阿托品控制近视进展及作用机制研究现状

Mechanism and clinical effects of atropine on myopia progression

阿托品是控制近视进展的选择之一,临床研究已证实从0.01%到1%等多种浓度的阿托品对近视进展均有控制作用,其中0.01%阿托品滴眼液因不良反应小、反弹少而被广泛采用。虽然阿托品控制近视进展有众多假说,但其具体的分子作用机制至今仍未完全阐明。研究表明,阿托品控制近视进展可能是通过影响视网膜和后部巩膜的相关受体,包括M1-M5、γ-氨基丁酸、多巴胺受体、ZENK基因、α2肾上腺素能受体等,通过胆碱能、G-蛋白等信号通路实现的;其作用部位主要在巩膜胶原蛋白和视网膜色素上皮以及脉络膜。临床研究还显示,低浓度阿托品滴眼液点眼联合角膜塑形镜配戴对近视进展的控制效果优于单纯使用角膜塑形镜。本文就阿托品控制儿童近视进展的作用机制、作用部位以及不同浓度阿托品的最新临床研究结果进行综述。

Atropine is one of the useful methods that can slow down myopia progression.The effect of atropine has been proved by clinical researches,among which,various concentrations of atropine from 0.01%to 1%are all effective on control myopia progression for children,and atropine 0.01% has been verified to have the best balance between efficiency and side effects.Though many hypotheses and theories have been proposed to explain the mechanism of atropine,no community agreement has been reached among global scientists.Researches have shown that the possible receptors of atropine include M1-M5 acetylcholine families,γ-aminobutyric acid(GABA)receptors,dopamine receptors,ZENK gene andα2-adrenergic receptors,which are located on retina and posterior sclera.The inhibitory effect of atropine on myopia progression might be achieved through cholinergic,G-protein and GABA signaling pathway.The target site of action of atropine is located on retinal pigment epithelium,choroid and scleral collagen.The effects of topical application of atropine combined with orthokeratology are better than wearing orthokeratology only.The mechanism,site of action and most relevant clinical researches of atropine of various concentrations were reviewed in this article.