中医综合疗法治疗水样液缺乏性干眼症方案的规范化研究
|
摘要
背景：干眼症是由于泪液的量或质或流体动力学异常引起的泪膜不稳定和(或)眼表损害,从而导致眼不适症状及视功能障碍的一类疾病。随着人类老龄化、空气污染等问题日益严重,以及电脑的普及和隐形眼镜的广泛应用等,干眼症已成为影响人们生活质量的一类重要的眼表疾病。其影响因素多,针对性的治疗困难,祛除病因和治疗原发病是提高干眼症治疗效果的关键,目前的治疗方法中人工泪液是一线用药,泪点塞在轻中度干眼症中效果确切,伴有中重度炎症者应用糖皮质激素、免疫抑制剂,全身应用促泪液分泌、性激素等有副作用风险。干眼症属于祖国医学“白涩症、干涩昏花症和神水将枯”范畴,中药润目灵和针刺单独应用治疗干眼症均取得较好疗效,在此基础上寻找安全可靠、疗效确切的传统治疗方法,需要进一步规范化整合中医综合疗法。
目的：通过规范性研究,归纳整合优化中医综合疗法治疗水样液缺乏性干眼症方案,完善针灸使用的技术标准操作规程,评价中医综合疗法对水样液缺乏性干眼症的疗效,形成便于在西医院和基层医院推广的应用指南和临床诊疗规范。
方法：采用随机、平行设计、阳性药对照、多中心方法,分为润目灵治疗组(A组)、中医综合疗法治疗组(B组)及泪然对照(C组),总例数645例,润目灵组215例,泪然组215例,中医综合疗法组215例。观察疗前疗后的症状、泪液分泌量、泪膜破裂时间和角膜荧光染色,进行优效性检验。
结果：中医综合疗法和中药润目灵疗效优于对照药泪然滴眼液：中医证候疗效有效率：A组为79.88%,B组为84.85%,C组为67.74%,差异有统计学意义,A组、B组优于C组；对于中、重度病人,B组疗效优于C组,差异有统计学意义；“单项症状”疗效中,A组干涩感、畏光症状消失率为12.35%和69.41%高于C组的10.86%和57.01%,组间差异有统计学意义,B组干涩感、异物感、烧灼感和视物疲劳症状消失率分别为21.89%、60.36%、81.66%和53.25%高于C组的10.86%、43.44%、74.21%和23.53%,两组间差异有统计学意义；治疗前后症状总积分改善情况,第6、8周A组和B组优于C组,差异有统计学意义；治疗前后泪膜破裂时间延长及泪流量增加,A、B组优于C组,差异有统计学意义；
中医综合疗法疗效优于中药润目灵：两组有效率相比,差异有统计学意义,B组优于A组；B组眼干涩、视物疲劳症状的消失率均高于A组,组间差异有统计学意义；症状总积分改善情况,第8周B组优于A组；“单项症状”疗效中,眼干涩、视物疲劳症状改善B组优于A组。
结论：中药润目灵治疗干眼症疗效确切,而中药润目灵联合针灸的综合疗法又优于单纯中药润目灵。
Background:Xeroma is a disease of ocular surface characterized by Symptoms of ocular discomforts and visual dysfunction, which is the result of abnormal tear quantity or quality or fluid dynamics of the tear film. With the problem of human aging, air pollution and the popularization of computer and contact lenses is increasingly serious.Xeroma has a Serious impact on people's quality of life. For the time being the cause and mechanism of xeroma are not fully known to us. The methods of effective treatments are still not present.Removing the causes and remedy of the primary disease is the key to the treatment of xeroma. Artificial tear substituent is the first-line drug, eternal or temporary blockage of tear duct in mild to moderate dry eye is effective,and Corticosteroids and immunosuppressants is effective for those with moderate to severe inflammatory reaction. There is risk of significant complications with systemic application of sex hormone and tear secretion. We have demonstrated that Runmuling, an oral granule preparation composed of Bidens Bipinnata L, medlar and chrysanthemum and acupuncture separately showed better curative effect in treatment of xeroma,on the basis of looking for safe, reliable and effective traditional treatment methods, we need to further standardize integration of integrated traditional Chinese medicine therapy.
Objective:Through standardized research,to summarize the integration and optimization of integrated traditional Chinese medicine therapy in the treatment of xeroma, improve the technical standards of operation procedures of acupuncture, investigate the exact curative effect and security of integrated Traditional Chinese Medicine therapy on xeroma, forming the guide of the clinical diagnosis and therapy standard and which is facilitated application and popularization in West hospitals and primary hospitals.
Methods:645patients with xeroma are investigated with A randomized, parallel design, positive drug control, multi-center method, divided into Runmuling treatment group (group A)215cases, integrated Traditional Chinese Medicine therapy group (group B)215cases and tears natural control group (group C)215cases separately, Since the beginning of the treatment, the patients are observed and evaluated every two weeks in terms of symptom score, SIT, BUT, corneal staining and the results were statistically analyzed by superiority test.
Results:The efficacy of Integrated traditional Chinese medicine therapy group and Runmuling treatment group is superior to tears natural control group:The efficiency of TCM syndrome curative effect of group A,B,and C is79.88%,84.85%and67.74%separately, Group A and B are superior to group C, the difference is statistically significant,especially efficiency in moderate to severe patients in group B is superior to group C statistically; About "symptom disappearance rate " efficacy, dryness, fear of light symptom disappearance rate in group A and group C is12.35%,69.41%and10.86%,57.01%, there was statistically significant difference between the groups; Symptom disappearance rate of dryness, foreign body sensation, burning sensation and visual fatigue symptoms in group B was21.89%,60.36%,81.66%and53.25%and those in group C was10.86%,43.44%,74.21%and23.53%, there are significant differences between the two groups before and after treatment, group B is superior to group C;there is statistically significant difference among the three groups in the total symptom score after6and8weeks of treatment, group A and B are superior to group C; there was also significant difference in BUT and SIT in group A, B than in group C, the difference was statistically significant;
The efficacy of Integrated Traditional Chinese Medicine therapy group is better than that of Runmuling group:The difference of curative effect between two groups was statistically significant, group B is better than group A;there was statistically significant difference in symptom disappearance rate of dryness and visual fatigue between group B and A; the total symptom score after8weeks of treatment in group B is superior to group A, the difference is statistically significant, the total symptom score improvement of dryness and visual fatigue in group B is better than that of group C, the difference was statistically significant;
Conclusion:Effect of Runmuling in treatment of xerophthalmia is exact,integrated traditional Chinese medicine therapy that combined of Runmuling and acupuncture is better than that of pure Chinese herbal medicine runmuling.
