本文選題：糖尿病　切入點(diǎn)：淚膜　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景和目的:正常的眼表結(jié)構(gòu)與功能是獲取清晰視覺(jué)的保證。眼表的健康依賴于淚膜的穩(wěn)定性和眼表上皮的完整性。任何原因引起的淚液質(zhì)或量的異常,均可引起淚膜穩(wěn)定性下降和眼表組織的損害,從而導(dǎo)致眼部出現(xiàn)異物感、干澀感、視物模糊等多種不適癥狀。糖尿病可以引起眼瞼、結(jié)膜、角膜等眼表組織的多種病變。本研究通過(guò)對(duì)糖尿病患者與健康志愿者眼表相關(guān)指標(biāo)進(jìn)行檢查、比較,觀察糖尿病患者的眼表情況,探討糖尿病對(duì)眼表組織的影響。方法:選取在我院內(nèi)分泌科就診的糖尿病患者(符合1999年世界衛(wèi)生組織制定的糖尿病診斷標(biāo)準(zhǔn))30例作為糖尿病組;自愿接受檢查的健康志愿者30例作為對(duì)照組。分別進(jìn)行以下檢查:裂隙燈顯微鏡檢查眼瞼、結(jié)膜、角膜等眼表組織;眼表疾病指數(shù)(Ocular Surface Disease Index,OSDI)問(wèn)卷調(diào)查表評(píng)估眼部癥狀;Keratograph眼表綜合分析儀進(jìn)行淚河高度、淚膜破裂時(shí)間(Tear Break-up Time,TBUT)、角膜熒光素染色(Corneal Fluorescein Staining,CFS)及瞼板腺檢查;角膜地形圖儀檢測(cè)自然睜眼狀態(tài)時(shí)及持續(xù)睜眼10秒(second,s)后角膜表面規(guī)則指數(shù)(Surface Regular Index,SRI);淚液分泌試驗(yàn) I(Schirmer I Test,SIt)檢查淚液分泌情況;記錄檢查結(jié)果并進(jìn)行統(tǒng)計(jì)學(xué)分析。所有研究對(duì)象均自愿接受以上檢查并簽署知情同意書(shū),同一檢查均由同一位檢查者在相同條件下進(jìn)行。結(jié)果:糖尿病患者存在不同程度的眼部燒灼感、異物感、干澀感、刺激感及視力下降等不適癥狀,健康志愿者出現(xiàn)上述癥狀的情況較少、不適癥狀的程度較輕,糖尿病組OSDI分值較對(duì)照組高,兩組差異有統(tǒng)計(jì)學(xué)意義(P0.01);糖尿病組淚液分泌的質(zhì)和量均存在不同程度異常,與對(duì)照組相比,糖尿病患者的淚河高度、TBUT、SIt均有不同程度下降,兩組結(jié)果相比,均有統(tǒng)計(jì)學(xué)差異(均P0.01);糖尿病組角膜上皮受損程度、角膜熒光素染色陽(yáng)性率及著染程度均較對(duì)照組明顯,CFS評(píng)分及角膜SRI(自然睜眼狀態(tài)時(shí)及持續(xù)睜眼10s后)較對(duì)照組高,兩組結(jié)果差異有統(tǒng)計(jì)學(xué)意義(均P0.05);糖尿病組與對(duì)照組的瞼板腺缺失情況無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:糖尿病可引起淚液質(zhì)和量的異常,導(dǎo)致淚膜穩(wěn)定性下降及眼表上皮損傷,從而引起燒灼感、異物感、干澀感、視疲勞等多種眼部不適癥狀。
[Abstract]:Background and objective: normal ocular surface structure and function are the guarantee of clear vision. The health of eye surface depends on the stability of tear film and the integrity of ocular surface epithelium. Can cause tear film stability decline and ocular surface tissue damage, resulting in the eyes of foreign body feeling, dry sense, blurred vision and other symptoms. Diabetes can cause eyelid, conjunctiva, In this study, the ocular surface of diabetic patients and healthy volunteers were examined and compared to observe the ocular surface of diabetic patients. Methods: 30 patients with diabetes mellitus (in accordance with the diabetes diagnostic criteria established by the World Health Organization in 1999) were selected as the diabetic group. 30 healthy volunteers who volunteered to be examined as control group were examined as follows: slit-lamp microscope was used to examine eyelid, conjunctiva, cornea and other ocular surface tissues; The ocular symptom was evaluated by Keratograph synthetic analyzer. The tear film rupture time (Tear Break-up time), cornea fluorescein staining (Corneal Fluorescein Stainingus) and tarsal gland were examined. The corneal surface rule index (Regular index) and tear secretion test (I) were detected by corneal topography when the eyes opened naturally and when the eyes were opened at 10 seconds. The results were recorded and statistically analyzed. All the subjects voluntarily accepted the above examination and signed the informed consent form. The same examination was carried out by the same examiner under the same conditions. Results: the diabetic patients had different degrees of eye burning, foreign body sensation, dry feeling, irritating feeling and decreased visual acuity, etc. The OSDI score of the diabetic group was higher than that of the control group, the difference between the two groups was statistically significant (P 0.01), the quality and quantity of tear secretion in the diabetic group were abnormal in different degrees. Compared with the control group, the level of TBUTSIt in diabetic patients decreased in varying degrees, and there were significant differences between the two groups (all P 0.01), and the degree of corneal epithelium damage in the diabetic group was significantly higher than that in the control group. The positive rate and staining degree of fluorescein staining in cornea were significantly higher than those in the control group, and the corneal SRI (when the eyes opened naturally and after 10 seconds of continuous opening) were higher than those in the control group. There was significant difference between the two groups (P 0.05), but there was no significant difference between the diabetic group and the control group. Conclusion: diabetes can cause the abnormality of tear quality and quantity, the decrease of tear film stability and the injury of ocular surface epithelium. Thus causing burning, foreign body sensation, dry sense, visual fatigue and other eye discomfort symptoms.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2;R771.3

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本文編號(hào)：1617953