雄激素疗法对去势雌性大鼠泪膜稳定性的改善作用

背景 绝经期女性干眼的发病率明显高于男性,提示性激素在干眼的发病过程中可能发挥一定的作用,绝经期女性应用雌激素时于眼症状加重也提示雄激素可能参与干眼病程.雄激素的应用是否可以减轻干眼症状正在受到关注. 目的 探讨雄激素对去卵巢雌鼠泪液及泪膜稳定性的影响,探讨雄激素维持泪膜稳定性的可能作用机制. 方法 清洁级3月龄雌性性成熟Wistar大鼠48只按照随机数字表法分为正常对照组、假手术组、去势模型组和丙酸睾丸酮组,去势模型组和丙酸睾丸酮组大鼠行双侧卵巢摘除术以制备去势模型,造模后5同始丙酸睾丸酮组大鼠按3.75 mg/kg剂量肌内注射丙酸睾丸酮,每3天1次,持续6周,而假手术组大鼠仅切除腹内脂肪组织而不摘除卵巢.于丙酸睾丸酮组大鼠给药后6周时测定各组大鼠血清雄激素质量浓度,检测并比较各组大鼠Schirmer试验Ⅰ（SⅠt）、泪膜破裂时间（BUT）结果.于丙酸睾丸酮组大鼠给药前及给药后6周时各组过量麻醉法任意处死10只大鼠,制备结膜和角膜组织切片,行角膜结膜免疫荧光染色,检测各组大鼠结膜表面MUC5AC的阳性表达;采用扫描电子显微镜检测角膜细胞表面的超微结构改变.实验动物的使用和喂养遵循南方医科大学实验动物管理细则,并通过南方医科大学实验动物伦理委员会审核批准.结果 去势模型组大鼠血清睾丸酮质量浓度为（1.83±0.12） ng/ml,SⅠt值为（3.63±0.26） mm/5 min,BUT值为（3.73±0.38）s,分别低于正常对照组的（2.56±0.14） ng/ml、（7.47±0.66） mm/5 min和（9.57±0.76）s,差异均有统计学意义（均P=0.000）;而丙酸睾丸酮组大鼠血清睾丸酮质量浓度为（3.38±0.24） ng/ml,SⅠt值为（6.37±0.45） mm/5 min,BUT值为（7.54±0.55）s,均明显高于去势模型组,差异均有统计学意义（均P=0.000）.去势模型组大鼠结膜组织中MUC5AC阳性染色强度明显较正常对照组减弱,呈线状或点状着色,丙酸睾丸酮组大鼠结膜中MUC5AC阳性染色明显强于去势模型组大鼠.正常对照组及假手术组大鼠角膜细胞表面微绒毛较长,排列规则,细胞新陈代谢的裂孔结构正常,去势模型组大鼠角膜细胞表面微绒毛短小,排列紊乱,细胞新陈代谢裂孔消失,而丙酸睾丸酮组大鼠角膜细胞表面微绒毛排列较去势模型组规则,细胞新陈代谢裂孔较去势模型组增多,但仍少于正常对照组.结论 去势模型大鼠的泪液分泌减少及泪膜不稳定可能与血清雄激素水平下降有关,给予全身雄激素疗法能改善泪液分泌及泪膜稳定性,减少眼表组织损害.

Efficacy observation of acupuncture for dry eye syndrome of lung-yin deficiency pattern

Objective:To observe the clinical efficacy of combining two needling manipulations,Er Long Xi Zhu(two dragons playing with a pearl)and Guo Yan Re(heat produced to reach the eyes),in treating dry eye syndrome(DES)of lung-yin deficiency pattern.Methods:Fifty-six eligible DES patients of lung-yin deficiency were randomized into an observation group and a control group,with 28 cases in each group.Same acupoints were selected in the two groups:Cuanzhu(BL 2),Sizhukong(TE 23),Taiyang(EX-HN 5)and Fengchi(GB 20)were chosen as the major points and Feishu(BL 13)and Chize(LU 5)as the adjuvant.Er Long Xi Zhu and Guo Yan Re needling manipulations were applied in the observation group while twirling reinforcing manipulation was used in the control group.Treatment was conducted once per day in both groups,for two sets of 15 consecutive days at a 2-day interval.Changes in the symptom score,tear break-up time(BUT)and tear production were observed afterwards,and the clinical efficacy was also compared between the two groups.Results:The total effective rate was 92.8%in the observation group,higher than 71.4%in the control group,and the between-group difference was statistically significant(P<0.05).After treatment,the symptom score,tear BUT and tear production showed significant improvements in both groups(all P<0.05);the symptom score,BUT and tear production in the observation group were significantly different from those in the control group(all P<0.05).Conclusion:Given the same acupoint selection,combining Er Long Xi Zhu and Guo Yan Re needling manipulations can produce more significant clinical efficacy than twirling reinforcing manipulation in treating DES of lung-yin deficiency pattern.