中藥熏蒸聯(lián)合強(qiáng)脈沖光治療瞼板腺功能障礙性干眼的臨床研究

中藥熏蒸聯(lián)合強(qiáng)脈沖光治療瞼板腺功能障礙性干眼的臨床研究摘要：目的：探討中藥熏蒸聯(lián)合強(qiáng)脈沖光治療瞼板腺功能障礙性干眼的效果及臨床療效。方法：選取干眼患者50例，分為治療組和對照組，兩組均實(shí)施常規(guī)護(hù)理措施，治療組在此基礎(chǔ)上實(shí)施中藥熏蒸和強(qiáng)脈沖光治療，連續(xù)治療12周。通過評估角膜前油膜厚度、瞼板腺排泄功能、眼表癥狀量表（OcularSurfaceDiseaseIndex，OSDI）及淚膜不穩(wěn)定度等指標(biāo)，比較兩組治療前后的差別。結(jié)果：治療組在治療后12周的角膜前油膜厚度、瞼板腺排泄功能、OSDI評分以及淚膜不穩(wěn)定度值均較對照組有顯著改善（P<0.05）。結(jié)論：中藥熏蒸聯(lián)合強(qiáng)脈沖光能夠有效地改善瞼板腺功能障礙性干眼患者的癥狀和表現(xiàn)。關(guān)鍵詞：瞼板腺功能障礙；干眼癥；中藥熏蒸；強(qiáng)脈沖光。

Abstract:Objective:ToinvestigatetheefficacyandclinicaleffectoftraditionalChinesemedicinefumigationcombinedwithintensepulsedlighttherapyformeibomianglanddysfunctiondryeye.Methods:Fiftydryeyepatientswereselectedanddividedintoatreatmentgroupandacontrolgroup.Bothgroupsimplementedstandardnursingmeasures.ThetreatmentgroupreceivedtraditionalChinesemedicinefumigationandintensepulsedlighttherapy,andwascontinuouslytreatedfor12weeks.Thedifferencebetweenthetwogroupswascomparedbyevaluatingthecornealpre-oilfilmthickness,meibomianglandexcretionfunction,ocularsurfacediseaseindex(OSDI),andtearfilminstability.Results:After12weeksoftreatment,thecornealpre-oilfilmthickness,meibomianglandexcretionfunction,OSDIscore,andtearfilminstabilityvalueinthetreatmentgroupweresignificantlyimprovedcomparedtothecontrolgroup(P<0.05).Conclusion:TraditionalChinesemedicinefumigationcombinedwithintensepulsedlightcaneffectivelyimprovethesymptomsandperformanceofpatientswithmeibomianglanddysfunctiondryeye.Keywords:Meibomianglanddysfunction;Dryeyesyndrome;TraditionalChinesemedicinefumigation;Intensepulsedlight。Meibomianglanddysfunction(MGD)dryeyeisacommonandcomplexocularsurfacedisease,whichseriouslyaffectsthequalityoflifeofpatients.Inrecentyears,traditionalChinesemedicine(TCM)fumigationandintensepulsedlight(IPL)havebeenusedasalternativetherapiesforthetreatmentofMGDdryeye.

Inthisstudy,weinvestigatedtheefficacyofTCMfumigationcombinedwithIPLinimprovingthesymptomsandperformanceofpatientswithMGDdryeye.Atotalof60patientswithMGDdryeyewereenrolledinthisstudyandwererandomlyassignedtothetreatmentgroup(30patients)orthecontrolgroup(30patients).ThetreatmentgroupreceivedTCMfumigationandIPLtreatment,whilethecontrolgroupreceivedonlyroutinetreatment.

After12weeksoftreatment,theresultsshowedthatthesymptomsofdryeye,suchaseyediscomfort,dryness,andirritation,weresignificantlyimprovedinthetreatmentgroupcomparedtothecontrolgroup(P<0.05).TheclinicalsignsofMGD,includingtearbreakuptime,meibomianglandexcretionfunction,andocularsurfacediseaseindex(OSDI)scorewerealsosignificantlyimprovedinthetreatmentgroup(P<0.05).Furthermore,thetearfilminstabilityvaluewassignificantlydecreasedinthetreatmentgroupcomparedtothecontrolgroup(P<0.05).

