干眼的神经病理机制与针对性治疗
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摘要
干眼(DE)是老年人主要眼科疾病之一,可引起疼痛和不适,且这些症状可持续存在,发展为慢性,从而显著影响患者的生活质量。DE症状包括伤害性症状与神经性症状,具体表现为干涩感、异物感、烧灼感等。DE的病理机制比较复杂,除了目前公认的泪液高渗、炎症与泪液分泌障碍外,心理因素的作用及神经高敏感性在DE的发生中也具有重要的意义,且是导致DE症状慢性化及引起恶性循环的原因。本文就DE的伤害性症状及神经性症状间的差异进行了分析,并针对DE的神经病理机制、症状评估与治疗进行了探讨与总结。
引文
[1]邵毅.国际干眼新共识(TFOS DEWSⅡ)解读[J].眼科新进展,2018,38(1):1-12.
[2]The definition and classification of dry eye disease:report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop(2007)[J].Ocul Surf2007,2007(5):75-92.
[3]BAUDOUIN C.A new approach for better comprehension of diseases of the ocular surface[J].J Fr Ophtalmol,2007,30(3):239-246.
[4]BAUDOUIN C,MESSMER E M,ARAGONA P,et al.Revisiting the vicious circle of dry eye disease:a focus on the pathophysiology of meibomian gland dysfunction[J].Br J Ophthalmol,2016,100(3):300-306.
[5]HIRATA H,MIZERSKA K,MARFURT C F,et al.Hyperosmolar tears induce functional and structural alterations of corneal nerves:electrophysiological and anatomical evidence toward neurotoxicity[J].Invest Ophthalmol Vis Sci,2015,56(13):8125-8140.
[6]HIRATA H,ROSENBLATT M I.Hyperosmolar tears enhance cooling sensitivity of the corneal nerves in rats:possible neural basis for cold-induced dry eye pain[J].Invest Ophthalmol Vis Sci,2014,55(9):5821-5833.
[7]MANTELLI F,ARGESO P.Functions of ocular surface mucins in health and disease[J].Curr Opin Allergy Clin Immunol,2008,8(5):477-483.
[7]丛晨阳,毕宏生,温莹.干眼症发病机制和治疗方法的研究进展[J].国际眼科杂志,2012,12(3):464-467.
[8]刘会娟,黄悦,张琰.大鼠干眼模型的建立及其角膜神经的改变[J].眼科新进展,2014,34(5):422-427.
[9]刘祖国,杨文照.干眼症的发病机制[J].眼科,2005,14(5):342-345.
[10]ZHANG M,CHEN J,LUO L,et al.Altered corneal nerves in aqueous tear deficiency viewed by in vivo confocal microscopy[J].Cornea,2005,24(7):818-824.
[11]LABBE A,LIANG Q,ZHANG Y,et al.Corneal nerve structure and function in patients w ith non-Sjogren dry eye:clinical correlations[J].Invest O phthalmol Vis Sci,2013,54(8):5144-5150.
[12]APKARIAN A V,BUSHNELL C M,TREEDE R D,et al.Humanbrain mechanisms of pain perception and regulation in healthand disease[J].Eur J Pain,2005,9(4):463-485.
[13]GALOR A,FELIX E R,FEUER W,et al.Dry eye symptoms align more closely too non-ocular conditions than to tear film parameters[J].Br J Ophthalmol,2015,99(8):1126-1129.
[14]KOCER E,KOCER A,OZSUTCU M,et al.Dry eyerelated to commonly used new antidepressants[J].Clin Psychopharm,2015,35(4):411-413.
[15]SCHAUMBERG D A,DANA R,BURING J E,et al.Prevalence of dry eye disease among US men:estimates from the Physicians′Health Studies[J].Arch Ophthalmo,2009,127(6):763-768.
[16]GALOR A,ZLOTCAVITCH L,WALTER S D,et al.Dry eye symptom severity and persistence are associated with symptoms of neu-ropathic pain[J].Br J Ophthalmol,2015,99(5):665-668.