目的：通过规范性研究,归纳整合优化中医综合疗法治疗水样液缺乏性干眼症方案,完善针灸使用的技术标准操作规程,评价中医综合疗法对水样液缺乏性干眼症的疗效,形成便于在西医院和基层医院推广的应用指南和临床诊疗规范。
方法：采用随机、平行设计、阳性药对照、多中心方法,分为润目灵治疗组(A组)、中医综合疗法治疗组(B组)及泪然对照(C组),总例数645例,润目灵组215例,泪然组215例,中医综合疗法组215例。观察疗前疗后的症状、泪液分泌量、泪膜破裂时间和角膜荧光染色,进行优效性检验。
结果：中医综合疗法和中药润目灵疗效优于对照药泪然滴眼液：中医证候疗效有效率：A组为79.88%,B组为84.85%,C组为67.74%,差异有统计学意义,A组、B组优于C组；对于中、重度病人,B组疗效优于C组,差异有统计学意义；“单项症状”疗效中,A组干涩感、畏光症状消失率为12.35%和69.41%高于C组的10.86%和57.01%,组间差异有统计学意义,B组干涩感、异物感、烧灼感和视物疲劳症状消失率分别为21.89%、60.36%、81.66%和53.25%高于C组的10.86%、43.44%、74.21%和23.53%,两组间差异有统计学意义；治疗前后症状总积分改善情况,第6、8周A组和B组优于C组,差异有统计学意义；治疗前后泪膜破裂时间延长及泪流量增加,A、B组优于C组,差异有统计学意义；
中医综合疗法疗效优于中药润目灵：两组有效率相比,差异有统计学意义,B组优于A组；B组眼干涩、视物疲劳症状的消失率均高于A组,组间差异有统计学意义；症状总积分改善情况,第8周B组优于A组；“单项症状”疗效中,眼干涩、视物疲劳症状改善B组优于A组。
结论：中药润目灵治疗干眼症疗效确切,而中药润目灵联合针灸的综合疗法又优于单纯中药润目灵。
Background:Xeroma is a disease of ocular surface characterized by Symptoms of ocular discomforts and visual dysfunction, which is the result of abnormal tear quantity or quality or fluid dynamics of the tear film. With the problem of human aging, air pollution and the popularization of computer and contact lenses is increasingly serious.Xeroma has a Serious impact on people's quality of life. For the time being the cause and mechanism of xeroma are not fully known to us. The methods of effective treatments are still not present.Removing the causes and remedy of the primary disease is the key to the treatment of xeroma. Artificial tear substituent is the first-line drug, eternal or temporary blockage of tear duct in mild to moderate dry eye is effective,and Corticosteroids and immunosuppressants is effective for those with moderate to severe inflammatory reaction. There is risk of significant complications with systemic application of sex hormone and tear secretion. We have demonstrated that Runmuling, an oral granule preparation composed of Bidens Bipinnata L, medlar and chrysanthemum and acupuncture separately showed better curative effect in treatment of xeroma,on the basis of looking for safe, reliable and effective traditional treatment methods, we need to further standardize integration of integrated traditional Chinese medicine therapy.
Objective:Through standardized research,to summarize the integration and optimization of integrated traditional Chinese medicine therapy in the treatment of xeroma, improve the technical standards of operation procedures of acupuncture, investigate the exact curative effect and security of integrated Traditional Chinese Medicine therapy on xeroma, forming the guide of the clinical diagnosis and therapy standard and which is facilitated application and popularization in West hospitals and primary hospitals.
Methods:645patients with xeroma are investigated with A randomized, parallel design, positive drug control, multi-center method, divided into Runmuling treatment group (group A)215cases, integrated Traditional Chinese Medicine therapy group (group B)215cases and tears natural control group (group C)215cases separately, Since the beginning of the treatment, the patients are observed and evaluated every two weeks in terms of symptom score, SIT, BUT, corneal staining and the results were statistically analyzed by superiority test.
Results:The efficacy of Integrated traditional Chinese medicine therapy group and Runmuling treatment group is superior to tears natural control group:The efficiency of TCM syndrome curative effect of group A,B,and C is79.88%,84.85%and67.74%separately, Group A and B are superior to group C, the difference is statistically significant,especially efficiency in moderate to severe patients in group B is superior to group C statistically; About "symptom disappearance rate " efficacy, dryness, fear of light symptom disappearance rate in group A and group C is12.35%,69.41%and10.86%,57.01%, there was statistically significant difference between the groups; Symptom disappearance rate of dryness, foreign body sensation, burning sensation and visual fatigue symptoms in group B was21.89%,60.36%,81.66%and53.25%and those in group C was10.86%,43.44%,74.21%and23.53%, there are significant differences between the two groups before and after treatment, group B is superior to group C;there is statistically significant difference among the three groups in the total symptom score after6and8weeks of treatment, group A and B are superior to group C; there was also significant difference in BUT and SIT in group A, B than in group C, the difference was statistically significant;
The efficacy of Integrated Traditional Chinese Medicine therapy group is better than that of Runmuling group:The difference of curative effect between two groups was statistically significant, group B is better than group A;there was statistically significant difference in symptom disappearance rate of dryness and visual fatigue between group B and A; the total symptom score after8weeks of treatment in group B is superior to group A, the difference is statistically significant, the total symptom score improvement of dryness and visual fatigue in group B is better than that of group C, the difference was statistically significant;
Conclusion:Effect of Runmuling in treatment of xerophthalmia is exact,integrated traditional Chinese medicine therapy that combined of Runmuling and acupuncture is better than that of pure Chinese herbal medicine runmuling.
引文
1.刘祖国.眼表疾病学[M].北京：人民卫生出版社,2003：286-287
2.Smith J,Albeitz J,Begley C,et al:The epidemiology of dry eye disease:report of the Epidemiology Subcommittee of the International Dry Eye Workshop (2007).Ocul Surf 2007(5):93-107
3.刘莹,邹留河,播志强等,眼科门诊患者中干眼症的初步调查,眼科,2004,13(4)：233-235
4.肖秀林,韦福邦,韦礼友等,广西柳州市普通人群干眼症流行病学的调查[J],国际眼科杂志,2009,9(5)：947-949
5.张宏,安晓,陈雪艺,眼科门诊干眼的流行病学调查及相关危险因素分析[J],眼科新进展,2008,28(3)：214-218
6.严厉,顾宝文,司马晶,眼科门诊患者中干眼症的流行病学调查[J],解剖与临床杂志,2006,11(3)：200-201
7.张怡,葛玲,黄惠丽等,上海市花木社区中老年人群干眼的患病率调查分析,实用临床医学,2010,11(3)：127-130
8.The definition and classification of dry eye disease:report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf.2007 Apr;5(2):75-92.
