摘要
目的汇总分析环孢素、糖皮质激素类和非甾体类滴眼液以及联合用药在干眼治疗中的疗效和优缺点。设计Meta分析。研究对象治疗干眼的随机对照试验文献。方法对截止2022年8月7日的有关环孢素、糖皮质激素类和非甾体类滴眼液治疗干眼的随机对照试验(RCT)文献进行检索。对纳入的文献数据使用R Meta(5.2.0)软件包进行分析。主要指标Schirmer泪液测试(SIT)、泪膜破裂时间(TBUT)、角膜荧光素染色(FL)、症状评分、有效率和不良反应发生率。结果共纳入57篇随机对照试验文献的5850例(7945眼)。其中试验组3008例(4056眼),对照组2842例(3889眼)。结果显示,糖皮质激素类和非甾体类药物较对照组不良反应率无显著差异,环孢素较对照组不良反应率升高,三种药物干眼症状评分均显著好于对照组;三类药物均能显著提高TBUT和FL的结果;环孢素滴眼液试验组的SIT(无麻醉)显著高于对照组;联合用药组在SIT(无麻醉)、TBUT、FL和不良反应率中均与单独用药组无显著差异。结论基于本Meta的数据结果显示,环孢素、糖皮质激素类和非甾体类滴眼液均能有效地改善和治疗干眼。环孢素和糖皮质激素类滴眼液在改善各类指标方面互有优劣,且均较非甾体类滴眼液更优。糖皮质激素、环孢素联合用药较糖皮质激素或环孢素单独用药无显著优越性,但联合用药并未导致不良反应率显著上升。
Objective To summarize and analyze the curative effect,advantages and disadvantages of cyclosporine,glucocorticoids,non-steroidal eye drops and combination therapy in dry eye disease.Design Meta-analysis.Participants Random controlled trial(RCT)researches that were conducted for dry eye treatment.Methods The RCT researches on cyclosporine,glucocorticoids and non-steroidal eye drops in the treatment of dry eye up to August 7,2022 were searched.The included literature data were analyzed using the R Meta(5.2.0)software package.Main Outcome Measures Schirmer test(SIT),tear film breakup time(TBUT),corneal fluorescein staining(FL),symptom score,effective rate and incidence of adverse reactions.Results A total of 5850 cases(7945 eyes)from 57 randomized controlled trials were included.There were 3008 cases(4056 eyes)in the test group and 2842 cases(3889 eyes)in the control group.The results showed that there was no significant difference in the adverse event rate of glucocorticoids and non-steroidal drugs compared with the control group,but the adverse event rate of cyclosporine was higher than that of the control group,and the dry eye scores of the three drugs were significantly better than those of the control group.All three classes of drugs significantly improved the outcomes of TBUT and FL.SIT(without anesthesia)was significantly higher in the cyclosporine eye drop test group than in the control group.There were no significant differences between the combined drug group and the single drug group in SIT(no anesthesia),TBUT,and FL.Conclusion Based on the data of this Meta-analysis,cyclosporine,glucocorticoids,and non-steroidal eye drops can all effectively improve and treat dry eye.Cyclosporin and glucocorticoid eye drops have advantages and disadvantages in improving various indicators,and both are better than non-steroidal eye drops.The combination of glucocorticoid and cyclosporine has no significant advantage over glucocorticoid or cyclosporine alone,but the combination did not lead to a significant increase in the rate of adverse reactions.
作者
宁垦
王新铭
李莹
余洋
朱舟
瞿邢芳
Ning Ken;Wang Xinming;Li Ying;Yu Yang;Zhu Zhou;Qu Xingfang(Department of Ophthalmology,Chinese Academy of Medical Sciences,Peking Union Medical College Hospital,Beijing 100730,China;Basic Medical Science Institute,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100730,China;Department of Biochemistry&Molecular Biology,Pennsylvania State University,State College,PA 16801,USA;School of International Chinese Language Education,Beijing Normal University,Beijing 100875,China)
出处
《眼科》
CAS
2023年第2期108-119,共12页
Ophthalmology in China
