郑华?周晓佳?

【摘要】目的 闡明翼状胬肉伴发干眼时，炎性因子的表达情况及其临床意义。方法 采用横断面研究设计，纳入103例原发性翼状胬肉（76例胬肉伴干眼组、27例单纯胬肉组）为实验组，30例干眼者为干眼对照组以及30名正常人为正常对照组。收集所有实验对象的基础分泌泪液10 μl、采用液相芯片测量泪液中6种细胞因子[（IL-6、IL-8、基质金属蛋白酶-1（MMP-1）、MMP-9、血管内皮生长因子（VEGF）和碱性成纤维细胞生长因子（bFGF）]表达量。结果 VEGF在胬肉伴干眼组升高，泪液中IL-6、IL-8、MMP-1、MMP-9在胬肉伴干眼组、单纯胬肉组中较正常人组表达升高，bFGF在胬肉伴干眼和单纯胬肉组较两个对照组均升高（P均< 0.05/6）。泪液IL-6表达量与干眼严重度呈正相关，泪液VEGF、bFGF、MMP-1和MMP-9浓度与胬肉活动性呈正相关（P均< 0.05）。讨论 干眼与翼状胬肉的致病性细胞因子具有高度的一致性，可能是导致两者具有共同高发病率的原因和重要病理机制;及时控制眼表炎症可提高2种疾病的疗效。

【关键词】翼状胬肉;干眼症;泪液炎性因子

Role and clinical significance of inflammation in incidence and development of pterygium complicated with dry eye Zheng Hua， Zhou Xiaojia. Refractive Surgery Department， State Key Laboratory of Ophthalmology， Zhongshan Ophthalmic Center， Sun Yat-sen University， Guangzhou 510060， China

Corresponding author， Zheng Hua， E-mail： zhenghua666@ 126. com

【Abstract】Objective To investigate the expression levels and clinical significance of inflammatory cytokines in patients with pterygium complicated with dry eye. Methods In this cross-sectional study， 103 patients with primary pterygium （76 cases of pterygium complicated with dry eye and 27 cases of pterygium alone） were assigned into the study group， and 30 cases of dry eyes and 30 healthy subjects were allocated into the control groups. A portion of 10 μl of basic tear samples were collected from all subjects. The expression levels of six cytokines （IL-6， IL-8， MMP-1， MMP-9， VEGF and bFGF） were quantitatively measured by liquid chip. Results VEGF expression level was significantly up-regulated in the pterygium complicated with dry eye group. The expression levels of IL-6， IL-8， MMP-1 and MMP-9 in the tear from patients with pterygium complicated with dry eye and those with pterygium alone were significantly up-regulated than those in healthy counterparts. In these two groups， the expression levels of bFGF were significantly up-regulated than that in the control groups （all P < 0.05/6）. The expression level of IL-6 in the tear was positively correlated with the severity of dry eye. The expression levels of VEGF， bFGF， MMP-1 and MMP-9 in the tear were positively associated with the activity of pterygium（all P < 0.05）. Conclusions The pathogenic cytokines of dry eye and pterygium are highly consistent， which may be the cause and pathological mechanism for the common high incidence of dry eye and pterygium. Timely management of ocular surface inflammation can improve the clinical efficacy in the treatment of these two diseases.

【Key words】Pterygium;Dry eye;Tear inflammatory cytokine

翼狀胬肉和干眼都是常见的眼表疾病，翼状胬肉患者中干眼发病率远高于正常人群发病率，因此，翼状胬肉被列为干眼的相关因素[1-2]。表现为患眼泪膜破裂时间缩短，泪膜不稳定，并认为这类干眼的原因可能是翼状胬肉改变了眼表规则性所致[3]。但也有研究得出截然不同的结果，部分翼状胬肉患者眼表泪膜稳定性与正常人无差异[4]。我们前期的临床研究曾发现，进展期与静止期翼状胬肉呈现不同的干眼体征，提示翼状胬肉与干眼中可能存在某些更深层次的内在联系[5] 。

慢性免疫性炎症在干眼中的核心作用已得到公认并被深入研究[6]。干眼患者眼表组织中存在有大量CD4+ T淋巴细胞浸润为主的慢性免疫性炎症，同时有大量的相关细胞因子和炎性介质在其中起到重要作用[7]。……