专家述评
ENGLISH ABSTRACT
干眼药物研究的沿革与展望
王明武
于莉
作者及单位信息
·
DOI: 10.3760/cma.j.cn115989-20200204-00049
Evolution and outlook of dry eye pharmatheutical research
Mingwu Wang
Yu Li
Authors Info & Affiliations
Mingwu Wang
NeuVision Medical Institute, Department of Ophthalmology and Vision Science, University of Arizona College of Medicine, Tucson 85710, USA
Yu Li
Shenzhen Eye Hospital, Jinan University Affiliated Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Shenzhen 518004, China
·
DOI: 10.3760/cma.j.cn115989-20200204-00049
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摘要

干眼是一种多因素诱导的眼部常见病和多发病,严重的干眼不但给患者的工作和生活质量带来影响,同时也增加了其他眼疾并发症的风险。由于发病机制比较复杂,治疗周期较长,干眼已成为一个重要的社会公共卫生问题。传统的干眼治疗药物通常可以减轻干眼症状但不能彻底消除干眼症状,因而远远不能满足临床的需要。国内外新上市的抑制T细胞功能的抗炎药物以及促进泪液分泌的干眼药物一定程度上标志着干眼药剂研究的快速进展,但临床上干眼治疗的局面尚未因此明显改善。干眼的治疗仍面临着很大挑战,干眼新药的研发仍有很大空间。对干眼发病机制的深入研究是今后干眼靶向治疗的基础,目前干眼药物研发取得的进展为临床上干眼的治疗方案设计提供了新的选择。眼科医生应密切关注干眼相关的研究进展和干眼药物的作用机制,以更好地服务于广大患者。

干眼;环孢素A;他克莫司;Xiidra;氨溴索;全氟己基辛烷
ABSTRACT

Dry eye is a common, highly prevalent and multifactorial ocular disease.Severe dry eye not only has a serious impact on the patient's work performance and quality of life, but also increases the risk of other ocular disease complications.Due to its complex pathogenesis and prolonged treatment cycle, dry eye has become an important social and public health problem.Traditional dry eye drugs can usually alleviate, but not completely eliminate, the symptoms of dry eye, and are far from meeting current clinical demands.Newly marketed domestic and foreign anti-inflammatory drugs that inhibit T cell function as well as drugs that promote tear secretion represent, to some extent, the rapid progress of dry eye drug research.Even so, the overall state of clinical dry eye management has not been significantly improved.Dry eye treatment still faces great challenges; a huge gap exists between clinical needs and the development of new drugs.Insightful research on the pathogenesis of dry eye is the basis for identifying new pharmatheutical targets.Progress in the research and development of dry eye drugs brings about new options for treatment strategies.Ophthalmologists should keep updated to the research progress in dry eye and to the mechanism of actions of new drugs in order to better serve dry eye patients.

Dry eye;Cyclosporin A;Tacrolimus;Xiidra;Ambroxol;Perfluorohexyloctane
Mingwu Wang, Email: mocdef.labiamtohgnawuwgnim
引用本文

王明武,于莉. 干眼药物研究的沿革与展望[J]. 中华实验眼科杂志,2021,39(02):97-101.

DOI:10.3760/cma.j.cn115989-20200204-00049

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*以上评分为匿名评价
干眼是常见的眼表疾病,其病因复杂,病情受年龄、用眼强度、激素水平、自身免疫性疾病、药物、角膜屈光手术、环境等诸多因素的影响。中国干眼的发病率为21%~30% [ 1 ],严重影响各个年龄层的人群。干眼会导致角膜炎及视力下降,重症干眼可引起角膜溃疡,甚至致盲,目前已成为重要的社会公共卫生问题。干眼是一种多因素疾病,主要特征是不同原因造成的泪膜稳态失衡,继而导致泪液渗透压升高、眼表的炎症反应和神经功能异常,此外,除了干眼的器质性病变外,功能性干眼的概念也逐渐引起重视。随着对干眼发病机制认识的不断深入,干眼治疗药物研发面临新的挑战。泪膜由水、脂类、黏蛋白和抗菌物质组成,是保护角结膜不受外源性微生物、化学物质和环境影响的屏障,有利于维持清晰视觉所需的光滑折光表面,其中盐、水、黏蛋白等成分占绝大部分,表层的脂类层有防止水液蒸发的作用。由于细胞膜脂质成分天然的疏水性,黏蛋白可将泪膜固定在眼表并起润滑和保护眼表组织的作用,凝胶状黏蛋白则决定上皮黏液层的流变特性。MUC5AC是由结膜上皮中杯状细胞分泌的一种主要的凝胶状黏蛋白,能够起表面活性剂的作用,使泪膜均匀地铺展湿润疏水性上皮细胞表面,瞬目则有利于均匀分布的结膜黏蛋白清除眼表的杂物和病原体,因此泪液中黏蛋白的重要性不可低估。眼表疾病可造成结膜杯状细胞密度和黏蛋白数量的改变,引起严重干眼,如Sjögren综合征甚至可以表现为杯状细胞的完全丧失伴终期角化 [ 2 ]。目前中国按泪液来源组织的不同将干眼细分为水液缺乏型、脂类缺乏型、黏蛋白缺乏型、泪液动力学异常型和混合型干眼 [ 1 ]。干眼症状主要表现为干涩感、异物感、烧灼感、痒感、视物模糊、眼红、角膜接触镜不耐受等。国内外治疗干眼的方法主要包括保护黏膜的眼表润滑剂(包括人工泪液)和抗眼表炎症药物的应用、泪小点塞置放以减少泪液流失以及眼睑的物理疗法以恢复睑板腺的脂类分泌功能,但是各种方法仅能够减轻却无法彻底消除干眼症状,更不能治愈干眼。因此对干眼发病机制进行深入研究以发现新的干眼药物十分重要。
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备注信息
A
王明武,Email: mocdef.labiamtohgnawuwgnim
B
王明武为表面应用氨溴索治疗眼表疾病的国际专利发明人之一,其他作者声明不存在利益冲突
C
深圳市科创委自由探索项目 (JCYJ20170306140638792)
深圳市科创委国际合作项目 (GJHZ20180929145202083)
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