专家述评
ENGLISH ABSTRACT
关注干眼抗氧化治疗及其新药研究
洪佳旭
徐建江
周旭娇
作者及单位信息
·
DOI: 10.3760/cma.j.cn115989-20220303-00086
Focusing on antioxidant treatment of dry eye and novel drug study
Hong Jiaxu
Xu Jianjiang
Zhou Xujiao
Authors Info & Affiliations
Hong Jiaxu
Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
Xu Jianjiang
Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
Zhou Xujiao
Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
·
DOI: 10.3760/cma.j.cn115989-20220303-00086
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摘要

干眼在全球的患病率日益升高,发病机制复杂,疾病呈慢性过程且治疗效果欠佳。目前认为干眼是多因素导致的眼表疾病,不同致病因素所致的泪膜不稳定和泪液高渗透压、眼表炎症反应、眼表组织神经感觉异常是其主要自然病理过程,由于多种因素参与致病及病情多样化的特点,因此单一的治疗方法疗效不佳。研究发现氧化应激与干眼的发生密切相关,互为因果。当泪膜稳定性下降时,氧化应激系统产生的活性氧分子可损伤眼表神经髓鞘和破坏泪膜脂质层稳态,从而诱发或加重眼表的炎症反应。抗氧化疗法旨在靶向干眼发病的关键因素,阻断干眼炎症反应各环节的恶性循环,缓解患者的病情。目前,国际上的抗干眼创新药物研究已逐渐聚焦于抗炎、抗氧化药物的研发,且在靶向氧化应激生物标志物、线粒体靶向药物、黏液素分泌促进剂、糖蛋白硒和乳铁蛋白等抗氧化酶以及多功能纳米制剂等方面取得了一定进展,其中基于纳米材料开发的抗氧化滴眼液具有更好的优势,预测抗氧化治疗是干眼临床研究的未来方向之一。眼科医师和研究者应充分认识和关注干眼抗氧化治疗的研究进展及其新药的研发,并积极参与相关研究。

干眼;氧化应激;抗炎药物;抗氧化剂;滴眼液;药物研发
ABSTRACT

Dry eye is becoming more common worldwide.Its pathophysiology is complicated, and its condition is chronic.Treatment options of dry eye are ineffective.As a multifactorial ocular surface disease, tear film instability, tear hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities resulted from various causes are main natural pathological processes of dry eye.This multifactorial process of the disease leads to poor efficacy of single anti-inflammatory therapy.Oxidative stress is closely related to the occurrence of dry eye.During the decrease of tear film stability, reactive oxygen species produced by oxidative stress system damage the myelin sheath of ocular nerve and the lipid layer of tear film, inducing or aggravating the ocular inflammatory response.Targeting the main causes of dry eye's pathogenesis, stopping the vicious cycle of inflammatory responses in each link, and relieving patients' conditions are the main goals of antioxidant therapy.The development of anti-inflammatory and antioxidant medications is currently the main focus of international research on novel anti-dry eye medications.Some progresses have been made in the area of targeting oxidative stress biomarkers, mitochondrial targeting medications, mucin secretion, antioxidant enzymes like glycoprotein selenium and lactoferritin, as well as multifunctional nanoagents, and the antioxidant eye drops using nanomaterials have more advantages.Antioxidant treatment may be one of the potential future avenues of dry eye clinical research.Ophthalmologists and researchers should be fully aware of, pay close attention to and actively participate in investigations that are relevant to dry eye antioxidant therapy and the development of new medications.

Dry eye;Oxidative stress;Anti-inflammation agent;Antioxidants agent;Ophthalmic solutions;Drug development
Hong Jiaxu, Email: grodef.tabneedfgnoh.uxaij
引用本文

洪佳旭,徐建江,周旭娇. 关注干眼抗氧化治疗及其新药研究[J]. 中华实验眼科杂志,2022,40(12):1119-1124.

DOI:10.3760/cma.j.cn115989-20220303-00086

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干眼是常见的眼表疾病,据统计,北京市干眼患病率约为21%,上海市为15%~30%,在气候干燥的中国西部和高海拔地区,干眼患病率高达31.93%~52.40% [ 1 , 2 , 3 ]。干眼的发病机制研究是干眼诊疗研究的基础,研究表明氧化应激是多种眼病发生和发展的关键共同通路,近年来其在干眼发病中的作用引起研究者的高度重视。角膜长期暴露在大气氧环境和其他环境压力源中,是眼表疾病累及的主要靶组织之一。角膜透明且无血管分布,其抗氧化系统主要依赖于泪膜和房水中的抗氧化物 [ 4 ]。干眼患者由于泪膜不稳定难以形成正常的保护效应 [ 5 ],眼表组织细胞学研究及动物实验均表明,角膜、结膜和泪腺损伤与氧化应激反应密切关联,如干眼患者眼表组织和泪液中DNA氧化损伤产物8-羟基-2-脱氧鸟苷、脂质氧化产生的4-羟基-2-壬烯酸和丙二醛水平均明显升高 [ 6 ],表明活性氧生成与内源性抗氧化系统解毒能力之间持续失衡会进一步激活炎症反应,造成眼表组织损伤,参与干眼的发生。近年诸多研究也证实,仅采用抗氧化治疗或进行辅助性抗氧化治疗均能改善干眼病情。认识和关注干眼抗氧化治疗的研究进展,积极开展或参与相关研究,可为拓展干眼的临床治疗方法提供新的思路。
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备注信息
A
洪佳旭,Email: grodef.tabneedfgnoh.uxaij
B
所有作者均声明不存在任何利益冲突
C
国家自然科学基金项目 (81970766、82171102、82271044)
上海市科技创新行动计划医学创新研究专项项目 (22Y21900900)
上海申康临床三年行动计划五新转化项目 (SHDC2020CR3052B)
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