目的探讨2型糖尿病患者角膜透明度的变化及其影响因素。
方法采用病例对照研究，纳入2020年10月1日至2021年10月30日于安徽医科大学第二附属医院就诊的2型糖尿病患者52例104眼和年龄匹配的健康对照者23例46眼，分别作为糖尿病组和正常对照组。糖尿病患者根据眼底情况分为无糖尿病视网膜病变(DR)组和DR组。采用Pentacam对角膜光密度(CD)进行评估。依据Pentacam仪器自带程序将角膜分为前、中、后层，并以角膜顶点为圆心分为0～2 mm、>2～6 mm、>6～10 mm和>10～12 mm区，仪器自动计算角膜各层和各区域CD值和总CD值。采用多因素线性回归分析模型分析糖尿病组总CD值的影响因素。
结果糖尿病组患者受检眼总CD值为20.24±3.10，明显高于正常对照组的18.79±3.31，差异有统计学意义( t＝－2.583， P＝0.011)。糖尿病组患者受检眼角膜前层、中层、0～2 mm、>2～6 mm区CD值均明显高于正常对照组，差异均有统计学意义(均 P<0.05)。无DR组和DR组受检眼前层CD值均高于正常对照组，无DR组受检眼角膜中层和后层CD值和总CD值均高于正常对照组和DR组，差异均有统计学意义(均 P<0.05)。0～2 mm和>2～6 mm环区无DR组和DR组受检眼CD值均明显高于正常对照组，>6～10 mm环区无DR组受检眼CD值明显高于DR组和正常对照组，差异均有统计学意义(均 P<0.05)。多因素线性回归分析显示，糖尿病患者年龄和糖化血红蛋白(HbA1c)水平是CD值升高的主要影响因素( β＝0.266， P<0.001； β＝0.423， P＝0.003)。
结论糖尿病患者的角膜透明度下降先于DR出现，糖尿病患者HbA1c水平控制不佳可引起角膜透明度下降。
ObjectiveTo investigate corneal transparency alteration in patients with type 2 diabetes and its influencing factors.
MethodsA case-control study was conducted.A total of 52 patients with type 2 diabetes mellitus (DM) (104 eyes) and 23 age-matched healthy controls (46 eyes) were enrolled as DM group and normal control group in the Second Affiliated Hospital of Anhui Medical University from October 1, 2020 to October 30, 2021.Patients with DM were further divided into non-diabetic retinopathy (non-DR) and DR groups according to their fundus conditions.Corneal densitometry (CD) was evaluated using the Pentacam.According to its built-in program, the cornea was divided into anterior, intermediate, and posterior layers and subdivided into 0-2 mm, >2-6 mm, >6-10 mm, and >10-12 mm annular regions with the corneal apex as the center of the circle.Pentacam automatically calculated the CD value of each corneal layer and region as well as the total CD value.The influencing factors of total CD value in diabetes group were analyzed by a multivariate linear regression analysis model.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Anhui Medical University (No.YX2023-129[F1]).Written informed consent was obtained from each subject before any medical examination.
ResultsThe total CD value of diabetes group was 20.24±3.10, which was significantly higher than 18.79±3.31 of normal control group ( t=-2.583, P=0.011).The CD values of the anterior layer, intermediate layer, 0-2 mm, and >2-6 mm regions were significantly higher in diabetes group than in normal control group (all at P<0.05).The CD values in the anterior layer were higher in non-DR and DR groups than in normal control group, and the CD values and total CD values in the middle and posterior layers were higher in non-DR group than in normal control group and DR group, and the differences were statistically significant (all at P<0.05).The CD values in the 0-2 mm and >2-6 mm regions were significantly higher in non-DR group than in normal control group, and the CD value in the >6-10 mm annular region was significantly higher in non-DR group than in DR group and normal control group (all at P<0.05).Multivariate linear regression analysis showed that age and glycosylated hemoglobin (HbA1c) level were the main influencing factors for the increase in CD values in diabetic patients ( β=0.266, P<0.001; β=0.423, P=0.003).
ConclusionsThe decrease of corneal transparency precedes the appearance of DR in patients with diabetes.Poor control of HbA1c level in diabetic patients may cause the decline of corneal transparency.
郑雨薇,郭斌,魏升升,等. 2型糖尿病患者角膜透明度变化及其影响因素[J]. 中华实验眼科杂志,2024,42(08)：716-721.
DOI:10.3760/cma.j.cn115989-20231008-00116版权归中华医学会所有。
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郑雨薇：试验设计、文章撰写；郭斌：数据统计分析、作图；魏升升、张慧芹、张佳媚：数据整理；王雁：研究指导、论文审阅及定稿
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