中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2012年
5期
445-449
,共5页
李东辉%龙琴%卞爱玲%张顺华%王淑然%李莹
李東輝%龍琴%卞愛玲%張順華%王淑然%李瑩
리동휘%룡금%변애령%장순화%왕숙연%리형
干眼%免疫诱导炎症反应%人类白细胞DR抗原%非甾体类抗炎药%随机对照试验
榦眼%免疫誘導炎癥反應%人類白細胞DR抗原%非甾體類抗炎藥%隨機對照試驗
간안%면역유도염증반응%인류백세포DR항원%비치체류항염약%수궤대조시험
Dry eye%Immuno-induced inflammation%Human leucocyte antigen-DR%Nonsteroidal antiinflammatory drug%Randomized controlled trial
背景 干眼是一种多因素影响的泪膜和眼表疾病,免疫炎症反应在干眼的发病中起至关重要的作用.非甾体类抗炎药物通过抑制环氧合酶通路,具有抑制眼部炎症和免疫调节的作用,是一种潜在的抗干眼药物.目的 研究非甾体类抗炎药物质量分数0.1％普拉洛芬滴眼液治疗中重度干眼的临床疗效,并探讨其作用机制.方法 采用随机对照研究设计.对按标准纳入的中重度干眼患者30例按照随机数字表法随机分为试验组及对照组,均取右眼为试验眼.试验组15例15眼,给予0.1％普拉洛芬滴眼液和质量分数0.1％玻璃酸钠滴眼液联合用药；对照组15例15眼基线特征与试验组匹配,单独使用0.1％玻璃酸钠滴眼液.用药前和用药2周时进行临床和实验室指标检测.临床检测指标包括眼表疾病指数( OSDI)、泪膜破裂时间(BUT)、泪液分泌试验Ⅰ(Schirmer Ⅰ试验)、眼表染色(OSS)评分.实验室检测通过结膜印迹细胞学方法获取球结膜上皮细胞,应用流式细胞术检测球结膜上皮细胞中人类白细胞DR抗原(HLA-DR)及CD11b的表达.结果 试验组和对照组患者的年龄、性别构成比的差异均无统计学意义(t=0.412,P=0.684；x2=0.240,P=0.624),两组间各项临床和实验室指标实测值的比较差异均无统计学意义(P＞0.05).用药2周时,试验组受试者OSDI、OSS评分和球结膜上皮细胞中HLA-DR抗原表达明显低于对照组,而BUT均明显长于对照组,差异均有统计学意义(t=2.43,P=0.03；t=2.83,P=0.01；t=3.29,P=0.00；t=3.23,P=0.00),两组受试者的Schirmer Ⅰ试验和结膜上皮细胞CD11b表达量用药2周后对比差异均无统计学意义(t=0.17,P=0.87;t=0.28,P=0.79).试验组用药2周和用药前相比,OSDI、OSS评分和BUT较用药前均明显改善,球结膜上皮细胞中HLA-DR抗原表达量降低,差异均有统计学意义(t=12.30、10.70、6.10、7.92,P=0.00)；对照组用药前后各项指标差异均无统计学意义(P＞0.05).试验组用药2周结膜上皮细胞HLA-DR抗原表达量与OSDI和OSS评分均呈正相关(r=0.601,P=0.018；r=0.586,P=0.022),与BUT间呈负相关(r=-0.697,P=0.004).结论 0.1％普拉洛芬滴眼液联合0.1％玻璃酸钠滴眼液用药短期内可有效缓解中重度干眼的症状和体征,其作用机制与降低眼表免疫炎症标志物HLA-DR抗原的表达相关.
