方法：收集2016-04/08在我院内分泌科住院确诊的2型糖尿病患者85例85眼，用复方托吡卡胺滴眼液进行散瞳，共3次，30min后测量瞳孔直径，根据糖尿病的病程、糖化血红蛋白水平、眼底病变程度及周围神经病变进行分组，比较各组中瞳孔散大水平。

结果：糖尿病病程5a以下组、5～10a组和10a以上组瞳孔散大水平分别是6.98±0.78、6.18±0.67、6.00±0.73mm，三组间差异有统计学意义(P<0.01)。非增殖期糖尿病视网膜病变组瞳孔散大水平(6.05±0.92mm)明显低于临床前期组(6.75±0.76mm)，两组间差异有统计学意义(P=0.001)。踝-膝传导速度正常组瞳孔散大水平(6.70±0.84mm)明显大于传导速度异常组(6.23±0.81mm)，两组间差异有统计学意义(P<0.05)。糖化血红蛋白水平<8.4%组、8.4%～13.4%组和>13.4%组瞳孔散大水平分别是6.60±0.82、6.53±0.86、6.73±0.73mm，三组间差异无统计学意义(P=0.708)。

结论：影响2型糖尿病患者瞳孔散大因素有糖尿病病程、糖尿病视网膜病变及周围神经的病变。要改善糖尿病对瞳孔的影响，必须尽早发现糖尿病并及时治疗。对瞳孔不易散大的糖尿病患者，需更加注重对眼底的检查，以免糖尿病视网病变的漏诊。

METHODS: Totally 85 patients with type 2 diabetes were collected from April 2016 to August 2016 in department of Endocrinology in our hospital. Compound tropicamide was instilled in the right eyes of the 85 patients,then pupil diameters were measured 30min after instillation. They were divided into different groups according to the duration of diabetes, glycosylated hemoglobin levels, the degree of retinopathy and peripheral neuropathy. Influencing factors of the dilated pupil were analyzed.

RESULTS: In the three groups as the duration of diabetes was 5a, 5-10a or 10a or more respectively, the pupil diameters were 6.98±0.78mm, 6.18±0.67mm and 6.00±0.73mm, and the difference between the three groups was statistically significant(P<0.01). In non-proliferative diabetic retinopathy group, the pupil diameters(6.05±0.92mm)was significantly lower than that in the pre-clinical group(6.75±0.76mm), the difference between the two groups was statistically significant(P=0.001). The normal group of the ankle-knee conduction velocity(6.70±0.84mm)was significantly higherthan that in the abnormal group(6.23±0.81mm), and the difference was statistically significant between the two groups(P<0.05). In the three groups as the level of glycosylated hemoglobin was less than 8.4%, 8.4%～13.4% or more than 13.4%, pupil diameters were 6.60±0.82mm, 6.53±0.86mm and 6.73±0.73mm, the difference between the three groups was not statistically significant(P=0.708).

CONCLUSION: The main factors influencing the pupil are duration of diabetes, diabetic retinopathy and peripheral nerve lesions. In order to improve the effect of diabetes mellitus on the pupils, it is necessary to discover and treat the diabetic patients as early as possible. Diabetes patients with small pupil should more pay attention to the fundus examination, in order to avoid missed diagnosis of diabetic retinopathy.