제 2형 당뇨환자들의 건성안증후군과 마이봄샘의 형태학적 변화
Dry Eye Syndrome and Morphological Changes of Meibomian Glands in Type 2 Diabetic Patients
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목적: 제 2형 당뇨환자들에서 건성안증후군과 마이봄샘 형태학적 변화를 평가하고, 영향을 미치는 인자에 대해 분석하고자 하였다. 대상과 방법: 당뇨망막병증 평가를 위해 안과에 의뢰된 제 2형 당뇨환자 중 건성안 증상을 호소한 총 72명의 의무기록을 후향적으로 검토하였다. 결과: 총 72명의 환자(56.3 ± 13.3세)에 대하여 분석하였으며, 당뇨망막병증이 존재하는 군(52명)에서 당뇨망막병증이 없는 군(20명)에 비해 통계학적으로 유의하게 눈물막파괴시간이 짧고(p=0.046) 쉬르머검사값이 낮았으며(p=0.005), 상안검(p=0.036) 및 하안검(p=0.017) 마이봄샘 소실 면적의 비율이 높았다. 당뇨 관련 특성과 함께 성별과 나이를 추가적으로 고려하여 시행한 다중선형회귀분석 결과, 쉬르머검사값은 당뇨망막병증의 병기가 증가할수록 낮았고(β=-1.180, p=0.016), 상안검 마이봄샘 소실 면적의 비율은 나이(β=0.605, p<0.001), 당화혈색소(β=1.881, p=0.011), 당뇨망막병증의 병기(β=4.458, p=0.001)가 증가할수록 증가하였으며, 하안검 마이봄샘 소실 면적의 비율은 나이(β=0.443, p=0.001), 당뇨망막병증의 병기(β=4.879, p=0.001)가 증가할수록 증가하였다. 결론: 당뇨환자에서 당뇨망막병증이 심할수록 마이봄샘 소실 면적이 증가할 수 있으므로 주의 깊게 평가하여 적절한 치료가 이루어지도록 해야 할 것이다.
Abstract
Purpose: To evaluate the morphological changes of meibomian glands and dry eye syndrome in patients with type II diabetes. Methods: The medical records of 72 diabetic patients referred to the ophthalmology clinic for the evaluation of diabetic retinopathy, who had dry eye symptoms, were retrospectively reviewed. Results: A total of 72 patients, with an age of 56.3 ± 13.3 years, were analyzed. The group with diabetic retinopathy (52 patients) had a significantly lower tear film break-up time (p = 0.046), lower Schirmer’s test value (p = 0.005), and higher percentage of upper (p = 0.036) and lower (p = 0.017) meibomian gland area losses than the group without diabetic retinopathy (20 patients). According to multilinear regression analyses considering sex, age, and diabetes-related characteristics, the Schirmer’s test value was significantly lower with increasing stage of diabetic retinopathy (β = -1.180, p = 0.016). The percentage of upper meibomian gland area loss was significantly increased with increasing age (β = 0.605, p < 0.001), glycosylated hemoglobin (β = 1.881, p = 0.011), and stage of diabetic retinopathy (β = 4.458, p = 0.001). The percentage of lower meibomian gland loss area was significantly increased with increasing age (β = 0.443, p = 0.001) and stage of diabetic retinopathy (β = 4.879, p = 0.001). Conclusions: In patients with type 2 diabetes, the more severe the diabetic retinopathy, the more likely the meibomian gland loss will occur, so careful and appropriate treatment should be conducted.
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