揹景 榦眼是一種多因素影響的淚膜和眼錶疾病,免疫炎癥反應在榦眼的髮病中起至關重要的作用.非甾體類抗炎藥物通過抑製環氧閤酶通路,具有抑製眼部炎癥和免疫調節的作用,是一種潛在的抗榦眼藥物.目的 研究非甾體類抗炎藥物質量分數0.1％普拉洛芬滴眼液治療中重度榦眼的臨床療效,併探討其作用機製.方法 採用隨機對照研究設計.對按標準納入的中重度榦眼患者30例按照隨機數字錶法隨機分為試驗組及對照組,均取右眼為試驗眼.試驗組15例15眼,給予0.1％普拉洛芬滴眼液和質量分數0.1％玻璃痠鈉滴眼液聯閤用藥；對照組15例15眼基線特徵與試驗組匹配,單獨使用0.1％玻璃痠鈉滴眼液.用藥前和用藥2週時進行臨床和實驗室指標檢測.臨床檢測指標包括眼錶疾病指數( OSDI)、淚膜破裂時間(BUT)、淚液分泌試驗Ⅰ(Schirmer Ⅰ試驗)、眼錶染色(OSS)評分.實驗室檢測通過結膜印跡細胞學方法穫取毬結膜上皮細胞,應用流式細胞術檢測毬結膜上皮細胞中人類白細胞DR抗原(HLA-DR)及CD11b的錶達.結果 試驗組和對照組患者的年齡、性彆構成比的差異均無統計學意義(t=0.412,P=0.684；x2=0.240,P=0.624),兩組間各項臨床和實驗室指標實測值的比較差異均無統計學意義(P＞0.05).用藥2週時,試驗組受試者OSDI、OSS評分和毬結膜上皮細胞中HLA-DR抗原錶達明顯低于對照組,而BUT均明顯長于對照組,差異均有統計學意義(t=2.43,P=0.03；t=2.83,P=0.01；t=3.29,P=0.00；t=3.23,P=0.00),兩組受試者的Schirmer Ⅰ試驗和結膜上皮細胞CD11b錶達量用藥2週後對比差異均無統計學意義(t=0.17,P=0.87;t=0.28,P=0.79).試驗組用藥2週和用藥前相比,OSDI、OSS評分和BUT較用藥前均明顯改善,毬結膜上皮細胞中HLA-DR抗原錶達量降低,差異均有統計學意義(t=12.30、10.70、6.10、7.92,P=0.00)；對照組用藥前後各項指標差異均無統計學意義(P＞0.05).試驗組用藥2週結膜上皮細胞HLA-DR抗原錶達量與OSDI和OSS評分均呈正相關(r=0.601,P=0.018；r=0.586,P=0.022),與BUT間呈負相關(r=-0.697,P=0.004).結論 0.1％普拉洛芬滴眼液聯閤0.1％玻璃痠鈉滴眼液用藥短期內可有效緩解中重度榦眼的癥狀和體徵,其作用機製與降低眼錶免疫炎癥標誌物HLA-DR抗原的錶達相關.
배경 간안시일충다인소영향적루막화안표질병,면역염증반응재간안적발병중기지관중요적작용.비치체류항염약물통과억제배양합매통로,구유억제안부염증화면역조절적작용,시일충잠재적항간안약물.목적 연구비치체류항염약물질량분수0.1％보랍락분적안액치료중중도간안적림상료효,병탐토기작용궤제.방법 채용수궤대조연구설계.대안표준납입적중중도간안환자30례안조수궤수자표법수궤분위시험조급대조조,균취우안위시험안.시험조15례15안,급여0.1％보랍락분적안액화질량분수0.1％파리산납적안액연합용약；대조조15례15안기선특정여시험조필배,단독사용0.1％파리산납적안액.용약전화용약2주시진행림상화실험실지표검측.림상검측지표포괄안표질병지수( OSDI)、루막파렬시간(BUT)、루액분비시험Ⅰ(Schirmer Ⅰ시험)、안표염색(OSS)평분.실험실검측통과결막인적세포학방법획취구결막상피세포,응용류식세포술검측구결막상피세포중인류백세포DR항원(HLA-DR)급CD11b적표체.결과 시험조화대조조환자적년령、성별구성비적차이균무통계학의의(t=0.412,P=0.684；x2=0.240,P=0.624),량조간각항림상화실험실지표실측치적비교차이균무통계학의의(P＞0.05).용약2주시,시험조수시자OSDI、OSS평분화구결막상피세포중HLA-DR항원표체명현저우대조조,이BUT균명현장우대조조,차이균유통계학의의(t=2.43,P=0.03；t=2.83,P=0.01；t=3.29,P=0.00；t=3.23,P=0.00),량조수시자적Schirmer Ⅰ시험화결막상피세포CD11b표체량용약2주후대비차이균무통계학의의(t=0.17,P=0.87;t=0.28,P=0.79).시험조용약2주화용약전상비,OSDI、OSS평분화BUT교용약전균명현개선,구결막상피세포중HLA-DR항원표체량강저,차이균유통계학의의(t=12.30、10.70、6.10、7.92,P=0.00)；대조조용약전후각항지표차이균무통계학의의(P＞0.05).시험조용약2주결막상피세포HLA-DR항원표체량여OSDI화OSS평분균정정상관(r=0.601,P=0.018；r=0.586,P=0.022),여BUT간정부상관(r=-0.697,P=0.004).결론 0.1％보랍락분적안액연합0.1％파리산납적안액용약단기내가유효완해중중도간안적증상화체정,기작용궤제여강저안표면역염증표지물HLA-DR항원적표체상관.
