中医药治疗干眼症研究进展

近年来人们对干眼症的关注与日俱增,中医药发挥其传统优势,运用内治,外治,针灸等方法,达到机体脏腑功能平衡,气血津液充足,化生泪液有源,泪液不乏。但是,目前中医学对于干眼症的研究还存在一些问题。第一,干眼的疗效评价标准参照西医学标准,中医方面尚无统一标准。第二,干眼症的中医辨证分型也无统一标准,数据可信度难以保证。第三,临床的研究设计多为小样本,科研设计不够严谨,缺乏相关的动物实验研究。干眼症是多种原因诱发的疾病,已经逐步引起人们的重视,但就其发病的病因及机制应更进一步的深入研究。治疗上应在中医整体观念的指导下,运用辨证施治同时结合现代医学理论。应统一干眼症的辨证分型及疗效评价标准,增加临床观察指标的客观性及可信度,同时临床学者及科研工作者应尝试采取大样本,多中心的随机对照实验,让研究结果更有说服力,也应该尝试更多的动物实验研究,运用先进的科学技术及方法研究本病的病理生理状况,预防等,将其结果转化为临床可用的知识,为干眼症的诊疗开辟新的篇章。     

玻璃酸钠与抗炎药联用治疗沙眼性干眼症的疗效

目的 观察沙眼性干眼症应用玻璃酸钠+抗炎药物联合治疗的临床效果。方法 抽取延长县中医 医院2020年1月-2021年7月收治的76例沙眼性干眼症患者为研究对象,根据随机数字表法分为对照组与 研究组,各38例。对照组接受玻璃酸钠治疗,研究组接受玻璃酸钠+抗炎药物治疗,比较两组患者治疗效 果、泪液分泌状况、泪膜破裂时间、角膜地形图参数。结果 研究组治疗总有效率为92.11%,高于对照组 的76.32%,差异有统计学意义（P＜0.05）;研究组治疗后SchirmerⅠ试验结果、BUT均高于对照组,差异 有统计学意义（P＜0.05）;研究组SRI、SAI均低于对照组,差异有统计学意义（P＜0.05）。结论 玻璃酸 钠+抗炎药物联合治疗沙眼性干眼症患者具有积极意义,能有效改善眼部干涩症状,延缓泪腺分泌状况, 临床效果确切,具有推广价值。     

Nutritional status of mauritanian children during a drought emergency

Nutritional surveys were conducted in three regions of Mauritania between September and November, 1983, to assess the impact of a severe drought and to determine priorities for relief assistance. Survey sites and children were chosen at random using established Centers for Disease Control survey methodology. A total of 1,498 children between the ages of 6 months and 5 years were weighed, measured and examined for xerophthalmia and scurvy. Information on age, sex, diarrhea, measles immunization, diet and food aid was collected for each child. Levels of acute malnutrition (< 80 % of median weight‐for‐height) ranged from 8.2 to 17.2% in the 3 regions, and both xerophthalmia and scurvy were seen. The children between 1 to 3 years of age had the highest levels of malnutrition. Food aid deliveries were irregular and inadequate in the two regions with the highest rates of malnutrition. Implications for targeting and choice of relief efforts are discussed.     

儿童轻度过敏性结膜炎中干眼的研究及治疗

目的〖KG*2〗探讨儿童轻度过敏性结膜炎中干眼发生的原理及不同方案疗效,为过敏性结膜炎的治疗提供指导依据。 〖HTH〗方法〖KG*2〗回顾性分析4～10岁轻度过敏性结膜炎患儿（观察组）101例及健康儿童（对照组）100例。过敏性结膜炎患儿检测过敏原。比较2组泪膜破裂时间(tear film breakup time,BUT)、角膜荧光素染色（fluorescein,FL）评分、泪河高度（tear meniscus height,TMH）,分析BUT、FL评分、TMH与病程的相关性。观察组根据治疗方案中是否有人工泪液分为A组42例和B组59例,比较A、B组治疗前后BUT、FL评分、TMH。 〖HTH〗结果〖KG*2〗观察组BUT短于对照组;FL评分高于对照组（P＜0.01）;2组TMH差异无统计学意义(P＞0.05）。观察组过敏性结膜炎BUT与病程呈负相关（r=-0.439,P＜0.01）,FL评分与病程呈正相关（r=0.396,P＜0.01）,TMH与病程无相关性（r=0.043,P＞0.05）。治疗后,A、B组BUT长于治疗前,FL评分低于治疗前,A组TMH高于治疗前;A组BUT长于B组,FL评分低于B组,TMH高于B组,差异有统计学意义（P＜0.05）。 〖HTH〗结论〖KG*2〗儿童过敏性结膜炎通过降低双眼泪膜稳定性,破坏角膜上皮完整性,造成干眼症状,而对泪液分泌无显著影响。病程越长泪膜稳定性越低,角膜上皮破坏越严重。联合人工泪液治疗过敏性结膜炎效果更佳。     

Vitamin A deficiency in a Kenyan prison

OBJECTIVE: To estimate the prevalence and causes of vitamin A deficiency disorders (VADD) in adult male prisoners in Nakuru, Kenya. METHODS: A total of 1048 male prisoners aged > or =16 years in Nakuru Government of Kenya prison in Nakuru, Kenya were examined by an ophthalmologist for signs of xerophthalmia. Two hundred and forty-one cases with xerophthalmia and 448 controls randomly selected from the remaining prison population were interviewed about risk factors for xerophthalmia and blood samples were taken to measure serum retinol and haemoglobin. RESULTS: 23.6% (95% CI = 21.1-26.3%) of examined inmates showed at least one sign of xerophthalmia, mostly night blindness (98.8% of cases). In the case-control study, the age-adjusted analyses showed that xerophthalmia was associated with age, length of imprisonment and previous imprisonment. Men with xerophthalmia were significantly more likely be in poor health characterised by significant illness, recent hospital admission, persistent cough, diarrhoea, fever or chronic illness. After multivariate adjustment, duration of imprisonment remained strongly associated with xerophthalmia (OR comparing >4 years with <6 months = 20.1, 95% CI = 8.3-48.8). Previous imprisonment, fever, diarrhoea, hospital admission and chronic illness were also significant predictors. Serum retinol levels were significantly lower in cases than controls, while there was no difference in haemoglobin levels. CONCLUSION: Vitamin A deficiency was a significant public health problem among these Kenyan male prisoners, indicating that it may be important in vulnerable groups other than young children and pregnant or lactating women.     