9.Moss S E,Klein R,Klein B E,Prevalence of and risk factors for dry eye syndrome[J],Arch Ophthalm ol,2000,118(9):1264-1268
10.Zhou L,Beuerman R W,Chan C M,et al Identification of tear f luid biomarkers in dry eye syndrome using iTRAQ quantitative proteomics [J],JProteome Res,2009,8(11):4889-4905
11.Baudouin C,The pathology of dry eye[J],Surv Ophthalmol,2001,54(Suppl 12):s211-220 Baudouin C,The pathology of dry eye[J],Surv Ophthalmol,2001,54(Suppl 12):s211-220
12.Schirra F,Seitz B,Knop N,et al Sex hormones and dry eye [J], Ophthalmology,2009,106(11):988-994
13.Tavakoli M,Kallinikos PA,Efron N,et al Corneal sensitivity is reduced and relates to the severity of n europathy in patients with diabetes[J].Diabetes Care,2007,30(7):1895-1897
14.Chang YH, Yoon JS, Chang JH, et al. Changes in corneal and conjunctival sensitivity,tear film stability and tear sectrtion after strabismus surgery[J],Jpediatr Ophthalmol Strabismus 2006,43(2):95-99
15.LIU Zuzuo,LIU Lihui,ZHING Zhengping,et al,Tear film changes after phacoe mulsification[J]. China J Ophthalmol,2002,38(5):274-277
16. McCollum CJ,Foulks GN, Bodner B,et al,Rapid assay of lactoferrin in keratoconjunctivitis sicca [J],Cornea,1994,13(6):505-508
17.Solomon A, Dursun D,Liu Z,et al,Pro-and anti-inflammatory forms of interleukin-1 in the tear fluid an d conjunctiva of patients with dry-eye disease[J],Invest Ophthalmol Vis Sci,2001,42(10):2283-2292
18.ZoukhriD,HodgesRR,ByonD,Kublin CL.Role ofproinflam-matory cytokines in the impaired lacrimation associated withautoimmune xerophthalm ia[J].InvestOphthalm olVis Sci,2002,43(5):1429-1436.
19.Gao J, Schwalb TA, Addeo JV, et al. The role of apoptosis in thepathogenesis of canine keratoconjunctivitis sicca:the effect of topicalcyclosporin A therapy[J].Cornea,1998.17:654-663
20.马轶群,王传富,下青.维生素A缺乏于眼症兔泪腺凋亡及相大基因的表达[J].眼科新进展,2003,23(6)：406
21.Brignole F,De Saint-Jean M,Goldschild M,et al. Expression of Fas-Fas ligand antigens and apoptotic marker APO2.7 by the human conjunctival epithelium.Positive correlation with class II HLADR expression in inflammatory ocular surface disorders[J].ExpEye Res,1998(67):687-697
22.Fujihara T,Fujita H,Tsubota K,et al.Preferential localization of CD8+ alpha E beta 7+ T cells around acinar epithelial cells with apoptosis in patients with Sjogren syndrome[J],J Immunol,1999,163:2226-2235
23.Manganelli P,Fietta P. Apoptosis and Sjogren syndrome[J],SeminArthritis Rheum.2003, (33):49-65
24.Xu KP,Yagi Y,Tsubota K,Decrease in corneal sensitivity and change in tear function in dry eye[J].Cornea,1996,15:235-239
25.Zoukhri D,Hodges RR,Dartt DA.Lacrimal gland innervation is not altered with the onset and progression of disease in a murine model of Sjogren syndrome[J].Clin Immunol Immunopathol,1998,89:126-133
26.Hojal BM,Ornek N,Zilelioglu G,et al,Morphology of corneal nerves and corneal sensation in dry eye:a preliminary study[J].Eye,2005,19(12):1276-1279
27.Wickham LA,Gao J,Toda I,et al,Identification of androgen,estrogen and progesterone receptor mRNAs in the eye[J],Acta Ophthalmol Scand,2000,78:146-153
28.Sullivan DA,Block L,Pena JD,Influence of androgens and pituitary hormones on the structural profile and secretory activity of the lacrimal gland,Acta Ophthalmol Scand,1996,74:421-435
29.Oprea L,Tiberghien A,Creuzot-Garcher C,et al,Hormonal regulatory influence in tear film[J],JFr Ophtalmol,2004,27:933-941
30.Mrukwa KE,Rogowska GA,Gierek CS,Effect of anti-inflammatory therapy on the treatment of dry eye syndrome,Klin Oczna,2007,109(13):79-84
31.Suzuki T,Sullivan DA,Estrogen stimulation of proinflammatory cytokine and matrix metalloproteinase gene expression in human corneal epithelial cells,Cornea,2005,24(8):1004-1009
32.Mathers WD,Stovall D,Lane JA,et al,Menopause and tear function.the influence of prolactin and sex hormones on human tear production[J],Cornea,1998,17(4):353
33.Obata H,Anatomy and histopathology of the human lacrimal gland[J]Cornea 2006,25:S82-S89
34.Rivas L, Oroza MA, Perez-Esteban A, et al:Morphological changes in ocular surface in dry eyes and other disorders by impression cytology. Graefes Arch Clin Exp Ophthalmol 1992;230:329-334.
35.Tseng SC,Staging of conjunctival squamous metaplasia by impression cytology[J]Ophthalmology,1985,92:728-733
36.Liu Z,Pflugfelfer SC,Corneal thickness is reduced in dry eye[J], Comea,1999,18(4):403-407
37.Nakamori K,Odawara M,Nakajima O,et al,Blinking is controlled primarily by ocular surface conditions[J],Am J Ophthalmol,1997,124(1):24-30
38.刘敏,高卫萍,120例干眼症临床特征分析[J],浙江中医药大学学报,2009,33(1)：59-60.
39.Lemp MA, New strategies in the treatment of dry-eye states.Cornea,1999,18:625-632.
