中药密蒙花离子导入对干眼患者泪液白细胞介素6、细胞间黏附分子1表达的影响
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摘要
目的观察中药密蒙花离子导入治疗干眼的疗效及可能作用机制。方法将60例(120眼)干眼患者随机分为观察组(30例60眼)和对照组(30例60眼)。观察组予以中药密蒙花离子导入和玻璃酸钠滴眼液滴眼,对照组仅予以玻璃酸钠滴眼液滴眼,共治疗4周。于治疗前及治疗2、4周后比较两组患者干眼症状问卷评分、基础泪液分泌(Schirmer-Ⅰ)、泪膜破裂时间(BUT)、角膜染色评分和泪液白细胞介素6(IL-6)、细胞间黏附分子1 (ICAM-1)表达,治疗4周后评价临床疗效,随访3个月观察干眼复发情况。结果观察组临床疗效总有效率为93. 33%,对照组为80. 00%,观察组临床疗效优于对照组(P <0. 01)。治疗2、4周后,两组患者干眼症状问卷评分、Schirmer-Ⅰ、BUT、角膜染色评分和泪液IL-6、ICAM-1表达与本组治疗前比较均明显改善,且观察组均优于对照组(P <0. 05或P <0. 01)。随访3个月,观察组复发率为14. 81%,低于对照组的39. 2%(P <0. 05)。结论中药密蒙花通过离子导入眼表组织,可消除或缓解干眼患者症状,降低复发率,抑制IL-6和ICAM-1炎症因子表达可能是其机制之一。
Objective To observe the effects of Chinese medicine Mimenghua( Flos Buddlejae) Iontophoresis on interleukin-6( IL-6),intercellular adhesion molecule-1( ICAM-1) in tear of dry eye patients and its possible mechanism. Methods A total of 60 patients( 120 eyes) with dry eye were randomly divided into observation group( 30 patients,60 eyes) and control group( 30 patients,60 eyes). The observation group was treated by Chinese medicine Flos Buddlejae iontophoresis and sodium hyaluronate eye drops,and the control group was only treated by sodium hyaluronate eye drops,for totally 4 weeks. The dry eye symptoms questionnaire scores,Schirmer-Ⅰtest,break-up time( BUT),cornea staining scores and the expression of IL-6,ICAM-1 in tear were compared before treatment and 2 and4 weeks after treatment. The curative effects were evaluated after 4 weeks' treatment. The recurrence of dry eye was observed after 3 months of follow-up. Results The total effective rate was 93. 33% and 80. 00% in observation group in the control group. The clinical efficacy in the observation group was more significant( P < 0. 01). After 2 weeks and 4 weeks treatment,dry eye symptoms questionnaire scores,Schirmer-Ⅰtest,BUT test,cornea staining scores and tear IL-6,ICAM-1 expression of two groups were significantly improved,and the observation group was better than the control group( P < 0. 05 or P < 0. 01). After 3 months' follow-up,the recurrence rate of the observation group was 14. 81%,which was lower than 39. 2% in the control group( P < 0. 05). Conclusion Chinese medicine Flos Buddlejae covered ocular surface by iontophoresis can eliminate or alleviate symptoms of dry eye patient,and reduce recurrence rate,the possible mechanisim might be inhibiting the expression of inflammatory cytokines IL-6 and ICAM-1.
Objective To observe the effects of Chinese medicine Mimenghua( Flos Buddlejae) Iontophoresis on interleukin-6( IL-6),intercellular adhesion molecule-1( ICAM-1) in tear of dry eye patients and its possible mechanism. Methods A total of 60 patients( 120 eyes) with dry eye were randomly divided into observation group( 30 patients,60 eyes) and control group( 30 patients,60 eyes). The observation group was treated by Chinese medicine Flos Buddlejae iontophoresis and sodium hyaluronate eye drops,and the control group was only treated by sodium hyaluronate eye drops,for totally 4 weeks. The dry eye symptoms questionnaire scores,Schirmer-Ⅰtest,break-up time( BUT),cornea staining scores and the expression of IL-6,ICAM-1 in tear were compared before treatment and 2 and4 weeks after treatment. The curative effects were evaluated after 4 weeks' treatment. The recurrence of dry eye was observed after 3 months of follow-up. Results The total effective rate was 93. 33% and 80. 00% in observation group in the control group. The clinical efficacy in the observation group was more significant( P < 0. 01). After 2 weeks and 4 weeks treatment,dry eye symptoms questionnaire scores,Schirmer-Ⅰtest,BUT test,cornea staining scores and tear IL-6,ICAM-1 expression of two groups were significantly improved,and the observation group was better than the control group( P < 0. 05 or P < 0. 01). After 3 months' follow-up,the recurrence rate of the observation group was 14. 81%,which was lower than 39. 2% in the control group( P < 0. 05). Conclusion Chinese medicine Flos Buddlejae covered ocular surface by iontophoresis can eliminate or alleviate symptoms of dry eye patient,and reduce recurrence rate,the possible mechanisim might be inhibiting the expression of inflammatory cytokines IL-6 and ICAM-1.
