神经保护药物干预治疗退行性眼底病的研究进展

Current opinions about using of medication intervention as neuroprotective therapy for degenerativeocular fundus diseases

近年的多项研究结果表明，药物可以作用于视网膜神经细胞凋亡的多个环节，对退行性眼底病的视网膜损伤有保护作用。N-甲基-D-天冬氨酸受体拮抗剂及其相关的钙离子通道阻滞剂和乙酰胆碱受体类药物，通过抑制谷氨酸盐引起的兴奋性毒性，对视网膜的损伤有神经保护作用。一氧化氮合酶抑制剂通过抑制细胞内的一氧化氮合酶活性，减少一氧化氮的产生，阻止细胞凋亡，减少视网膜神经细胞的丧失。抗氧化剂及具有抗氧化作用的中药，通过抑制细胞内的过氧化反应，减少超氧自由基的产生，对退行性眼底病的视网膜损伤有保护作用。另外，神经营养因子激活相应的受体，对视网膜细胞也有重要的营养和保护作用。上述研究结果为临床应用神经保护药物干预治疗退行性眼底病奠定了理论基础。（中华聪群杂志，2012，48：943-947）

Recently, many studies indicated that certain medications can delay the apoptosis of retinal nerve cells at different points during the process of apoptosis and have neuroprotective effect on preventing degenerative ocular fundus diseases. N-methyl-D-aspartate receptor （NMDAR） antagonists, NMDAR-associated calcium channel blockers and acetylcholine receptor agonists have been shown to have neuroprotective effects for retinal damages by inhibiting NMDA-induced excitotoxicity. The inhibitors of nitric oxide synthase （NOS） can prevent the cell apoptosis and reduce the retinal cell loss by suppressing the activity of NOS as well as the production of the nitric oxide. Antioxidants and some Chinese traditional medicine with antioxidant activities can also have protective effect on retinal damage caused by degenerative ocular fundus diseases through their functions in decreasing the peroxidation reaction and the production of the superoxide radicals in the cells. In addition, activation of neurotrophic factor receptors by their ligands plays a key role in neuroprotective and trophic effects for the retina. All of these studies not only provide the foundation, but also offer new theoretical supports for drug neuroprotective therapies in clinical practice. （Chin J Opbthalmol , 2012,48：943-947 ）