PDR group was significantly shorter than NPDR group(P<0.05). Spearman rank correlation analysis showed that there was a negative correlation between DR stage and nerve fiber length(r_s=-0.347, P<0.001).

CONCLUSION: There was a correlation between the severity of DR and the changes of corneal SNP. The length of nerve fibers in patients with PDR was significantly shorter than patients with NPDR; Both PDR and NPDR have a loss of neural structure and should pay attention to the evaluation and treatment of ocular surface lesions in the treatment of T2DM fundus lesions.