密蒙花总黄酮对去势雄鼠干眼症泪腺TGF-β_1及其基因表达的影响

目的观察密蒙花总黄酮对去势雄鼠导致干眼症泪腺TGF-β1及其基因表达的影响。方法90只健康1月龄SPF级Wistar雄性大鼠切除双侧睾丸及附睾建立干眼症模型;30只匹配大鼠切开阴囊而不切除睾丸作为假手术组。手术1周后,雄激素治疗组用丙酸睾酮注射液1 mg/kg股四头肌内注射,每3日1次（30只模型鼠）;密蒙花总黄酮治疗组以密蒙花总黄酮0.02 g/kg与生理盐水混悬液灌胃,每日1次（30只模型鼠）;正常组（30只正常鼠）、假手术组、模型组（30只）以生理盐水灌胃,每日1次。造模1、3、5个月后各组随机抽取10只大鼠处死,取双眼泪腺组织免疫组织化学法检测TGF-β1的表达,采用实时定量PCR（real-time PCR）法荧光定量检测TGF-β1mRNA的表达。结果造模5个月后,正常组和假手术组大鼠泪腺组织细胞中几乎无TGF-β1阳性表达,而模型组、雄激素治疗组和密蒙花总黄酮治疗组大鼠泪腺组织细胞中TGF-β1大量阳性表达,表现为大量棕黄色颗粒沉着。正常组、假手术组大鼠泪腺组织细胞中TGF-β1的平均光密度值（OD）高于模型组,差异有统计学意义（P〈0.05）;密蒙花总黄酮治疗组和雄激素治疗组大鼠泪腺组织细胞中TGF-β1的平均OD值大于模型组,差异有统计学意义（P〈0.05）;密蒙花总黄酮治疗组的大鼠泪腺组织细胞中TGF-β1的平均OD值小于雄激素治疗组,差异有统计学意义（P〈0.05）。TGF-β1mRNA在不同组大鼠泪腺组织细胞中的表达差异比较与TGF-β1表达相同（P〈0.05）。结论密蒙花总黄酮可抑制去势雄鼠干眼症泪腺炎症反应,上调TGF-β1mRNA的表达以增加TGF-β1的合成是其作用途径之一。     

中西医结合治疗干眼症疗效观察

目的:观察中西医结合治疗干眼症的临床效果。方法:将78例患者随机分为治疗组48例,对照组30例。治疗组给予自拟增视润目汤加减,连服1个月并双眼滴用卡波姆眼液,每天4次;对照组单纯滴用卡波姆眼液,每天4次。结果:治疗1个月后,治疗组症状明显减轻,BUT≥10s、Schinmer≥10mm,总有效率为93.75%,对照组总有效率70.00%。结论:采用中西医结合的方法治疗干眼症可以标本兼顾,较单纯使用眼液有着更好的疗效。     

干眼I号颗粒治疗肝肾阴虚型干眼症的疗效观察

目的客观评价干眼I号颗粒治疗肝肾阴虚型干眼症的临床疗效。方法将水样液缺乏性肝肾阴虚型干眼症72例（144只眼）患者随机分为2组。治疗组口服干眼I号颗粒，对照组口服环戊硫酮片。观察用药前及用药1个月后患者中医证候、主观症状、泪膜破裂时间（BUT）、泪液分泌试验I（SIt）及角膜荧光素染色（FL）评分情况。结果治疗1个月后，治疗组中医证候总有效率为77．1％（54／70），对照组总有效率为54．5％（36／66），治疗组疗效优于对照组（P〈0．05）。治疗后治疗组中医证候总积分改善优于对照组（P〈0．05），主观症状总积分、BUT、SIt、FL评分改善2组比较，差异无统计学意义（P〉0．05）。结论干眼I号颗粒治疗水样液缺乏性肝肾阴虚型干眼症在有效缓解包括眼部症状、全身症状在内的肝肾阴虚证候方面较环戊硫酮片效果更加明显，在延长BUT、促进泪液分泌、改善FL方面，两者治疗效果无明显差异。     

中老年屈光异常性视疲劳戴镜矫正对干眼症疗效的影响

目的:探讨中老年屈光异常性视疲劳戴镜矫正对干眼症治疗疗效的影响。方法:将86例40～58岁的干眼症合并屈光异常性视疲劳病例,按1∶1随机分为药物治疗组和药物+戴镜联合治疗组,治疗3mo。观察治疗前后的眼部症状、泪液分泌量、泪膜破裂时间、角膜荧光素染色等疗效性指标。结果:随访3mo,两组患者泪液分泌量、泪膜破裂时间和角膜荧光素染色都有显著性差异(P<0.05),联合治疗组效果明显优于药物治疗组。结论:戴镜矫正配合药物联合治疗干眼可明显改善干眼症状,增加泪液分泌量,延长泪膜破裂时间,改善角膜上皮情况,较单纯药物治疗理想。