不同抗青光眼眼药对开角型青光眼24小时眼压的影响

The effect of antiglaucoma drugs on 24-hour intraocular pressure of open-angle glaucoma

目的探讨3种不同作用机理抗青光眼药物对原发性开角型青光眼(POAG)患者24小时眼压的影响。方法将临床新诊断21例(42眼)POAG患者随机分为3组,分别用前列腺素类(拉坦前列腺素滴眼液)、β受体阻滞剂类(噻吗洛尔滴眼液)或者碳酸酐酶抑制剂类(布林佐胺滴眼液)3种不同药物机理的降眼压抗青光眼药物进行治疗,监测24小时眼压,绘制眼压日曲线,与基线眼压相比较,分析各种药物对患者随机眼压、24小时眼压峰值、24小时眼压平均值及24小时眼压波动的影响。用方差分析(ANOVA)法分析3组患者的随机眼压、眼压峰值和平均眼压下降值及24小时眼压波动之间的差异。结果拉坦前列腺素组用药后随机眼压降低(7.6±2.3)mm Hg,眼压峰值下降(7.1±2.0)mm Hg,平均眼压下降(7.4±2.1)mm Hg,24小时眼压波动(5.1±2.3)mm Hg;噻吗洛尔组用药后随机眼压降低(7.1±2.7)mm Hg,眼压峰值下降(5.4±2.0)mm Hg,平均眼压下降(7.4±2.2)mm Hg,24小时眼压波动(8.1±2.3)mm Hg;布林佐胺组用药后随机眼压降低(5.1±2.5)mm Hg,眼压峰值下降(6.8±2.1)mm Hg,平均眼压下降(5.4±2.3)mm Hg,24小时眼压波动(6.9±2.3)mm Hg。相对于基线眼压,3种降眼压药眼压下降值有显著性差异(P<0.05);随机眼压和24小时平均眼压拉坦前列腺组下降幅度最大,与布林佐胺组比较差异显著(P<0.05);与噻吗洛尔组比较,拉坦前列腺素组24小时眼压波动小,而24小时眼压峰值下降幅度大,差异有显著性(P<0.05)。结论药物治疗POAG,拉坦前列腺素能够稳定有效地降低24小时眼压;噻吗洛尔对24小时平均眼压和白天眼压的降低作用与拉坦前列腺素相当,但是24小时眼压波动大,夜间眼压峰值高;布林佐胺对夜间眼压峰值的降低作用与拉坦前列腺素相当。

Objective To determine the effect of 3kinds of antiglaucoma drugs on 24-hour-intraocular pressure（IOP）in patients with primary open-angle glaucoma（POAG）.Methods 21 new diagnosed patients with POAG（42eyes）were randomly divided into three treatment groups treated with latanoprost,beta-blocker timolol,and carbonic anhydrase inhibitor brinzolamide.24-hour IOP were obtained in the sitting position with a non-contact tonometer at 3-hour intervals.Office IOP,maximum 24-hour IOP,mean 24-hour IOP and 24-hour IOP fluctuation of every group were analyzed and compared with baseline IOP.Results In the latanoprost group,the reduction of office IOP（mean±SD）was7.6±2.3mm Hg.The reduction of maximum 24-hour IOP was 7.1±2.0mm Hg,and the reduction of mean 24-hour IOP was 7.4±2.1mm Hg.24-hour IOP fluctuation of latanoprost group was 5.1±2.3mm Hg.In the timolol group,after two weeks treatment the reduction of office IOP was 7.1±2..7mm Hg.The reduction of maximum 24-hour IOP was 5.4±2.0mm Hg,and the reduction of mean 24-hour IOP was 7.4±2.2mm Hg.24-hour IOP fluctuation of timolol group was 8.1±2.3mm Hg.In the brinzolamide group,after two weeks treatment the reduction of office IOP was 5.1±2.5mm Hg.The reduction of maximum 24-hour IOP was 6.8±2.1mm Hg,and the reduction of mean 24-hour IOP was 5.4±2.3 mm Hg.24-hour IOP fluctuation of brinzolamide group was 6.9±2.3 mm Hg.There was significant difference among three treatment groups（P〈0.05）.Compared with brinzolamide and timolol,latanoprost had the most extent reduction office IOP,maximum 24-hour IOP and mean 24-hour IOP.The minimum 24-hour IOP fluctuation was the latanoprost group.Conclusion In treatment of open-angle glaucoma,latanoprost can induce a uniform reduction in IOP during the 24-hour period.Timolol is as effective as latanoprost during the daytime,and brinzolamide is as effective as latanoprost at night.