本研究比较强脉冲光(IPL)联合睑板腺表达(MGX)(IPL组)和即时温敷联合MGX(理疗组)治疗睑板腺功能障碍(MGD)相关干眼症(DED)后泪液炎性细胞因子水平的变化,探讨其治疗机制的异同。
本研究是一项随机对照试验的事后分析。每组招募了13名MGD相关DED患者,并以3周的间隔接受了3次治疗。20种泪液细胞因子的水平,即,TNF-α,IL-6,MMP-9,CXCL8/IL-8,CXCL10/IP-10,IL-10,EGF,IL-6R,IL-1β,IFN-γ,乳铁蛋白,Fas配体,IL-17A,LT-α,S100A9,LCN2/NGAL,IL-13,IL-12/IL-23p40,Fas,和CCL11/Eotaxin,在基线测量,在第二次和第三次治疗之前,第三次治疗后3周。主要结果是基线和最后一次测量之间的细胞因子水平差异,并在每个测量点分析趋势。
在最后一次测量时,与基线相比,IPL组和物理治疗组的所有泪液细胞因子均显著下降.IPL组显示IL-6,IL-6R,IL-1β,IL-13和CCL11/Eotaxin比物理治疗组。TNF-α,CXCL8/IL-8、CXCL10/IP-10、IL-10、EGF、IL-1β,IFN-γ,Lipocalin-2/NGAL水平随治疗时间持续下降。在IL-6和IL-13水平的变化中发现了重要的相互作用,治疗后,理疗组的水平先下降,然后略有上升,而IPL组继续下降。
IPL和物理治疗MGD相关DED的机制均与减轻炎症有关,IPL的优越性可归因于其对IL-6等炎性细胞因子的更好抑制作用。此外,几种细胞因子在治疗期间呈下降趋势,这表明DED的恶性循环被抑制了。
This study compared the changes in
tear inflammatory cytokine levels after intense pulsed light (IPL) combined with meibomian gland expression (MGX) (IPL group) and instant warm compresses combined with MGX (physiotherapy group) as treatments for meibomian gland dysfunction (MGD)-related dry eye disease (DED) to explore their similarities and differences in therapeutic mechanisms.
This study was a post-hoc analysis of a randomized controlled trial. Thirteen patients with MGD-related DED were enrolled in each group and received three treatments correspondingly with 3-week intervals. The levels of 20
tear cytokines, namely, TNF-α, IL-6, MMP-9, CXCL8/IL-8, CXCL10/IP-10, IL-10, EGF, IL-6R, IL-1β, IFN-γ, lactoferrin, Fas ligand, IL-17A, LT-α, S100A9, LCN2/NGAL, IL-13, IL-12/IL-23p40, Fas, and CCL11/Eotaxin, were measured at baseline, before the second and third treatments, and 3 weeks after the third treatment. The primary outcome was the difference in cytokine levels between baseline and the last measurement, and the trends were analyzed at each measurement point.
At the last measurement, a significant decrease was observed in all
tear cytokines for both IPL and physiotherapy groups compared with baseline. The IPL group showed greater reductions in IL-6, IL-6R, IL-1β, IL-13, and CCL11/Eotaxin than the physiotherapy group. TNF-α, CXCL8/IL-8, CXCL10/IP-10, IL-10, EGF, IL-1β, IFN-γ, and Lipocalin-2/NGAL levels continued to decrease with treatment time. Important interactions were found in the changes of IL-6 and IL-13 levels, where the levels first decreased and then slightly increased in the physiotherapy group after treatment, while they continued to decrease in the IPL group.
The mechanisms of IPL and physiotherapy in treating MGD-related DED were both associated with reducing inflammation, and the superiority of IPL could be attributed to its better inhibitory effect on inflammatory cytokines like IL-6. In addition, several cytokines were on a downward trend during treatment, suggesting that the vicious cycle of DED was suppressed.