干眼症发病机制与发病因素的研究进展
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摘要
干眼症的发病率逐年升高,已成为最常见的眼部疾病之一。目前,干眼症的治疗仍以人工泪液缓解症状为主。近年来,对干眼症发病机制的研究已不再局限于泪液分泌不足和泪液蒸发增加,而是涉及泪膜稳定性、泪液渗透压、神经感觉异常及眼表炎症等多方面,其中眼表产生的细胞因子是研究热点。环境、年龄、性别、全身性因素等也是干眼症发病的因素,医源性因素逐渐引起临床医师的重视。分析干眼症的发病机制及发病因素,有利于对干眼症进行分类、检查、诊断及治疗,提高患者的视觉质量。
Xerophthalmia has become one of the most common eye diseases with increasing incidence year by year. At present,the treatments still rely on artificial tear. In recent years,the research on the pathogenesis of xerophthalmia is no longer limited to simple insufficient lacrimal secretion or increased evaporation,but involves many aspects such as tear film stability,tear osmotic pressure,nerve sensory abnormalities and ocular surface inflammation. And the activity of ocular surface cytokines has become a hot topic. The study on the factors of xerophthalmia involves environment,age,sex,systemic factors and so on,among which iatrogenic factors have been paid more and more attention by the clinicians. The analysis of the pathogenesis and factors of xerophthalmia is crucial to the classification,examination,diagnosis and treatment,so as to improve the visual quality of the patients.
Xerophthalmia has become one of the most common eye diseases with increasing incidence year by year. At present,the treatments still rely on artificial tear. In recent years,the research on the pathogenesis of xerophthalmia is no longer limited to simple insufficient lacrimal secretion or increased evaporation,but involves many aspects such as tear film stability,tear osmotic pressure,nerve sensory abnormalities and ocular surface inflammation. And the activity of ocular surface cytokines has become a hot topic. The study on the factors of xerophthalmia involves environment,age,sex,systemic factors and so on,among which iatrogenic factors have been paid more and more attention by the clinicians. The analysis of the pathogenesis and factors of xerophthalmia is crucial to the classification,examination,diagnosis and treatment,so as to improve the visual quality of the patients.
引文
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[2]Craig JP,Nichols KK,Akpek EK,et al.TFOS DEWSⅡDefinition and Classification Report[J].Ocul Surf,2017,15(3):276-283.
[3]刘祖国,王华.关注干眼慢性疾病管理体系的建设[J].中华眼科杂志,2018,54(2):81-83.
[4]蔡蓉蓉,张朝然.粘蛋白与干眼症[J].眼科研究,2008,26(11):877-880.
[5]Yu DF,Chen Y,Han JM,et al.MUC19 expression in human ocular surface and lacrimal gland and its alteration in Sj9gren syndrome patients[J].Exp Eye Res,2008,86(2):403-411.
[6]Woodward AM,Argüeso P.Expression analysis of the transmembrane mucin MUC20 in human corneal and conjunctival epithelia[J].Invest Ophthalmol Vis Sci,2014,55(10):6132-6138.
[7]Ablamowicz AF,Nichols JJ.Ocular Surface Membrane-Associated Mucins[J].Ocul Surf,2016,14(3):331-341.
[8]Mantelli F,Argueso P.Functions of ocular surface mucins in health and disease[J].Curr opin Allergy Clin Immunol,2008,8(5):477-483.
[9]祁俏然,沈光林,马晓萍.眼表黏蛋白的研究进展及其与干眼的相关性[J].国际眼科杂志,2016,16(4):681-685.
[10]Govindarajan B,Gipson IK.Membrane-tethered mucins have multiple functions on the ocular surface[J].Exp Eye Res,2010,90(6):655-663.
[11]祁俏然,沈光林,马晓萍.眼表黏蛋白在干眼中的研究进展[J].中国临床医学,2015,22(5):710-714.
[12]The definition and classification of Dry Eye Disease:Report of the Definition and classification subcommittee of the international Dry Eye Work shop[J].Ocul surf,2007,5(2):75-92.
[13]El Annan J,Goyal S,Zhang Q,et al.Regulation of T-cell chemotaxis by programmed death-ligand 1(PD-L1)in dry eye-associated corneal inflammation[J].Invest Ophthalmol Vis Sci,2010,51(7):3418-3423.
[14]Bikker A,van Woerkom JM,Kruize AA.Increased expression of interleukin-7 in labial salivary glands of patients with primary Sj9gren's syndrome correlates with increased inflammation[J].Arthritis Rheum,2010,62(4):969-977.
[15]梅欢,金龙山,金花,等.IL-17在干眼发病中的作用及相关机制的研究进展[J].中国社区医师,2017,33(28):7-8,11.
[16]Sugaya S,Sakimoto,Shoji J,et al.Regulation of soluble interleukin-6(IL-6)receptor release from corneal epithelial cells and its role in the ocular surface[J].Jpn J Ophthalmol,2011,55(3):277-282.
[17]Tanaka H,Harauma A,Takimoto M,et al.Association between very long chain fatty acids in the meibomian gland and dry eye resulting from n-3 fatty acid deficiency[J].Prostaglandins Leukot Essent Fatty Acids,2015,97:1-6.
[18]Morreale de Escobar G.The role of thyroid hormone in fetal neurodevelopment[J].J Pediatr Endocrinol Metab,2001,14 Suppl 6:1453-1462.
[19]Haddow JE.Maternal thyroxine and fetal brain development:The latest chapter,a look back,and considerations for the future[J].J Clin Endocrinol Metab,2013,98(4):1388-1390.
[20]高彩凤,陈慧瑾,靳瑛,等.Th17相关细胞因子在干眼患者眼表的表达及其相关性研究[J].中华实验眼科杂志,2014,32(7):641-646.