40.Smith J,Albeitz J,Begley C,et al,The epidemiology of dry eye disease:report of the Epidemiology Subcommittee of the International Dry Eye WorkShop (2007),Ocul Surf 2007;5:93-107
41.张梅,陈家祺,刘祖国等,干眼患者115例的临床特点分析[J],中华眼科杂志,2003,39(1)：5-9
42.邓新国,孙倩娜,高杨,干眼症患者435例临床症状分析[J],眼科新进展,2008,28(10)：763-765
43.TodaI,Fujishima H,Tsubota K,Ocular fatigue is the major symptom of dry eye, Acta Ophthalmol,1993,71:347-352
44.邵静,吴彤霞,孙慧华等,泪黏液蕨样结晶与干燥性角膜炎.中国实用眼科杂志,2001(19)：23-27
45.刘祖国,彭娟,干眼的诊断与治疗规范,眼科研究,2008(26)：162
46. Li Shi-min,Nikulina K,DeVoss J,et al.Small proline-rich protein 1 B (SPRR1B) is a biomarker for squamous metaplasia in dry eye disease[J].Invest Ophthalmol Vis Sci,2008,49(1):34-41
47. Goto E, Tseng SC. Differentiation of lipid tear deficiency dry eye by kinetic analysis of tear interference images[J]. Arch Ophthalmol,2003(121):173-180
48.刘祖国,彭娟,干眼的诊断与治疗规范[J],眼科研究,2008,26：162
49.Management and therapy of dry eye disease:report of the Management and Therapy Subcommittee of the International Dry Eye Workshop [J].Ocul Surf,2007,5:163-178
50.吕帆,翟佳,陈洁,硅胶泪点或泪管栓塞术治疗干眼症[J],眼科研究,2000,18(2)：179-181
51.Mrukwa KE,Rogowska GA,Gierek CS,Effect of anti-inflammatory therapy on the treatment of dry eye syndrome,Klin Oczna,2007,109(13):79-84
52.Gilbard JP,Dry eye:pharmcological approaches,effects and progress,CLAO,1996,141-145
53.张汗承,周祖嫌,赵咸荣,干眼病记分分级和人工泪液疗效评价的研究[J],眼科研究,1994,12(1)：25
54.Matsuo T,Trehalose versus hyaluronan or cellulosemeye drops for the treatment of dry eye[J],Jpn J Ophthalmol,2004,48(4);321-327
55.胡燕华,查仲玲,陈飞,聚丙烯酸凝胶人工泪液的研制及其观察[J],同济医科大学学报,2000,29(2)：151-152
56.王丽娅,张月琴,祝磊等,重组人表皮生长因子衍生物滴眼剂治疗角膜病的随机双盲平行对照临床研究[J].实用诊断与治疗杂志,2004,18(4)：262-266.
57.赵治,石春和,贝复舒(重组bFGF)滴眼液治疗干眼的疗效观察[J].江苏大学学报(医学版),2004,(4)：287-288
58.Matsuo T,Trehalose versus hyaluronan or cellulose in eyedrops for the treatment of dry eye[J],Jpn J Ophthalmol,2004,48:321-327
59.Ogawa Y,Okamoto S,Mori T,et al,Autologous serum eye drops for the treatment of severe dry eye in patients with chronic graft-versus-host disease[J]·Bone Marrow Transplant,2003,31(7):579
60.黄林英,晏晓明,荣蓓,不同浓度人血清滴眼液治疗重症干眼大鼠的实验研究[J],眼科,2010,19(3)：174-178
61.刘凤,刘汝瑜,贾桂芹,溴苄环己胺治疗干眼症的疗效评价[J],天津医药,2001,29(12)：752-753
62.谢汉平,张汉承,家兔干眼模刑的角膜上皮超微结构及儿种眼药的疗效[J],眼科研究,1992,10(1)：10-12
63.Tauber J,Davitt WF,Bokosky JE,et al,Double-masked,placebo-controlled safety and efficacy trial of diquafosol tetrasodium (INS365)ophthalmic solution for the treatment of dry eye[J],Cornea,2004,23:784-792
64.Stephen CP,Anti-inflammatory therapy for dry eye[J],Am Jophthalmol,2004,137(2):337-342
65.Kunert KS,Tisdale AS,Gipson IK,Goblet cell numbers and epithelial proliferation in the conjunctiva of patients with dry eye syndrome treated with cyclosporine[J],Arch Ophthalmol,2002,120(3):330-337
66.Gao J,Schwalb TA,Addeo JV,et al,The role of apoptosis in thepathogenesis of canine keratoconjunctivitis sicca:the effect of topical Cyclosporin A therapy[J],Cornea,1998,17:654-663
67.Aoki S,Mizote H,Minamoto A,et al,Systemic FK506 improved tear secretion in dry eye associated with chronic graft versus host disease[J],Br J Ophthalmol,2005,89(2):243-244
68.Azzarolo AM,Mircheff AK,Kaswan RL,et al,Androgen support of lacrimal gland function.Endocrine,1997,(6):39-45
69.Schirra F,Suzuki T,Richards SM,et al,Androgen control of gene expression in the mouse meibomian gland[J].Invest Ophthalmol Vis Sci.2005 Oct;46(10):3666-75.
70.Sullivan DA,Wickham LA,Rocha EM,et al,Influence of gender,sex steroid hormones,and the hypothalamic-pituitary axis on the structure and function of the lacrimal gland[J],Adv Exp Med Biol. 1998,438:11-42
71.Sullivan DA,Rocha EM,Ullman MD,et al,Androgen regulation of the meibomian gland. Adv Exp Med Biol. 1998,438:327-331
72.肖秀林,激素替代疗法在更年期妇女干眼症的应用[J],中国实用眼科杂志,2006,24(3)：329-330
73.Sator MO,Joura EA,Golaszewski T,et al Treatment of menopausal keratoconjnctivitis with topical oestradiol.BrJ Obstet Gynaecol,1998,105(1):100-102
74. Murube J,Marcos MG,Javate R,Amylase in mare lacrimale in Patients with Submandibular salivary gland transplantation to the lacrimal basin,Adv Exp MedBiol,1994,350:565-570
75.Geerling G,Sieg P,Bastian GO,Transplantation of the autologous submandibular gland for most severe cases of keratoconjunctivitis sicca[J],Ophthalmology,1998,Feb,105(2):327-35
76.明.傅仁宇.审视瑶函[M].上海：上海卫生出版社,1958.107,181,202
77.明.王肯堂.证治准绳[M].北京：人民卫生出版社,1991,726
78.清.黄庭镜.口经大成[M].北京：中医古籍出版社,1987,145
79.隋.巢元方.诸病源候论[M].沈阳：辽宁科技出版社,1997.133
80.段俊国 中西医结合眼科学[M]北京：中国中医药出版社2005,134
81.王利民.试述从肝肾论治干眼病[J].四川中医,2005,23(7)：13-14
82.王高,谷安琪,雷世奇.中药治疗干眼症的临床疗效观察[J].中国中医眼科杂志,2003,13(3)：143-145.
