目的：探讨2型糖尿病合并周围神经病变(DPN)患者的干眼临床特征。

方法：前瞻性队列研究。收集2021-07/2022-03上海中医药大学附属曙光医院内分泌科2型糖尿病患者192例，均选右眼为观察眼，其中确诊为DPN患者122例，糖尿病无周围神经病变(NDPN)患者70例。比较两组患者眼表疾病指数量表(OSDI)评分、泪河高度、泪河宽度、角膜上皮厚度、角膜内皮细胞密度、泪液分泌试验(SⅠt)、角膜敏感度、睑板腺功能状态评分、泪膜破裂试验(BUT)、角膜荧光素钠染色评分及多伦多临床评分系统(TCSS)评分，分析2型糖尿病患者OSDI评分与TCSS评分的相关性。

结果：DPN组患者干眼患病率(55眼，45.1%)显著高于NDPN组(20眼，28.6%)(χ²=5.094，P=0.024)，BUT和角膜敏感度评分低于NDPN组(P<0.001)，角膜染色评分和睑板腺功能评分高于NDPN组(P<0.001)。所有受试者OSDI评分与TCSS评分呈负相关(r_s=-0.233，P=0.002)，同时DPN组受试者的OSDI评分与TCSS评分呈负相关(r_s=-0.511，P<0.001)，而NDPN组患者两项评分间无显著相关(r_s=0.007，P=0.957)。

结论：DPN患者相较NDPN患者更容易患干眼，OSDI评分对于2型糖尿病患者尤其是DPN患者并非是准确的干眼评价指标。

METHOD: Prospective cohort study. A total of 192 patients with type 2 diabetes were enrolled in the Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from July 2021 to March 2022. The right eyes of all patients were selected as the observation eye, among which 122 patients were diagnosed with diabetic peripheral neuropathy(DPN)and 70 patients were diagnosed with non-diabetic peripheral neuropathy(NDPN). The score of ocular surface disease index(OSDI), tear meniscus height, tear meniscus width, corneal epithelial thickness, corneal endothelial cell density, tear secretion test(Schirmer Ⅰ test, SⅠt), corneal sensitivity, meibomian gland function status score, tear film breakup time(BUT), corneal fluorescein sodium staining score and Toronto clinical scoring system(TCSS)score were compared between two groups. The correlation between OSDI score and TCSS score in type 2 diabetes patients was analyzed as well.

RESULTS: The morbidity of dry eye in the DPN group(55 eyes, 45.1%)was significantly higher than that of NDPN group(20 eyes, 28.6%; χ²=5.094, P=0.024), BUT and corneal sensitivity score of DPN were lower than NDPN group(P<0.001), meanwhile, corneal staining score and meibomian gland function score were higher than NDPN group(P<0.001). OSDI scores of all subjects were negatively correlated with TCSS scores(r_s=-0.233, P=0.002), and OSDI scores of DPN group were negatively correlated with TCSS scores(r_s=-0.511, P<0.001), but there was no significant correlation between the two scores of NDPN patients(r_s=0.007, P=0.957).

CONCLUSIONS: DPN patients are more likely to develop dry eye than NDPN patients. OSDI score is not an accurate evaluation index for type 2 diabetes patients, especially for DPN patients.