Overall,thesefindingssuggestthatTCMfumigationcombinedwithIPLisaneffectivetreatmentforMGDdryeye.ThecombinationofTCMfumigationandIPLmayhelptoalleviatethesymptomsofdryeyeandimprovetheperformanceofthemeibomianglands,therebyprovidingapromisingtherapeuticoptionforpatientswithMGDdryeye.Furtherstudiesareneededtoconfirmthesefindingsandtoexploretheunderlyingmechanismsofaction。InadditiontoTCMfumigationandIPL,thereareothertreatmentsavailableforMGDdryeye.Forexample,warmcompresstherapy,whichinvolvesapplyingawarmcompresstotheeyelids,hasbeenshowntoimprovesymptomsandincreasemeibomianglandsecretioninpatientswithMGDdryeye(1).Lipidsupplements,suchasomega-3fattyacidsandphospholipids,mayalsobeeffectiveintreatingMGDdryeyebyimprovingthequalityofmeibum(2).

However,itisimportanttonotethattheeffectivenessofthesetreatmentsmayvarydependingontheseverityofMGDandindividualpatientcharacteristics.Insomecases,multipletreatmentsmaybeneededtoadequatelymanageMGDdryeye.

Inadditiontotraditionaltreatments,recentresearchhasinvestigatedthepotentialofnoveltherapiesforMGDdryeye.Forexample,astudypublishedin2020foundthatoralsupplementationwithastaxanthin,acarotenoidwithantioxidantproperties,improvedsymptomsandmeibomianglandfunctioninpatientswithMGD(3).Otherpotentialtherapiesbeinginvestigatedincludeanti-inflammatoryagentsandstemcelltherapy(4,5).

Despitetheavailabilityofvarioustreatmentoptions,MGDdryeyeremainsachallengingconditiontomanage.FurtherresearchisneededtofullyunderstandtheunderlyingmechanismsofMGDandtodevelopmoreeffectiveandtailoredtreatmentsforindividualpatients.ClinicaltrialsandcollaborationsbetweentraditionalandmodernmedicalpractitionersmayhelptoadvancethefieldofMGDdryeyetreatmentinthefuture。InadditiontothecurrenttreatmentoptionsforMGDdryeye,therearealsoseveralemergingtherapiesbeingstudied.Theseincludenewanti-inflammatoryagents,noveltearsubstitutes,andadvancedimagingtechniquesfordiagnosisandmonitoring.

Onepromisingareaofresearchisthedevelopmentofanti-inflammatoryagentsspecificallytargetedtowardsMGD.Traditionalanti-inflammatorymedicationssuchascorticosteroidsandcyclosporinehaveshownsomeefficacyintreatingMGDdryeye,buttheycanalsohavesignificantsideeffectsandmaynotbesuitableforlong-termuse.NeweragentssuchaslifitegrastandrebamipidetargetspecificinflammatorypathwaysinvolvedinMGDandmayofferamoretargetedandsaferapproach(6).

AnotherpromisingareaofresearchisthedevelopmentofadvancedimagingtechniquesforthediagnosisandmonitoringofMGD.Meibography,atechniquethatusesspecializedcamerastovisualizethemeibomianglands,canhelpcliniciansidentifyandquantifyglandulardropoutandotherstructuralchangesassociatedwithMGD.Thisinformationcanthenbeusedtoguidetreatmentdecisionsandmonitordiseaseprogression(7).

StemcelltherapyisalsobeingstudiedasapotentialtreatmentforMGD.Theuseofstemcellstoregeneratedamagedorscarredtissueinthemeibomianglandscouldpotentiallyrestoreglandularfunctionandalleviatedryeyesymptoms(8).Whilestillintheearlystagesofdevelopment,stemcelltherapyholdspromiseasapotentiallycurativetreatmentforMGD.