83.国家中医药管理局.中医病证诊断疗效标准[S].南京：南京大学山版社,1995.101
84.陈小华,肖汇颖,戎曙欣等,浅析从肝论治干眼症[J],新中医2012,7,(44)7：190
85.张彩霞,郝小波教授辨证治疗干眼症经验介绍[J],新中医,2005,37(4)：23
86.刘锋祥,干眼症的辨证分型治疗[J],中外健康文摘,2007,10(4)：60-61
87.郑静,陈国孝,干眼症64例病因及中医证治分析[J],广西中医药,2011,12(34)6：18-19
88.钟新娜,曹岐新,辨证治疗干眼症40例临床观察[J],浙江中医杂志,2008,43(9)：521
89.高卫萍,杨瑛,陆绵绵辨证论治水液缺乏性干眼症的疗效观察[J],中医药信息2010,27(1)：80-82
90.董玉,王鹏,张昆等,苏藩主任辨证分型治疗干眼症60例[J],云南中医中药杂志2012,33(5)：3-5
91.韦东,李越虹,张玉平,干眼Ⅰ号颗粒治疗肝肾阴虚型干眼症的疗效观察[J],中国中医药信息杂志,2010,17(11)：10-12
92.高卫萍,王育良,陆绵绵等,润目灵治疗干眼病的临床研究[J],中国中医眼科杂志,1998,8(3)：157-159
93.陈建峰,冯燕敏,陈娇英.八物汤治疗干眼症的临床观察[J].中国中医眼科杂志,2007,17(3)：163
94.李凯,王育良,高卫萍等,中药润目灵治疗水样液缺乏性干眼症的临床疗效[J],国际眼科杂志,2009,11,9(11)：2116-2117
95.汪伟,李妍,冯小梅,养阴清肺汤治疗肺阴不足型干眼症临床观察,新中医,2011,43(12)：35-37
96.尹连荣,高健生,自拟温肾逍遥汤治疗围绝经期干眼症的疗效观察[J],中国中医眼科杂志,2011,21,(5)：253-255
97.张笑吟,王志敏,中西医结合治疗肝肾阴虚型干眼症临床观察[J]光明中医2009,24(5)：902-903
98.林秋霞,韦企平,杞菊地黄丸治疗干眼症的临床研究[J],中国中医眼科杂志,2012,22(3)3：172-175
99.赵志敏,李朝军,芍药甘草汤加减治疗干眼症36例[J].河南职工医学院学报,2006,18(3)：220-222
100.易昀敏,邵毅,王慧珍等,密蒙花茶治疗更年期女性中重度干眼症疗效观察[J],眼科新进展,2011,31(11)：1049-1053
101.宋立,苏艳丽,许家骏,中药超声凉雾治疗干眼症的疗效观察[J],中国中医眼科杂志,2011,21(5)：273-275
102.刘宏伟,彭淑玲,周毅等,杞菊滴眼液治疗实验性干眼症泪液减少和角膜上皮病变[J],中国中医眼科杂志,2011,21(1)：12-15
103.李钟睿,张晓梅,刘丽娟,中药熏眼联合人工泪液治疗干眼症的临床观察[J],哈尔滨医科大学学报,2012,46(2)：184-185
104.郭霭春.黄帝内经灵枢校注语译[M].天津：天津科学技术出版社,1989.250
105.龚岚,孙兴怀,马晓芃等,针刺治疗干眼症临床疗效和安全性观察的初步研究[J]中华眼科杂志,2006,42(11)：1026-1028
106.黄洁,赵婕,徐红,针灸联合人工泪液治疗干眼症的疗效观察[J],眼科新进展,2012,32(9)：847-849
107.刘桂霞,周丹,针刺治疗泪液分泌不足型干眼症临床观察[J]中华中医药学刊,2012,30(8)：1748-1749
108.魏立新,杨威,王宏才,针灸对干眼症泪液分泌影响的疗效评价,中国针灸,2010,30(9)：709-782
109.高卫萍,李影,眼周针刺对干眼患者泪液流量及泪膜的影响,辽宁中医药大学学报,2011,13(7)：22-24
110.高卫萍王健,张燕,针刺治疗缺泪性干眼症31例疗效观察[J],新中医,2007,39(6)：41-42
111.张义彪,高卫萍,针刺对水液缺乏型干眼兔泪液分泌及泪腺微观形态的影响[J]南京中医药大学学报,2010,26(1)：47-50
112.李淑萍,挤按法联合复方炉甘石眼膏治疗老年睑板腺功能异常干眼症疗效观察[J],中医学报,2011,26(7)：881-882
113.侯曙红,穴位按摩治疗视疲劳干眼症200例报告[J],山东医药,2004,44(18)；69-70
114.郭承伟,路斌,吕璐,综合方法治疗睑缘炎相关性干眼症临床观察,实用中医药杂志,2011,27(3)：178-179
115.Gulati A,dana M,Keratoconjunctivitis sicca:clinical aspects.In:Foster C,Azar D,Dohlman C(ends)Smolin and Thoft's The cornea.Philadelphia:Lippincott Williams & Wilkins,2005:603-627
116.Zoukhri D,Hodges RR,Byon D,et al.Role of proinflammatory cytokines in impaired lacrimation associated with autoimmune xerophthalmia.Invest Ophthalmol Vis Sci 2002,43:1429-1436
117. Liu H, Zheng Q, Farley JM:Antimuscarinic actions of antihistamines on the heart.J Biomed Sci 2006; 13:395-401.
118.严厉,顾宝文,司马晶等,眼科门诊患者中干眼症的流行病学调查[J],解剖与临床,2006,(11)3：200-201
119.王惟一.铜人腧穴针灸图经[M].北京：中国书店影印,1987.(3)22,25,19,(5)：11
120.杨继洲著,针灸大成[M],北京：中医古籍出版社,1998,304-343
121.龚岚,孙兴怀,马晓,针刺对兔泪液分泌及泪腺血管活性肠肽浓度的影响,针刺研究[J],2006,31(6)：347-350
122.高卫萍,张义彪,李桥,针刺对干眼兔模型泪液分泌及泪腺中乙酰胆碱含量的影响[J],新中医,2011,43(3)：134-136
123.Steven E,Wilson SE,Inflammation:A unifying theory for the origin of dry eye syndrome[J].Managed Care,2003,12(12suppl):14-16
124.彭清华,刘慧莹,姚小磊等,针刺对干眼症患者性激素水平调节的影响[J],国际眼科杂志,2009,9(8)：1534-1536
2.Smith J,Albeitz J,Begley C,et al:The epidemiology of dry eye disease:report of the Epidemiology Subcommittee of the International Dry Eye Workshop (2007).Ocul Surf 2007(5):93-107
3.刘莹,邹留河,播志强等,眼科门诊患者中干眼症的初步调查,眼科,2004,13(4)：233-235
4.肖秀林,韦福邦,韦礼友等,广西柳州市普通人群干眼症流行病学的调查[J],国际眼科杂志,2009,9(5)：947-949
5.张宏,安晓,陈雪艺,眼科门诊干眼的流行病学调查及相关危险因素分析[J],眼科新进展,2008,28(3)：214-218
6.严厉,顾宝文,司马晶,眼科门诊患者中干眼症的流行病学调查[J],解剖与临床杂志,2006,11(3)：200-201
7.张怡,葛玲,黄惠丽等,上海市花木社区中老年人群干眼的患病率调查分析,实用临床医学,2010,11(3)：127-130
8.The definition and classification of dry eye disease:report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf.2007 Apr;5(2):75-92.
