口服ω-3不饱和必须脂肪酸对青光眼治疗后干眼的疗效观察

发布时间：2019-06-04 06:36

【摘要】：青光眼是主要的严重不可逆致盲眼病之一,目前尚无办法根治。青光眼患者在接受临床常用的长期药物治疗和手术治疗方法后,常可出现干眼相关的症状和体征。口服ω-3不饱和必须脂肪酸已被证实对包括干眼在内的多种慢性疾病有治疗效果,但目前并未作为我国临床对干眼治疗的常规方法,也未见应用于青光眼治疗后干眼的治疗。本文通过观察青光眼治疗后的干眼患者在接受口服ω-3不饱和必须脂肪酸治疗后,症状、体征等方面的改变,评价其治疗效果及应用前景。并且通过液相芯片技术检测患者泪液中细胞因子的表达水平,探讨口服ω-3不饱和必须脂肪酸对干眼治疗的作用机制。第一部分口服ω-3不饱和必须脂肪酸对青光眼相关的干眼症状和体征的影响目的：观察口服ω-3不饱和必须脂肪酸对青光眼长期药物治疗或手术治疗后出现的干眼症状、体征的影响,评价治疗效果。方法：103例受试者参与研究。被分为1)健康对照组,2)青光眼用药后干眼组,3)青光眼术后干眼组,4)非青光眼干眼组。每组随机分入2亚组。其中用药亚组每日2次每次1粒服用ω-3不饱和必须脂肪酸软胶囊3个月,另一亚组不使用口服药物。随访3个月观察干眼的症状评分、泪液分泌试验及泪膜破裂时间等方面的变化。结果：1)使用口服药物的青光眼长期用药亚组和青光眼术后亚组干眼症状改善。主观症状总评分分别由6.83±3.74和9.78±4.87下降至3.25±1.71和4.04±2.03,差异显著性具有统计学意义(t=6.62和t=7.50,P0.05)。未使用口服药物的亚组,主观症状评分差异显著性不具有统计学意义(P0.05)。2)青光眼用药组使用口服药物后泪液分泌试验及泪膜破裂时间平均值为7.35±1.90mm及8.01±2.48s,与未使用口服药物的亚组结果6.00±0.85mm及5.17±1.47s比较,差异显著性具有统计学意义(P0.05)。结论：口服ω-3不饱和必须脂肪酸对于改善青光眼治疗后出现的干眼的症状、体征是安全性良好的可行方法。第二部分口服ω-3不饱和必须脂肪酸对青光眼治疗后干眼患者泪液细胞因子水平的影响目的：观察口服ω-3不饱和必须脂肪酸青光眼治疗后干眼患者泪液细胞因子水平的影响,探讨其治疗作用的机制。方法：103例受试者参与研究。被分为1)健康对照组,2)青光眼用药后干眼组,3)青光眼术后干眼组,4)非青光眼干眼组。每组随机分入2亚组。其中用药亚组每日2次每次1粒服用ω-3不饱和必须脂肪酸软胶囊,另一亚组不使用口服药物。采集泪液标本,并以液相芯片技术检测泪液中细胞因子的表达水平。随访3个月后再次采集泪液标本并检测细胞因子水平。结果：1)基线访视时各干眼组泪液中白细胞介素(interleukin, IL) IL-lβ、IL-2、IL-4、IL-6及肿瘤坏死因子(tumor necrosis factor, TNF) TNF-α的水平与健康对照组差异显著性具有统计学意义(P0.05)。2)随访3个月后,接受口服ω-3不饱和必须脂肪酸的青光眼用药后干眼组、青光眼术后干眼组和非青光眼干眼组患者泪液中IL-1p水平与未口服药物组比较,差异显著性具有统计学意义(P0.05)。接受口服ω-3不饱和必须脂肪酸的青光眼用药后干眼组和非青光眼干眼组患者泪液中IL-6和TNF-α的水平与未口服药物组比较,差异显著性具有统计学意义(P0.05)。结论：口服ω-3EPUFAs对青光眼治疗后出现的干眼患者泪液中炎性细胞因子的表达水平存在抑制作用
[Abstract]:Glaucoma is one of the major non-reversible blind eye diseases. There is no cure at present. Patients with glaucoma often experience dry eye-related symptoms and signs after receiving a clinically common long-term drug treatment and a surgical treatment. Oral 1-3 unsaturated essential fatty acids have been proven to have therapeutic effects on a wide range of chronic diseases, including dry eye, but are not currently used as a conventional method for the treatment of dry eye in our country and are not applied to the treatment of dry eye after the treatment of glaucoma. In this paper, the effect of the treatment and the application of the treatment were evaluated by observing the changes of the symptoms, signs and the like in the patients with dry eye after the treatment of glaucoma. The expression level of cytokines in the patient's tear is detected by the liquid-phase chip technique, and the effect of the fatty acid on the dry eye treatment of the oral 1-3 unsaturated fatty acid is discussed. system. The first part of oral 1-3 unsaturated fatty acid must be used for the treatment of glaucoma-related xerophthalmia and body Objective: To observe the effect of oral 1-3 unsaturated fatty acid on the long-term drug treatment of glaucoma or the post-surgical treatment of dry eye. the effect of the sign, the evaluation, Treatment effect of price:103 cases The subjects were involved in the study. The subjects were divided into 1) healthy control group,2) post-glaucoma dry