中药熏蒸联合强脉冲光治疗睑板腺功能障碍性干眼的临床研究

中药熏蒸联合强脉冲光治疗睑板腺功能障碍性干眼的临床研究摘要：目的：探讨中药熏蒸联合强脉冲光治疗睑板腺功能障碍性干眼的效果及临床疗效。方法：选取干眼患者50例，分为治疗组和对照组，两组均实施常规护理措施，治疗组在此基础上实施中药熏蒸和强脉冲光治疗，连续治疗12周。通过评估角膜前油膜厚度、睑板腺排泄功能、眼表症状量表（OcularSurfaceDiseaseIndex，OSDI）及泪膜不稳定度等指标，比较两组治疗前后的差别。结果：治疗组在治疗后12周的角膜前油膜厚度、睑板腺排泄功能、OSDI评分以及泪膜不稳定度值均较对照组有显著改善（P<0.05）。结论：中药熏蒸联合强脉冲光能够有效地改善睑板腺功能障碍性干眼患者的症状和表现。关键词：睑板腺功能障碍；干眼症；中药熏蒸；强脉冲光。

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