【摘要】：青光眼是主要的嚴(yán)重不可逆致盲眼病之一,目前尚無辦法根治。青光眼患者在接受臨床常用的長期藥物治療和手術(shù)治療方法后,�？沙霈F(xiàn)干眼相關(guān)的癥狀和體征�？诜�-3不飽和必須脂肪酸已被證實(shí)對包括干眼在內(nèi)的多種慢性疾病有治療效果,但目前并未作為我國臨床對干眼治療的常規(guī)方法,也未見應(yīng)用于青光眼治療后干眼的治療。 本文通過觀察青光眼治療后的干眼患者在接受口服ω-3不飽和必須脂肪酸治療后,癥狀、體征等方面的改變,評價其治療效果及應(yīng)用前景。并且通過液相芯片技術(shù)檢測患者淚液中細(xì)胞因子的表達(dá)水平,探討口服ω-3不飽和必須脂肪酸對干眼治療的作用機(jī)制。 第一部分口服ω-3不飽和必須脂肪酸對青光眼相關(guān)的干眼癥狀和體征的影響 目的：觀察口服ω-3不飽和必須脂肪酸對青光眼長期藥物治療或手術(shù)治療后出現(xiàn)的干眼癥狀、體征的影響,評價治療效果。 方法：103例受試者參與研究。被分為1)健康對照組,2)青光眼用藥后干眼組,3)青光眼術(shù)后干眼組,4)非青光眼干眼組。每組隨機(jī)分入2亞組。其中用藥亞組每日2次每次1粒服用ω-3不飽和必須脂肪酸軟膠囊3個月,另一亞組不使用口服藥物。隨訪3個月觀察干眼的癥狀評分、淚液分泌試驗(yàn)及淚膜破裂時間等方面的變化。 結(jié)果：1)使用口服藥物的青光眼長期用藥亞組和青光眼術(shù)后亞組干眼癥狀改善。主觀癥狀總評分分別由6.83±3.74和9.78±4.87下降至3.25±1.71和4.04±2.03,差異顯著性具有統(tǒng)計學(xué)意義(t=6.62和t=7.50,P0.05)。未使用口服藥物的亞組,主觀癥狀評分差異顯著性不具有統(tǒng)計學(xué)意義(P0.05)。2)青光眼用藥組使用口服藥物后淚液分泌試驗(yàn)及淚膜破裂時間平均值為7.35±1.90mm及8.01±2.48s,與未使用口服藥物的亞組結(jié)果6.00±0.85mm及5.17±1.47s比較,差異顯著性具有統(tǒng)計學(xué)意義(P0.05)。 結(jié)論：口服ω-3不飽和必須脂肪酸對于改善青光眼治療后出現(xiàn)的干眼的癥狀、體征是安全性良好的可行方法。 第二部分口服ω-3不飽和必須脂肪酸對青光眼治療后干眼患者淚液細(xì)胞因子水平的影響 目的：觀察口服ω-3不飽和必須脂肪酸青光眼治療后干眼患者淚液細(xì)胞因子水平的影響,探討其治療作用的機(jī)制。 方法：103例受試者參與研究。被分為1)健康對照組,2)青光眼用藥后干眼組,3)青光眼術(shù)后干眼組,4)非青光眼干眼組。每組隨機(jī)分入2亞組。其中用藥亞組每日2次每次1粒服用ω-3不飽和必須脂肪酸軟膠囊,另一亞組不使用口服藥物。采集淚液標(biāo)本,并以液相芯片技術(shù)檢測淚液中細(xì)胞因子的表達(dá)水平。隨訪3個月后再次采集淚液標(biāo)本并檢測細(xì)胞因子水平。 結(jié)果：1)基線訪視時各干眼組淚液中白細(xì)胞介素(interleukin, IL) IL-lβ、IL-2、IL-4、IL-6及腫瘤壞死因子(tumor necrosis factor, TNF) TNF-α的水平與健康對照組差異顯著性具有統(tǒng)計學(xué)意義(P0.05)。2)隨訪3個月后,接受口服ω-3不飽和必須脂肪酸的青光眼用藥后干眼組、青光眼術(shù)后干眼組和非青光眼干眼組患者淚液中IL-1p水平與未口服藥物組比較,差異顯著性具有統(tǒng)計學(xué)意義(P0.05)。接受口服ω-3不飽和必須脂肪酸的青光眼用藥后干眼組和非青光眼干眼組患者淚液中IL-6和TNF-α的水平與未口服藥物組比較,差異顯著性具有統(tǒng)計學(xué)意義(P0.05)。 結(jié)論：口服ω-3EPUFAs對青光眼治療后出現(xiàn)的干眼患者淚液中炎性細(xì)胞因子的表達(dá)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
【學(xué)位授予單位】：武漢大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R775

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