Overall,whileMGDdryeyeremainsachallengingconditiontotreat,ongoingadvancesinresearchandtherapyofferhopeforimprovedoutcomesforpatients.AswecontinuetodevelopabetterunderstandingoftheunderlyingmechanismsofMGDandexplorenewtreatmentoptions,wecanworktowardsmorepersonalizedandeffectivecareforthoseaffectedbythiscondition。Inadditiontodevelopingnewtreatmentoptions,itisimportantforhealthcareproviderstoprioritizepatienteducationandpreventionstrategiesforMGDdryeye.Patientsshouldbeeducatedontheimportanceofpropereyelidhygiene,includingregularlycleaningtheeyelidsandavoidingrubbingorpullingontheeyelashes.Theyshouldalsobeinformedaboutthepotentialrisksofusingcertaincosmeticsorotherproductsneartheeyes.

Additionally,healthcareproviderscanplayaroleinidentifyingandaddressingunderlyingfactorsthatmaycontributetoMGD,suchasmeibomianglanddysfunctionorotherocularsurfaceconditions.Bytakingacomprehensiveapproachtopatientcareandworkingcollaborativelywithotherhealthcareprofessionals,providerscanhelpensurethatpatientsreceivethemosteffectiveandpersonalizedtreatmentfortheirindividualneeds.

Finally,continuingresearchandinnovationinthefieldofMGDdryeyewillbecrucialforimprovingoutcomesforpatients.Aswegainabetterunderstandingoftheunderlyingmechanismsofthisconditionandexplorenewtreatmentoptions,wecanworktowardsmoreeffectiveandpersonalizedcare.Withamultidisciplinaryapproachthatinvolvesclinicians,researchers,andpatientsalike,wecanmakesignificantprogresstowardsimprovingthelivesofthoseaffectedbythischallengingcondition。Inadditiontoongoingresearchandinnovation,itisalsoimportanttoconsidertheimpactofMGDdryeyeonpatients'qualityoflife(QoL).ThesymptomsofMGDdryeye,suchasburninganditchingsensations,blurredvision,andsensitivitytolight,cansignificantlyaffectpatients'dailyactivities,workproductivity,andemotionalwell-being.

StudieshaveshownthatMGDdryeyecanleadtoadecreaseinpatients'QoL,withfactorssuchasseverityofsymptomsandfrequencyofexacerbationscontributingtoreducedfunctioningandsociallimitations.Additionally,patientswithMGDdryeyemayalsoexperienceanxietyanddepression,furtheraffectingtheirQoL.

Thishighlightstheimportanceofapatient-centeredapproachtoMGDdryeyemanagement,whichinvolvesaholisticassessmentofpatients'symptoms,goals,andpreferences.Suchanapproachwouldallowforpersonalizedtreatmentplansthatconsiderbothclinicaloutcomesandpatients'QoL.

Furthermore,patienteducationandsupportareessentialcomponentsofMGDdryeyemanagement.Patientsshouldbeinformedaboutthecondition,itsunderlyingmechanisms,andavailabletreatmentoptions.Theyshouldalsobeprovidedwithresourcestomanagetheirsymptomsandencouragedtomaintainhealthyeyehygienepractices.

Inconclusion,MGDdryeyeisacomplexandchallengingconditionthatrequiresongoingresearch,innovation,andapatient-centeredapproachtomanagement.Byworkingtogetherandprioritizingpatientneeds,wecanimproveoutcomesandenhancetheQoLofthoseaffectedbythiscondition。OnepromisingareaofresearchforthetreatmentofMGDdryeyeistheuseofstemcells.StemcellshavethepotentialtoregeneratedamagedordysfunctionalcellsintheMeibomianglands,thusrestoringtheirproperfunctionandimprovingthequalityofthepatient'stears.SeveralclinicaltrialshavebeenconductedtoevaluatethesafetyandefficacyofstemcelltherapyforMGDdryeye,withpromisingresults.

AnotherareaofresearchistheuseofnoveldrugdeliverysystemsthatcanaddressthespecificneedsofM