9.Moss S E,Klein R,Klein B E,Prevalence of and risk factors for dry eye syndrome[J],Arch Ophthalm ol,2000,118(9):1264-1268
10.Zhou L,Beuerman R W,Chan C M,et al Identification of tear f luid biomarkers in dry eye syndrome using iTRAQ quantitative proteomics [J],JProteome Res,2009,8(11):4889-4905
11.Baudouin C,The pathology of dry eye[J],Surv Ophthalmol,2001,54(Suppl 12):s211-220 Baudouin C,The pathology of dry eye[J],Surv Ophthalmol,2001,54(Suppl 12):s211-220
12.Schirra F,Seitz B,Knop N,et al Sex hormones and dry eye [J], Ophthalmology,2009,106(11):988-994
13.Tavakoli M,Kallinikos PA,Efron N,et al Corneal sensitivity is reduced and relates to the severity of n europathy in patients with diabetes[J].Diabetes Care,2007,30(7):1895-1897
14.Chang YH, Yoon JS, Chang JH, et al. Changes in corneal and conjunctival sensitivity,tear film stability and tear sectrtion after strabismus surgery[J],Jpediatr Ophthalmol Strabismus 2006,43(2):95-99
15.LIU Zuzuo,LIU Lihui,ZHING Zhengping,et al,Tear film changes after phacoe mulsification[J]. China J Ophthalmol,2002,38(5):274-277
16. McCollum CJ,Foulks GN, Bodner B,et al,Rapid assay of lactoferrin in keratoconjunctivitis sicca [J],Cornea,1994,13(6):505-508
17.Solomon A, Dursun D,Liu Z,et al,Pro-and anti-inflammatory forms of interleukin-1 in the tear fluid an d conjunctiva of patients with dry-eye disease[J],Invest Ophthalmol Vis Sci,2001,42(10):2283-2292
18.ZoukhriD,HodgesRR,ByonD,Kublin CL.Role ofproinflam-matory cytokines in the impaired lacrimation associated withautoimmune xerophthalm ia[J].InvestOphthalm olVis Sci,2002,43(5):1429-1436.
19.Gao J, Schwalb TA, Addeo JV, et al. The role of apoptosis in thepathogenesis of canine keratoconjunctivitis sicca:the effect of topicalcyclosporin A therapy[J].Cornea,1998.17:654-663
20.马轶群,王传富,下青.维生素A缺乏于眼症兔泪腺凋亡及相大基因的表达[J].眼科新进展,2003,23(6)：406
21.Brignole F,De Saint-Jean M,Goldschild M,et al. Expression of Fas-Fas ligand antigens and apoptotic marker APO2.7 by the human conjunctival epithelium.Positive correlation with class II HLADR expression in inflammatory ocular surface disorders[J].ExpEye Res,1998(67):687-697
22.Fujihara T,Fujita H,Tsubota K,et al.Preferential localization of CD8+ alpha E beta 7+ T cells around acinar epithelial cells with apoptosis in patients with Sjogren syndrome[J],J Immunol,1999,163:2226-2235
23.Manganelli P,Fietta P. Apoptosis and Sjogren syndrome[J],SeminArthritis Rheum.2003, (33):49-65
24.Xu KP,Yagi Y,Tsubota K,Decrease in corneal sensitivity and change in tear function in dry eye[J].Cornea,1996,15:235-239
25.Zoukhri D,Hodges RR,Dartt DA.Lacrimal gland innervation is not altered with the onset and progression of disease in a murine model of Sjogren syndrome[J].Clin Immunol Immunopathol,1998,89:126-133
26.Hojal BM,Ornek N,Zilelioglu G,et al,Morphology of corneal nerves and corneal sensation in dry eye:a preliminary study[J].Eye,2005,19(12):1276-1279
27.Wickham LA,Gao J,Toda I,et al,Identification of androgen,estrogen and progesterone receptor mRNAs in the eye[J],Acta Ophthalmol Scand,2000,78:146-153
28.Sullivan DA,Block L,Pena JD,Influence of androgens and pituitary hormones on the structural profile and secretory activity of the lacrimal gland,Acta Ophthalmol Scand,1996,74:421-435
29.Oprea L,Tiberghien A,Creuzot-Garcher C,et al,Hormonal regulatory influence in tear film[J],JFr Ophtalmol,2004,27:933-941
30.Mrukwa KE,Rogowska GA,Gierek CS,Effect of anti-inflammatory therapy on the treatment of dry eye syndrome,Klin Oczna,2007,109(13):79-84
31.Suzuki T,Sullivan DA,Estrogen stimulation of proinflammatory cytokine and matrix metalloproteinase gene expression in human corneal epithelial cells,Cornea,2005,24(8):1004-1009
32.Mathers WD,Stovall D,Lane JA,et al,Menopause and tear function.the influence of prolactin and sex hormones on human tear production[J],Cornea,1998,17(4):353
33.Obata H,Anatomy and histopathology of the human lacrimal gland[J]Cornea 2006,25:S82-S89
34.Rivas L, Oroza MA, Perez-Esteban A, et al:Morphological changes in ocular surface in dry eyes and other disorders by impression cytology. Graefes Arch Clin Exp Ophthalmol 1992;230:329-334.
35.Tseng SC,Staging of conjunctival squamous metaplasia by impression cytology[J]Ophthalmology,1985,92:728-733
36.Liu Z,Pflugfelfer SC,Corneal thickness is reduced in dry eye[J], Comea,1999,18(4):403-407
37.Nakamori K,Odawara M,Nakajima O,et al,Blinking is controlled primarily by ocular surface conditions[J],Am J Ophthalmol,1997,124(1):24-30
38.刘敏,高卫萍,120例干眼症临床特征分析[J],浙江中医药大学学报,2009,33(1)：59-60.
39.Lemp MA, New strategies in the treatment of dry-eye states.Cornea,1999,18:625-632.