[17]ANDERSEN H H,YOSIPOVITCH G,GALOR A.Neuropathic symptoms of the ocular surface:dryness,pain,and itch[J].Curr Opin Allergy Clin Immunol,2017,17(5):373-381.
[18]TREEDE R D,JENSEN T S,CAMPBELL J N,et al.Neuropathic pain:redefinition and agrading system for clinical and research purposes[J].Neurology,2008,70(18):1630-1635.
[19]COSTIGAN M,SCHOLZ J,WOOLF C J.Neuropathic pain:a maladaptive response of the nervous system to damage[J].Ann Rev Neurosci,2009,32(1):1-32.
[20]LATREMOLIERE A,WOOLF C J.Central sensitization:agenerator of pain hypersensitivity by central neural plasticity[J].J Pain,2009,10(9):895-926.
[21]颜思思,叶佳瑜,蒋永亮,等.神经病理痛中枢敏化的TR-PV1机制及电针干预作用[J].云南中医学院学报,2015,38(3):88-91.
[22]ROSENTHAL P,BORSOOK D.The corneal pain system.Part 1:The missing piece of the dry eye puzzle[J].Ocul Surf,2012,10(1):2-14.
[23]ROSENTHAL P,BORSOOK D.Ocular neuropathic pain[J].Br J Ophthalmol,2016,100(1):128-134.
[24]李一敏.角膜神经痛的临床研究[D].上海:复旦大学,2012.
[25]ONG E S,FELIX E R,LEVITT R C,et al.Epidemiology of discordance between symptoms and signs of dry eye[J].2018,102(5):674-679.
[26]BELMONTE C,NICHOLS J J,COX S M,et al.TFOSDEWSⅡpain and sensation report[J].Ocul Surf,2017,15(3):404-437.
[27]ROSENTHAL P,BARAN I,JACOBS D S.Corneal pain without stain:is it real?[J].Ocul Surf,2009,7(1):28-40.
[28]SPIERER O,FELIX E R,MCCLELLAN A L,et al.Corneal mechanicalthresholds negatively associate with dry eye and ocular painsymptoms[J].Invest Ophthalmol Vis Sci,2016,57(2):617-625.
[29]沈永锋,俞文华,杜权,等.神经性疼痛的诊断和评估[J].中国现代医生,2016,54(18):164-168.
[30]GALOR A,LEVITT R C,FELIX E R,et al.Neu-ropathic ocular pain:an important yet underevaluated feature of dry eye[J].Eye,2015,29(3):301-312.
[31]倪书钦.干眼症的治疗[J].现代中西医结合杂志,2014,23(3):332-334.
[32]KIM J Y,RYU J S,PARK S Y,et al.Comparison of topical application of TSG-6,cyclosporine,and prednisolone for treating dry eye[J].Cornea,2016,35(4):536-542.
[33]LAMBIASE A,MICERA A,SACCHETTI M,et al.Alterations of tear neuromodulators in dry eye disease[J].ArchOphthalmol,2011,129(9):981-986.
[34]KOJIMA T,HIGUCHI A,GOTO E,et al.Autologous serum eye drops for the treatment of dry eye diseases[J].Cornea,2008,27Suppl 1:S25-30.
[35]赵小静.中西医结合治疗干眼症的现状与展望[J].国际眼科杂志,2013,13(2):299-301.
[36]石晶琳,缪晚虹.针刺对干眼症患者泪液中乳铁蛋白及泪液分泌影响的随机对照试验[J].中西医结合学报,2012,10(9):1003-1008.
[37]HAANPAA M L,BACKONJA M M,BENNETT M I,et al.Assessment of neuropathic pain in primary care[J].Am J Med,2009,122:S13-21.
[38]WEINER D K.Office management of chronic pain in the elderly[J].Am J Med,2007,120(4):306-315.
[39]HIRATA H,OKAMOTO K,BEREITER D A.GABA(A)receptor activation modulates corneal unit activity in rostral and caudal portions of trigeminal subnucleus caudalis[J].Neurophysiol,2003,90(5):2837-2849.
