目的：探究糖尿病合并睑板腺功能障碍(MGD)患者眼表相关指标及泪液中基质金属蛋白酶9(MMP-9)含量的变化，分析糖尿病对MGD患者眼表状况及泪液MMP-9水平的影响，为临床诊疗提供参考。

方法：前瞻性观察性研究。选取2024年6月至2024年12月我院眼科就诊的合并2型糖尿病的MGD患者(糖尿病合并MGD组)； 同期纳入无糖尿病病史、仅确诊MGD的患者(无糖尿病MGD组)。将糖尿病合并MGD患者按糖化血红蛋白(HbA1c)水平分为HbA1c<7.5%组和HbA1c≥7.5%组，按糖尿病病程分为病程<10 a组和病程≥10 a组。检测所有研究对象的眼表疾病指数(OSDI)评分、睑缘改变评分等多项眼表指标及泪液MMP-9含量，并进行比较分析。

结果：本研究共纳入2型糖尿病合并MGD患者101例202眼，其中男56例，女45例，年龄60.2±8.5岁； 无糖尿病MGD组纳入151例302眼，男82例，女69例，年龄57.5±7.8岁。HbA1c<7.5%组55例110眼，年龄59.6±8.2岁，男31例，女24例； HbA1c≥7.5%组共46例92眼，年龄60.9±8.7岁，男25例，女21例。病程<10 a组50例100眼，年龄58.7±8.1岁，男28例，女22例； 病程≥10 a组51例102眼，年龄61.6±8.4岁，男27例，女24例。糖尿病合并MGD患者的OSDI评分、睑板腺开口评分、睑板腺排出功能评分、分泌物性状评分、角膜荧光素染色评分及泪液MMP-9含量高于无糖尿病MGD患者(均P<0.01)，泪膜破裂时间(BUT)及泪液分泌试验小于无糖尿病MGD患者(均P<0.01)。针对糖尿病合并MGD患者，HbA1c≥7.5%组的OSDI评分、睑板腺开口评分、睑板腺排出功能评分、分泌物性状评分、角膜荧光素染色评分、泪液MMP-9含量显著高于HbA1c<7.5%组(均P<0.05)，BUT、泪液分泌检查显著低于HbA1c<7.5%组(均P<0.05)； 病程≥10 a组的OSDI评分、睑板腺开口评分、睑板腺排出功能评分、分泌物性状评分、角膜荧光素染色评分、泪液MMP-9含量显著高于病程<10 a组(均P<0.05)，BUT、泪液分泌试验显著低于病程<10 a组(均P<0.05)。

结论：糖尿病可能与MGD患者眼表损伤程度加重相关，可伴随泪液MMP-9含量升高； 血糖控制不佳及病程较长的糖尿病合并MGD患者眼表损伤更显著，泪液MMP-9水平更高。泪液MMP-9或可作为评估糖尿病合并MGD患者眼表炎症及损伤程度的参考指标，为临床治疗方案的制定提供一定依据。

METHODS: Prospective observational study.Patients with type 2 diabetes mellitus complicated with MGD who visited the Department of Ophthalmology of the hospital from June 2024 to December 2024 were enrolled(diabetes mellitus+MGD group), and patients diagnosed solely with MGD without a history of diabetes mellitus during the same period were recruited as the non-diabetic MGD group. Patients in the diabetes mellitus+MGD group were further subdivided into aglycosylated hemoglobin(HbA1c)<7.5% subgroup and an HbA1c≥7.5% subgroup based on HbA1c levels, and into a diabetes duration<10 y subgroup and a diabetes duration ≥10 y subgroup according to the duration of diabetes mellitus. Multiple ocular surface parameters, including the Ocular Surface Disease Index(OSDI)score and eyelid margin alteration score, as well as tear MMP-9 concentration, were measured in all participants, followed by between-group comparative analyses.

RESULTS:Total of 101 patients(202 eyes)with type 2 diabetes mellitus combined with MGD were enrolled, including 56 males and 45 females with a mean age of 60.2±8.5 y. The non-diabetic MGD group consisted of 151 patients(302 eyes), with 82 males and 69 females and a mean age of 57.5±7.8 y.The HbA1c <7.5% group comprised 55 patients(110 eyes)aged 59.6±8.2 y; 31 males and 24 females. The HbA1c ≥7.5% group included 46 patients(92 eyes)aged 60.9±8.7 y; 25 males and 21 females.The subgroup with diabetes duration <10 y had 50 patients(100 eyes)aged 58.7±8.1 y; 28 males and 22 females, and the subgroup with duration ≥10 y consisted of 51 patients(102 eyes)aged 61.6±8.4 y; 27 males and 24 females. Patients in diabetes mellitus+MGD group exhibited higher OSDI scores, meibomian gland orifice scores, meibum expressibility scores, meibum quality scores, corneal fluorescein staining scores, and tear MMP-9 levels compared with non-diabetic MGD patients(all P<0.01), while tear film breakup time(BUT)and Schirmer test values were lower(all P<0.01).Among diabetic patients with MGD, the HbA1c≥7.5% subgroup had significantly higher OSDI score, meibomian gland orifice score, meibum expressibility scores, meibum quality scores, corneal fluorescein staining scores, and tear MMP-9 concentration than the HbA1c<7.5% subgroup(all P<0.05), accompanied by significantly shorter BUT and lower Schirmer I test results(all P<0.05). Similarly, the diabetes duration≥10 y subgroup showed significantly higher OSDI score, meibomian gland orifice score, meibum expressibility scores, meibum quality scores, corneal fluorescein staining scores, and tear MMP-9 concentration compared with the diabetes duration<10 y subgroup(all P<0.05), whereas BUT and Schirmer I values were significantly lower(all P<0.05).

CONCLUSION: Diabetes mellitus may be associated with aggravated ocular surface damage in patients with MGD, accompanied by elevated tear MMP-9 levels. Poor glycemic control and longer disease duration are related to more severe ocular surface injury and higher tear MMP-9 levels. Tear MMP-9 may serve as a potential indicator for evaluating ocular surface inflammation and damage in diabetic patients with MGD, providing certain evidence for clinical treatment decision-making.