eye group,3) post-glaucoma dry eye group,4) Non-glaucoma dry eye group. Each group Randomly divided into 2 subgroups, in which a 3-month period of 3-month long-term soft capsule of the fatty acid soft capsule was administered once daily for 2 times a day, and the other subgroup No oral medication was used. Follow-up for 3 months to observe the symptom score of dry eye, tear secretion test, and tear film rupture Results:1) Long-term treatment of glaucoma using oral medications and glaucoma The overall scores of subjective symptoms decreased from 6.83 to 3.74 and 9.78 to 3.25, 1.71 and 4.04 to 2.03, respectively, and the difference was significant (t = 6.62 and t = 7, respectively). 50, P0.05). There was no significant difference in the scores of subjective symptoms (P0.05). The mean value of the tear secretion test and tear film rupture time after oral administration of the glaucoma medication group was 7.35, 1.90 mm and 8. .01-2.48 s with a statistically significant difference between 6.00, 0.85 mm and 5.17-1.47 s for subgroups not using oral medications Conclusion: Oral 1-3 unsaturated fatty acid must be used to improve the symptoms and signs of dry eye in the treatment of glaucoma. It is a feasible method for good safety. The second part of oral 1-3 unsaturated fatty acid must be dry after the treatment of glaucoma Objective: To observe the effect of oral 1-3 unsaturated fatty acid glaucoma after treatment. Dry eye patient's tear cytokine water The mechanism of the effect of the treatment on the effect of the treatment. Methods:103 subjects were involved in the study. Post-operative dry eye group,4) Non-glaucoma dry eye group. Each group was randomly divided into 2 subgroups. One of the two groups was given 1-3 unsaturations every 2 times a day. The soft capsule of the invention, the other subgroup does not use the oral drug. The sample of the tear is collected and the liquid phase core is used. The expression level of the cytokines in the tears was detected by the sheet technique. After 3 months of follow-up, Results:1) The levels of interleukinkin, IL-l, IL-2, IL-4, IL-6 and tumor necrosis factor (TNF) in the tear of each dry eye group were statistically different from those in the healthy control group at the baseline visit. (2) After 3 months of follow-up, the level of IL-1p in the dry eye group, the post-glaucoma dry eye group and the non-glaucoma dry eye group was compared with the non-oral drug group after 3 months of follow-up. The difference was significant (P0.05). The levels of IL-6 and TNF-1 in the tears of the dry eye group and the non-glaucoma dry eye group were compared with those of the non-oral drug group in the eyes of the dry eye group and the non-glaucoma dry eye group. The difference was significant (P0.05). Conclusion: The dry eye of the treatment of glaucoma after the treatment of glaucoma
【学位授予单位】：武汉大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R775

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