[40]ATTAL N,CRUCCU G,BARON R,et al.European Federation of Neurological Societies.EFNS guidelines on the pharmacological treatment of neuropathic pain:2010revision[J].Eur J Neurol,2010,17(9):e1113-1188.
[41]JENSEN T S,MADSEN C S,FINNERUP N B.Pharmacology and treatment of neuropathic pains[J].Curr Opin Neurol,2009,22(5):467-474.
[2]The definition and classification of dry eye disease:report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop(2007)[J].Ocul Surf2007,2007(5):75-92.
[3]BAUDOUIN C.A new approach for better comprehension of diseases of the ocular surface[J].J Fr Ophtalmol,2007,30(3):239-246.
[4]BAUDOUIN C,MESSMER E M,ARAGONA P,et al.Revisiting the vicious circle of dry eye disease:a focus on the pathophysiology of meibomian gland dysfunction[J].Br J Ophthalmol,2016,100(3):300-306.
[5]HIRATA H,MIZERSKA K,MARFURT C F,et al.Hyperosmolar tears induce functional and structural alterations of corneal nerves:electrophysiological and anatomical evidence toward neurotoxicity[J].Invest Ophthalmol Vis Sci,2015,56(13):8125-8140.
[6]HIRATA H,ROSENBLATT M I.Hyperosmolar tears enhance cooling sensitivity of the corneal nerves in rats:possible neural basis for cold-induced dry eye pain[J].Invest Ophthalmol Vis Sci,2014,55(9):5821-5833.
[7]MANTELLI F,ARGESO P.Functions of ocular surface mucins in health and disease[J].Curr Opin Allergy Clin Immunol,2008,8(5):477-483.
[7]丛晨阳,毕宏生,温莹.干眼症发病机制和治疗方法的研究进展[J].国际眼科杂志,2012,12(3):464-467.
[8]刘会娟,黄悦,张琰.大鼠干眼模型的建立及其角膜神经的改变[J].眼科新进展,2014,34(5):422-427.
[9]刘祖国,杨文照.干眼症的发病机制[J].眼科,2005,14(5):342-345.
[10]ZHANG M,CHEN J,LUO L,et al.Altered corneal nerves in aqueous tear deficiency viewed by in vivo confocal microscopy[J].Cornea,2005,24(7):818-824.
[11]LABBE A,LIANG Q,ZHANG Y,et al.Corneal nerve structure and function in patients w ith non-Sjogren dry eye:clinical correlations[J].Invest O phthalmol Vis Sci,2013,54(8):5144-5150.
[12]APKARIAN A V,BUSHNELL C M,TREEDE R D,et al.Humanbrain mechanisms of pain perception and regulation in healthand disease[J].Eur J Pain,2005,9(4):463-485.
[13]GALOR A,FELIX E R,FEUER W,et al.Dry eye symptoms align more closely too non-ocular conditions than to tear film parameters[J].Br J Ophthalmol,2015,99(8):1126-1129.
[14]KOCER E,KOCER A,OZSUTCU M,et al.Dry eyerelated to commonly used new antidepressants[J].Clin Psychopharm,2015,35(4):411-413.
[15]SCHAUMBERG D A,DANA R,BURING J E,et al.Prevalence of dry eye disease among US men:estimates from the Physicians′Health Studies[J].Arch Ophthalmo,2009,127(6):763-768.
[16]GALOR A,ZLOTCAVITCH L,WALTER S D,et al.Dry eye symptom severity and persistence are associated with symptoms of neu-ropathic pain[J].Br J Ophthalmol,2015,99(5):665-668.
[17]ANDERSEN H H,YOSIPOVITCH G,GALOR A.Neuropathic symptoms of the ocular surface:dryness,pain,and itch[J].Curr Opin Allergy Clin Immunol,2017,17(5):373-381.
[18]TREEDE R D,JENSEN T S,CAMPBELL J N,et al.Neuropathic pain:redefinition and agrading system for clinical and research purposes[J].Neurology,2008,70(18):1630-1635.