[21]De Paiva CS,Chotikavanich S,Pangelinan SB,et al.IL-17disrupts corneal barrier following desiccating stress[J].Mucosal Immunol,2009,2(3):243-253.
[22]Tan X,Sun S,Liu Y.Analysis of Th17-associated cytokines in tears of patients with dry eye syndrome[J].Eye(Lond),2014,28(5):608-613.
[23]Stern ME,Beuerman RW,Fox RI,et al.The pathology of dry eye:The interaction between the ocular surface and lacrimal glands[J].Cornea,1998,17(6):584-589.
[24]Belmonte C,Nichols JJ,Cox SM,et al.TFOS DEWSⅡpain and sensation report[J].Ocul Surf,2017,15(3):404-437.
[25]Zhang X,Zhao L,Deng S,et al.Dry Eye Syndrome in Patients with Diabetes Mellitus:Prevalence,Etiology,and Clinical Characteristics[J].J Ophthalmol,2016,2016:8201053.
[26]李秋月,许海玉,杨洪军.促炎因子TNF-α,IL-1β,IL-6在神经病理性疼痛中的研究进展[J].中国中药杂志,2017,42(19):3709-3712.
[27]刘祖国.关于干眼名词及分类的初步建议[J].中国眼耳鼻喉杂志,2004,4(1):4-5.
[28]Galor A,Feuer W,Lee DJ,et al.Ocular surface parameters in older male veterans[J].Invest Opthalmol Vis Sci,2013,54(2):1426-1433.
[29]Abusharha AA,Pearce EI,Fagehi R.Effect of Ambient Temperature on the Human Tear Film[J].Eye Contact Lens,2016,42(5):308-312.
[30]Schlote T,Kadner G,Freudenthaler N.Marked reduction and distinct patterns of eye blinking in patients with moderately dry eyes during video display terminal use[J].Graefes Arch Clin Exp Ophthalmol,2004,242(4):306-312.
[31]Palakuru JR,Wang J,Aquavella JV.Effect of blinking on tear dynamics[J].Invest Ophthalmol Vis Sci,2007,48(7):3032-3037.
[32]Kawashima M,Tsubota K.Tear lipid layer deficiency associated with incomplete blinking:A case report[J].BMC Ophthalmol,2013,13:34.
[33]梁庆丰,刘含若,李彬,等.重视环境因素相关眼表疾病的研究[J/CD].中华眼科医学杂志(电子版),2016,6(5):193-200.
[34]Raschka C,Rau R,Koch HJ.Influence of choking in Judo on vision in well-trained Judoka:An explorative field study[J].Nagoya J Med Sci,2003,66(1/2):31-38.
[35]Schaumberg DA,Sullivan DA,Dana MR.Epidemiology of dry eye syndrome[J].Adv Exp Med Biol,2002,506(Pt B):989-998.
[36]潘兰兰,贾卉.中老年干眼患者临床特征分析[J].国际眼科杂志,2006,6(5):1203-1206.
[37]Wickham LA,Gao J,Toda I,et al.Identification of androgen,estrogen and progesterone receptor mRNAs in the eye[J].Acta Ophthalmol Scand,2000,78(2):146-153.
[38]Sulllivan DA,Sullivan BD,Ullman MD,et al.Androgen influence on the meibomian gland[J].Invest Ophthalmol Vis Sci,2000,41(12):3732-3742.
[39]罗丰年,张汗承,孙叙清,等.去势雄兔泪液分泌及泪膜稳定性的改变[J].中华眼科杂志,2001,37(6):458-461.
[40]Gipson IK,Spurr-Michaud SJ,Senchyna M,et al.Comparison of mucin levels at the ocular surface of postmenopausal women with and without a history of dry eye[J].Cornea,2011,30(12):1346-1352.
[41]Srinivasan S,Jovce E,Jones LW.Tear osmolality and ferning patterns in postmenopausal women[J].Optom Vis Sci,2007,84(7):588-592.
[42]Tong L,Tan J,Thumboo J,et al.Dry eye[J].BMJ,2012,345:e7533.
[43]Xu Y,Wang L,He J,et al.Prevalence and control of diabetes in Chinese adults[J].JAMA,2013,310(9):948-959.
[44]Alj Aroush M,Badarudin NE,Che Azemin MZ.Comparison of Dry Eye Parameters between Diabetics and Non-Diabetics in District of Kuantan,Pahang[J].Malays J Med Sci,2016,23(3):72-77.
[45]Ljubimov AV.Diabetic complications in the cornea[J].Vision Res,2017,139:138-152.
[46]Liu H,Sheng M,Liu Y,et al.Expression of SIRT1 and oxidative stress in diabetic dry eye[J].Int J Clin Exp Pathol,2015,8(6):7644-7653.
[47]De Mill DL,Hussain M,Pop-Busui R,et al.Ocular surface disease in patients with diabetic peripheral neuropathy[J].Br J Ophthalmol,2016,100(7):924-928.
[48]Fuerst N,Langelier N,Massaro-Giordano M,et al.Tear osmolarity and dry eye symptoms in diabetics[J].Clin Ophthalmol,2014,8:507-515.
[49]Achtsidis V,Eleftheriadou I,Kozanidou E,et al.Dry eye syndrome in subjects with diabetes and association with neuropathy[J].Diabetes Care,2014,37(10):e210-211.
[50]唐均成.白介素-1β在2型糖尿病胰岛炎症中的研究进展[J].西南军医,2011,13(5):908-910.
[51]孙爱丽,丛海涛,陈玲阳,等.炎症反应在糖尿病及心血管并发症中的机制研究进展[J].中国现代医生,2018,56(28):159-164.
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