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

Effects of acupuncture on lactoferrin content in tears and tear secretion in patients suffering from dry eyes:a randomized controlled trial

背景:随着对干眼症发病机制中免疫炎性反应认识的不断深入,鉴于目前治疗上使用的人工泪液对症状缓解的有限性及各种促进泪液分泌药物或治疗手段的局限性,临床医生更加关注能促进泪液主动分泌的治疗手段,针刺治疗干眼症可能符合此要求。目的:以人工泪液泪然滴眼液为对照治疗药物,观察针刺对干眼症患者泪液中乳铁蛋白含量及泪液分泌的影响及效应持续时间,探讨针刺治疗干眼症的作用机制。设计、场所、对象和干预措施:所有患者均为2010年8月至2011年5月在上海中医药大学附属曙光医院眼科门诊就诊的、首次诊断为干眼症的患者。采用随机对照试验的设计方法,收集干眼症患者共65例(65眼),随机分为针刺治疗组及对照组,分别给予针刺治疗及人工泪液治疗3周。主要结局指标:采用酶联免疫吸附法测定治疗前后干眼症患者泪液中乳铁蛋白含量,来评价针刺对干眼症治疗的有效性。结果:与治疗前比较,治疗3周后针刺组泪液中乳铁蛋白浓度升高,泪膜破裂时间延长,基础泪液分泌量增加,且均优于对照组;对照组的乳铁蛋白浓度、泪膜破裂时间、基础泪液分泌量与治疗前比较,差异无统计学意义。治疗结束后1周,针刺治疗组患者的基础泪液分泌量、泪液中乳铁蛋白含量与治疗3周时比较差异无统计学意义,而泪膜破裂时间缩短;针刺组泪液中乳铁蛋白含量、泪膜破裂时间与对照组比较,差异无统计学意义,而基础泪液分泌量仍优于对照组。结论:针刺治疗可以增加干眼症患者泪液中的乳铁蛋白含量,促进干眼症患者泪液的分泌,延长其泪膜破裂时间。但针刺治疗对干眼症患者泪液分泌的改善及促进作用具有一定的时效性,随着治疗结束,治疗效应减弱。

BACKGROUND： With the understanding of the immune inflammatory response in the pathogenesis of dry eyes, and the limitations of widely used artificial tears and numerous pharmaceuticals and methods to pro- mote tear secretion, clinicians pay more attention to the therapies that can promote tear secretion actively. Acupuncture treatment for dry eye may meet this requirement. OBJECTIVE： To observe the clinical efficacy of acupuncture treatment on dry eye and the effects on duration, and to examine the mechanisms of acupuncture in treating patients with dye eyes. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： The study was performed at Department of Ophthalmology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine from August 2010 to May 2011. Patients with the primary diagnosis of dry eye were enrolled. Sixty-five patients were randomly divided into treatment group and control group, and were given 3 weeks of acupuncture treatment or artificial tear therapy respectively. MAIN OUTCOME MEASURES： The enzyme-linked immunosorbent assay was used to detect the lactoferrin content of the tears before and after treatment. In order to evaluate the efficacy of the treatment methods, the Schirmer J[ test and break-up time were also measured. RESULTS： Compared with before treatment, the lactoferrin content in the tears of patients in the treatment group increased, break-up time was prolonged and the result of the Schirmer ]_ test showed improvement after 3 weeks of treatment. The indexes mentioned above did not change in the control group after treatment. There were no significant differences in tear lactoferrin and Schirmer I test between one week after treatment and after 3-week treatment in the treatment group, but break-up time was significantly shortened. The result of Schirmer I test in the treatment group was significantly higher than that in the control group one week after treatment. CONCLUSION： Acupuncture can increase tear lactoferrin level, extend tear film break-up time and promote tear secretion in patients with dry eye in a time-limited trial. With the end of treatment, the effect decreased.