[19]COSTIGAN M,SCHOLZ J,WOOLF C J.Neuropathic pain:a maladaptive response of the nervous system to damage[J].Ann Rev Neurosci,2009,32(1):1-32.
[20]LATREMOLIERE A,WOOLF C J.Central sensitization:agenerator of pain hypersensitivity by central neural plasticity[J].J Pain,2009,10(9):895-926.
[21]颜思思,叶佳瑜,蒋永亮,等.神经病理痛中枢敏化的TR-PV1机制及电针干预作用[J].云南中医学院学报,2015,38(3):88-91.
[22]ROSENTHAL P,BORSOOK D.The corneal pain system.Part 1:The missing piece of the dry eye puzzle[J].Ocul Surf,2012,10(1):2-14.
[23]ROSENTHAL P,BORSOOK D.Ocular neuropathic pain[J].Br J Ophthalmol,2016,100(1):128-134.
[24]李一敏.角膜神经痛的临床研究[D].上海:复旦大学,2012.
[25]ONG E S,FELIX E R,LEVITT R C,et al.Epidemiology of discordance between symptoms and signs of dry eye[J].2018,102(5):674-679.
[26]BELMONTE C,NICHOLS J J,COX S M,et al.TFOSDEWSⅡpain and sensation report[J].Ocul Surf,2017,15(3):404-437.
[27]ROSENTHAL P,BARAN I,JACOBS D S.Corneal pain without stain:is it real?[J].Ocul Surf,2009,7(1):28-40.
[28]SPIERER O,FELIX E R,MCCLELLAN A L,et al.Corneal mechanicalthresholds negatively associate with dry eye and ocular painsymptoms[J].Invest Ophthalmol Vis Sci,2016,57(2):617-625.
[29]沈永锋,俞文华,杜权,等.神经性疼痛的诊断和评估[J].中国现代医生,2016,54(18):164-168.
[30]GALOR A,LEVITT R C,FELIX E R,et al.Neu-ropathic ocular pain:an important yet underevaluated feature of dry eye[J].Eye,2015,29(3):301-312.
[31]倪书钦.干眼症的治疗[J].现代中西医结合杂志,2014,23(3):332-334.
[32]KIM J Y,RYU J S,PARK S Y,et al.Comparison of topical application of TSG-6,cyclosporine,and prednisolone for treating dry eye[J].Cornea,2016,35(4):536-542.
[33]LAMBIASE A,MICERA A,SACCHETTI M,et al.Alterations of tear neuromodulators in dry eye disease[J].ArchOphthalmol,2011,129(9):981-986.
[34]KOJIMA T,HIGUCHI A,GOTO E,et al.Autologous serum eye drops for the treatment of dry eye diseases[J].Cornea,2008,27Suppl 1:S25-30.
[35]赵小静.中西医结合治疗干眼症的现状与展望[J].国际眼科杂志,2013,13(2):299-301.
[36]石晶琳,缪晚虹.针刺对干眼症患者泪液中乳铁蛋白及泪液分泌影响的随机对照试验[J].中西医结合学报,2012,10(9):1003-1008.
[37]HAANPAA M L,BACKONJA M M,BENNETT M I,et al.Assessment of neuropathic pain in primary care[J].Am J Med,2009,122:S13-21.
[38]WEINER D K.Office management of chronic pain in the elderly[J].Am J Med,2007,120(4):306-315.
[39]HIRATA H,OKAMOTO K,BEREITER D A.GABA(A)receptor activation modulates corneal unit activity in rostral and caudal portions of trigeminal subnucleus caudalis[J].Neurophysiol,2003,90(5):2837-2849.
[40]ATTAL N,CRUCCU G,BARON R,et al.European Federation of Neurological Societies.EFNS guidelines on the pharmacological treatment of neuropathic pain:2010revision[J].Eur J Neurol,2010,17(9):e1113-1188.
[41]JENSEN T S,MADSEN C S,FINNERUP N B.Pharmacology and treatment of neuropathic pains[J].Curr Opin Neurol,2009,22(5):467-474.