引文
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[4]李怀凤,彭清华,姚小磊,等.密蒙花总黄酮对去势雄鼠干眼症模型角膜和泪腺组织的保护作用[J].中国中医眼科杂志,2010,20(1):1-6.
[5]中华医学会眼科学分会角膜病学组.干眼临床诊疗专家共识(2013年)[J].中华眼科杂志,2013,49(1):73-75.
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[11]STERN ME,SCHAUMBURG CS,PFLUGFELDER SC.Dry eye as a mucosal autoimmune disease[J]. Int Rev Immunol,2013,32(1):19-41.
[12]BENITEZ-DEL-CASTILLO SNCHEZ J,MORILLO-ROJAS MD,GALBIS-ESTRADA C,et al. Determination of inmune response and inflammation mediators in tears:Changes in dry eye and glaucoma as compared to healthy controls[J]. Arch Soc Esp Oftalmol,2017,92(5):210-217.
[13]KIM CE,OH HN,LEE JH,et al. Effects of chondrocytederived extracellular matrix in a dry eye mouse model[J].Mol Vis,2015,21:1210-1223.
[14]傅彦江,黄欣.中医对干眼症的认识[J].中医杂志,2011,52(22):1978-1979.
[15]彭清华,姚小磊,吴权龙,等.密蒙花提取物对去势雄兔干眼症的预防作用[J].中华眼科杂志,2008,44(11):1011-1019.
[16]姚小磊,彭清华,吴权龙.密蒙花提取物治疗兔去势所致干眼症[J].眼视光学杂志,2008,10(1):21-26.
[17]陈佳文,彭清华,姚小磊,等.密蒙花总黄酮对去势雄鼠干眼症泪腺TGF-β1及其基因表达的影响[J].眼科研究,2010,28(4):311-314.
[18]陈佳文,彭清华,姚小磊,等.密蒙花总黄酮对去势雄鼠干眼症泪腺组织中白细胞介素-1β表达的影响[J].湖南中医药大学学报,2011,31(9):16-18,30.
[19]李宗信,黄小波,熬平,等.电离子导入技术国内外研究近况[J].中华理疗杂志,2000,23(6):372.
[2]赵堪兴,杨培增.眼科学[M]. 7版.北京:人民卫生出版社,2010:77-80.
[3]童毅,李晴,杨光.干眼症的中医药治疗进展[J].湖南中医杂志,2016,32(8):228-230.
[4]李怀凤,彭清华,姚小磊,等.密蒙花总黄酮对去势雄鼠干眼症模型角膜和泪腺组织的保护作用[J].中国中医眼科杂志,2010,20(1):1-6.
[5]中华医学会眼科学分会角膜病学组.干眼临床诊疗专家共识(2013年)[J].中华眼科杂志,2013,49(1):73-75.
[6]LEMP MA. Report of the National Eye Institute/Industry workshop on clinical Trials in Dry Eyes[J]. CLAO J,1995,21(4):221-232.
[7]刘祖国.干眼[M].北京:人民卫生出版社,2017.
[8]国家中医药管理局医政司.中医病证诊断疗效标准[S].北京:中国中医药出版社,2016:75.
[9]刘祖国,彭娟.干眼的诊断与治疗规范[J].眼科研究,2008,26(3):161-164.
[10]刘祖国,杨文照.干眼症的发病机制[J].眼科,2005,14(5):342-345.
[11]STERN ME,SCHAUMBURG CS,PFLUGFELDER SC.Dry eye as a mucosal autoimmune disease[J]. Int Rev Immunol,2013,32(1):19-41.
[12]BENITEZ-DEL-CASTILLO SNCHEZ J,MORILLO-ROJAS MD,GALBIS-ESTRADA C,et al. Determination of inmune response and inflammation mediators in tears:Changes in dry eye and glaucoma as compared to healthy controls[J]. Arch Soc Esp Oftalmol,2017,92(5):210-217.
[13]KIM CE,OH HN,LEE JH,et al. Effects of chondrocytederived extracellular matrix in a dry eye mouse model[J].Mol Vis,2015,21:1210-1223.
[14]傅彦江,黄欣.中医对干眼症的认识[J].中医杂志,2011,52(22):1978-1979.
[15]彭清华,姚小磊,吴权龙,等.密蒙花提取物对去势雄兔干眼症的预防作用[J].中华眼科杂志,2008,44(11):1011-1019.
[16]姚小磊,彭清华,吴权龙.密蒙花提取物治疗兔去势所致干眼症[J].眼视光学杂志,2008,10(1):21-26.
[17]陈佳文,彭清华,姚小磊,等.密蒙花总黄酮对去势雄鼠干眼症泪腺TGF-β1及其基因表达的影响[J].眼科研究,2010,28(4):311-314.
[18]陈佳文,彭清华,姚小磊,等.密蒙花总黄酮对去势雄鼠干眼症泪腺组织中白细胞介素-1β表达的影响[J].湖南中医药大学学报,2011,31(9):16-18,30.
[19]李宗信,黄小波,熬平,等.电离子导入技术国内外研究近况[J].中华理疗杂志,2000,23(6):372.