40.Smith J,Albeitz J,Begley C,et al,The epidemiology of dry eye disease:report of the Epidemiology Subcommittee of the International Dry Eye WorkShop (2007),Ocul Surf 2007;5:93-107
41.张梅,陈家祺,刘祖国等,干眼患者115例的临床特点分析[J],中华眼科杂志,2003,39(1)：5-9
42.邓新国,孙倩娜,高杨,干眼症患者435例临床症状分析[J],眼科新进展,2008,28(10)：763-765
43.TodaI,Fujishima H,Tsubota K,Ocular fatigue is the major symptom of dry eye, Acta Ophthalmol,1993,71:347-352
44.邵静,吴彤霞,孙慧华等,泪黏液蕨样结晶与干燥性角膜炎.中国实用眼科杂志,2001(19)：23-27
45.刘祖国,彭娟,干眼的诊断与治疗规范,眼科研究,2008(26)：162
46. Li Shi-min,Nikulina K,DeVoss J,et al.Small proline-rich protein 1 B (SPRR1B) is a biomarker for squamous metaplasia in dry eye disease[J].Invest Ophthalmol Vis Sci,2008,49(1):34-41
47. Goto E, Tseng SC. Differentiation of lipid tear deficiency dry eye by kinetic analysis of tear interference images[J]. Arch Ophthalmol,2003(121):173-180
48.刘祖国,彭娟,干眼的诊断与治疗规范[J],眼科研究,2008,26：162
49.Management and therapy of dry eye disease:report of the Management and Therapy Subcommittee of the International Dry Eye Workshop [J].Ocul Surf,2007,5:163-178
50.吕帆,翟佳,陈洁,硅胶泪点或泪管栓塞术治疗干眼症[J],眼科研究,2000,18(2)：179-181
51.Mrukwa KE,Rogowska GA,Gierek CS,Effect of anti-inflammatory therapy on the treatment of dry eye syndrome,Klin Oczna,2007,109(13):79-84
52.Gilbard JP,Dry eye:pharmcological approaches,effects and progress,CLAO,1996,141-145
53.张汗承,周祖嫌,赵咸荣,干眼病记分分级和人工泪液疗效评价的研究[J],眼科研究,1994,12(1)：25
54.Matsuo T,Trehalose versus hyaluronan or cellulosemeye drops for the treatment of dry eye[J],Jpn J Ophthalmol,2004,48(4);321-327
55.胡燕华,查仲玲,陈飞,聚丙烯酸凝胶人工泪液的研制及其观察[J],同济医科大学学报,2000,29(2)：151-152
56.王丽娅,张月琴,祝磊等,重组人表皮生长因子衍生物滴眼剂治疗角膜病的随机双盲平行对照临床研究[J].实用诊断与治疗杂志,2004,18(4)：262-266.
57.赵治,石春和,贝复舒(重组bFGF)滴眼液治疗干眼的疗效观察[J].江苏大学学报(医学版),2004,(4)：287-288
58.Matsuo T,Trehalose versus hyaluronan or cellulose in eyedrops for the treatment of dry eye[J],Jpn J Ophthalmol,2004,48:321-327
59.Ogawa Y,Okamoto S,Mori T,et al,Autologous serum eye drops for the treatment of severe dry eye in patients with chronic graft-versus-host disease[J]·Bone Marrow Transplant,2003,31(7):579
60.黄林英,晏晓明,荣蓓,不同浓度人血清滴眼液治疗重症干眼大鼠的实验研究[J],眼科,2010,19(3)：174-178
61.刘凤,刘汝瑜,贾桂芹,溴苄环己胺治疗干眼症的疗效评价[J],天津医药,2001,29(12)：752-753
62.谢汉平,张汉承,家兔干眼模刑的角膜上皮超微结构及儿种眼药的疗效[J],眼科研究,1992,10(1)：10-12
63.Tauber J,Davitt WF,Bokosky JE,et al,Double-masked,placebo-controlled safety and efficacy trial of diquafosol tetrasodium (INS365)ophthalmic solution for the treatment of dry eye[J],Cornea,2004,23:784-792
64.Stephen CP,Anti-inflammatory therapy for dry eye[J],Am Jophthalmol,2004,137(2):337-342
65.Kunert KS,Tisdale AS,Gipson IK,Goblet cell numbers and epithelial proliferation in the conjunctiva of patients with dry eye syndrome treated with cyclosporine[J],Arch Ophthalmol,2002,120(3):330-337
66.Gao J,Schwalb TA,Addeo JV,et al,The role of apoptosis in thepathogenesis of canine keratoconjunctivitis sicca:the effect of topical Cyclosporin A therapy[J],Cornea,1998,17:654-663
67.Aoki S,Mizote H,Minamoto A,et al,Systemic FK506 improved tear secretion in dry eye associated with chronic graft versus host disease[J],Br J Ophthalmol,2005,89(2):243-244
68.Azzarolo AM,Mircheff AK,Kaswan RL,et al,Androgen support of lacrimal gland function.Endocrine,1997,(6):39-45
69.Schirra F,Suzuki T,Richards SM,et al,Androgen control of gene expression in the mouse meibomian gland[J].Invest Ophthalmol Vis Sci.2005 Oct;46(10):3666-75.
70.Sullivan DA,Wickham LA,Rocha EM,et al,Influence of gender,sex steroid hormones,and the hypothalamic-pituitary axis on the structure and function of the lacrimal gland[J],Adv Exp Med Biol. 1998,438:11-42
71.Sullivan DA,Rocha EM,Ullman MD,et al,Androgen regulation of the meibomian gland. Adv Exp Med Biol. 1998,438:327-331
72.肖秀林,激素替代疗法在更年期妇女干眼症的应用[J],中国实用眼科杂志,2006,24(3)：329-330
73.Sator MO,Joura EA,Golaszewski T,et al Treatment of menopausal keratoconjnctivitis with topical oestradiol.BrJ Obstet Gynaecol,1998,105(1):100-102
74. Murube J,Marcos MG,Javate R,Amylase in mare lacrimale in Patients with Submandibular salivary gland transplantation to the lacrimal basin,Adv Exp MedBiol,1994,350:565-570
75.Geerling G,Sieg P,Bastian GO,Transplantation of the autologous submandibular gland for most severe cases of keratoconjunctivitis sicca[J],Ophthalmology,1998,Feb,105(2):327-35
76.明.傅仁宇.审视瑶函[M].上海：上海卫生出版社,1958.107,181,202
77.明.王肯堂.证治准绳[M].北京：人民卫生出版社,1991,726
78.清.黄庭镜.口经大成[M].北京：中医古籍出版社,1987,145
79.隋.巢元方.诸病源候论[M].沈阳：辽宁科技出版社,1997.133
80.段俊国 中西医结合眼科学[M]北京：中国中医药出版社2005,134
81.王利民.试述从肝肾论治干眼病[J].四川中医,2005,23(7)：13-14
82.王高,谷安琪,雷世奇.中药治疗干眼症的临床疗效观察[J].中国中医眼科杂志,2003,13(3)：143-145.