Background Dry eye is a multi-factorial-induced tear film and ocular surface disorder.Immunoinflammation plays a key role in the pathogenesis of dry eye.As inhibitor of the cyclo-oxygenase pathway,nonsteroidal anti-inflammatory drugs play an anti-inflammatory and anti-hypersensitivity role,and it can be a potential treatment for dry eyes. Objective This study was to investigate the effectiveness of nonsteroidal anti-inflammatory drugs (0.1％topical pranoprofen) on moderate to severe dry eyes and its mechanism. Methods This was a small sample of randomized controlled clinical trial.Thirty right eyes of 30 patients with moderate to severe dry eyes were included in the study according to the diagnosis criteria and randomized into two groups.The patients of the trial group received topical administration of 0.1％ pranoprofen plus 0.1％ sodium hyaluronate,and those of the control group received the topical 0.1％ sodium hyaluronate only.Ocular surface inflammation index scores (OSDI) and ocular surface fluorescine staining (OSS) scores were measured under the slit lamp,and tear film break-up time (BUT),Schirmer Ⅰ test values were evaluated.The expression of human leucocyte antigen-DR (HLA-DR) and CD11b in conjunctiva epithelial cells were detected by impression cytology and flow cytometry (FCM).All the indexes were compared between the two groups before and after treatment.Informed consent was obtained from all patients. Results There were no significant differences in terms of age and gender and their baseline values between the trial group and control group (t=0.412,P=0.684;x2=0.240,P=0.624),and so were all the indexes (P＞0.05).Compared with the control group,the OSDI,OSS scores and cells positive for HLA-DR were lowered but the BUT was delayed in the trial group on day 15 ( t=2.43,P=0.03;t=2.83,P=0.01;t=3.29,P=0.00;t=3.23,P=0.00 ).No significant differences were found in the Schirmer Ⅰ test value and CD11b expression between these two groups (t=0.17,P=0.87;t=0.28,P=0.79).The OSDI,OSS scores and BUT were significantly improved,and the number of cells positive for HLA-DR were reduced 15 days after administration of drugs in comparison with before treatment in the trial group ( t =12.30,10.70,6.10,7.92,P =0.00 ).However,there were no comparable alteration seen in these indexes before and after the usage of drugs in the control group ( P＞0.05).Positive correlations were found in HLADR expression with OSDI and OSS ( r =0.601,P =0.018 ; r =0.586,P =0.022 ) and a negative correlation in HLADR expression with BUT (r=-0.697,P=0.004) on day 15 in the trial group. Conclusions Topical usage of 0.1％ pranoprofen is beneficial for remitting the ocular signs and symptoms in moderate to severe dry eyes.This study illustrates that topical usage of 0.1％ pranoprofen can down-regulate the expression of inflammatory markers in conjunctival epithelial cells.