83.国家中医药管理局.中医病证诊断疗效标准[S].南京：南京大学山版社,1995.101
84.陈小华,肖汇颖,戎曙欣等,浅析从肝论治干眼症[J],新中医2012,7,(44)7：190
85.张彩霞,郝小波教授辨证治疗干眼症经验介绍[J],新中医,2005,37(4)：23
86.刘锋祥,干眼症的辨证分型治疗[J],中外健康文摘,2007,10(4)：60-61
87.郑静,陈国孝,干眼症64例病因及中医证治分析[J],广西中医药,2011,12(34)6：18-19
88.钟新娜,曹岐新,辨证治疗干眼症40例临床观察[J],浙江中医杂志,2008,43(9)：521
89.高卫萍,杨瑛,陆绵绵辨证论治水液缺乏性干眼症的疗效观察[J],中医药信息2010,27(1)：80-82
90.董玉,王鹏,张昆等,苏藩主任辨证分型治疗干眼症60例[J],云南中医中药杂志2012,33(5)：3-5
91.韦东,李越虹,张玉平,干眼Ⅰ号颗粒治疗肝肾阴虚型干眼症的疗效观察[J],中国中医药信息杂志,2010,17(11)：10-12
92.高卫萍,王育良,陆绵绵等,润目灵治疗干眼病的临床研究[J],中国中医眼科杂志,1998,8(3)：157-159
93.陈建峰,冯燕敏,陈娇英.八物汤治疗干眼症的临床观察[J].中国中医眼科杂志,2007,17(3)：163
94.李凯,王育良,高卫萍等,中药润目灵治疗水样液缺乏性干眼症的临床疗效[J],国际眼科杂志,2009,11,9(11)：2116-2117
95.汪伟,李妍,冯小梅,养阴清肺汤治疗肺阴不足型干眼症临床观察,新中医,2011,43(12)：35-37
96.尹连荣,高健生,自拟温肾逍遥汤治疗围绝经期干眼症的疗效观察[J],中国中医眼科杂志,2011,21,(5)：253-255
97.张笑吟,王志敏,中西医结合治疗肝肾阴虚型干眼症临床观察[J]光明中医2009,24(5)：902-903
98.林秋霞,韦企平,杞菊地黄丸治疗干眼症的临床研究[J],中国中医眼科杂志,2012,22(3)3：172-175
99.赵志敏,李朝军,芍药甘草汤加减治疗干眼症36例[J].河南职工医学院学报,2006,18(3)：220-222
100.易昀敏,邵毅,王慧珍等,密蒙花茶治疗更年期女性中重度干眼症疗效观察[J],眼科新进展,2011,31(11)：1049-1053
101.宋立,苏艳丽,许家骏,中药超声凉雾治疗干眼症的疗效观察[J],中国中医眼科杂志,2011,21(5)：273-275
102.刘宏伟,彭淑玲,周毅等,杞菊滴眼液治疗实验性干眼症泪液减少和角膜上皮病变[J],中国中医眼科杂志,2011,21(1)：12-15
103.李钟睿,张晓梅,刘丽娟,中药熏眼联合人工泪液治疗干眼症的临床观察[J],哈尔滨医科大学学报,2012,46(2)：184-185
104.郭霭春.黄帝内经灵枢校注语译[M].天津：天津科学技术出版社,1989.250
105.龚岚,孙兴怀,马晓芃等,针刺治疗干眼症临床疗效和安全性观察的初步研究[J]中华眼科杂志,2006,42(11)：1026-1028
106.黄洁,赵婕,徐红,针灸联合人工泪液治疗干眼症的疗效观察[J],眼科新进展,2012,32(9)：847-849
107.刘桂霞,周丹,针刺治疗泪液分泌不足型干眼症临床观察[J]中华中医药学刊,2012,30(8)：1748-1749
108.魏立新,杨威,王宏才,针灸对干眼症泪液分泌影响的疗效评价,中国针灸,2010,30(9)：709-782
109.高卫萍,李影,眼周针刺对干眼患者泪液流量及泪膜的影响,辽宁中医药大学学报,2011,13(7)：22-24
110.高卫萍王健,张燕,针刺治疗缺泪性干眼症31例疗效观察[J],新中医,2007,39(6)：41-42
111.张义彪,高卫萍,针刺对水液缺乏型干眼兔泪液分泌及泪腺微观形态的影响[J]南京中医药大学学报,2010,26(1)：47-50
112.李淑萍,挤按法联合复方炉甘石眼膏治疗老年睑板腺功能异常干眼症疗效观察[J],中医学报,2011,26(7)：881-882
113.侯曙红,穴位按摩治疗视疲劳干眼症200例报告[J],山东医药,2004,44(18)；69-70
114.郭承伟,路斌,吕璐,综合方法治疗睑缘炎相关性干眼症临床观察,实用中医药杂志,2011,27(3)：178-179
115.Gulati A,dana M,Keratoconjunctivitis sicca:clinical aspects.In:Foster C,Azar D,Dohlman C(ends)Smolin and Thoft's The cornea.Philadelphia:Lippincott Williams & Wilkins,2005:603-627
116.Zoukhri D,Hodges RR,Byon D,et al.Role of proinflammatory cytokines in impaired lacrimation associated with autoimmune xerophthalmia.Invest Ophthalmol Vis Sci 2002,43:1429-1436
117. Liu H, Zheng Q, Farley JM:Antimuscarinic actions of antihistamines on the heart.J Biomed Sci 2006; 13:395-401.
118.严厉,顾宝文,司马晶等,眼科门诊患者中干眼症的流行病学调查[J],解剖与临床,2006,(11)3：200-201
119.王惟一.铜人腧穴针灸图经[M].北京：中国书店影印,1987.(3)22,25,19,(5)：11
120.杨继洲著,针灸大成[M],北京：中医古籍出版社,1998,304-343
121.龚岚,孙兴怀,马晓,针刺对兔泪液分泌及泪腺血管活性肠肽浓度的影响,针刺研究[J],2006,31(6)：347-350
122.高卫萍,张义彪,李桥,针刺对干眼兔模型泪液分泌及泪腺中乙酰胆碱含量的影响[J],新中医,2011,43(3)：134-136
123.Steven E,Wilson SE,Inflammation:A unifying theory for the origin of dry eye syndrome[J].Managed Care,2003,12(12suppl):14-16
124.彭清华,刘慧莹,姚小磊等,针刺对干眼症患者性激素水平调节的影响[J],国际眼科杂志,2009,9(8)：1534-1536