自主神经控制与近视眼发病机制的研究进展

doi:10.3877/cma.j.issn.2095-2007.2021.02.011

中华眼科医学杂志(电子版) ›› 2021, Vol. 11 ›› Issue (02) : 119 -123. doi: 10.3877/cma.j.issn.2095-2007.2021.02.011

所属专题：青少年近视防控；

综述

自主神经控制与近视眼发病机制的研究进展

慕璟玉¹, 王雁², 张芮³, 杨依宁¹, 高云仙²^,^†(

)

^1. 830000　乌鲁木齐，新疆医科大学第四临床医学院2019级硕士研究生
^2. 830000　乌鲁木齐，新疆医科大学附属中医医院眼一科；830000　乌鲁木齐，新疆维吾尔自治区中医药研究院眼科
^3. 830000　乌鲁木齐，新疆医科大学第四临床医学院2018级硕士研究生

收稿日期:2021-02-08 出版日期:2021-04-28
通信作者: 高云仙
基金资助:
新疆维吾尔自治区自然科学基金(2019D01C176)

Advances on the autonomic nerve control and pathogenesis of myopia

Jingyu Mu¹, Yan Wang², Rui Zhang³, Yining Yang¹, Yunxian Gao²^,^†()

^1. Master′s degree 2019, The Fourth Clinical College of Xinjiang Medical University, Wulumuqi 830000, China
^2. The First Department of Ophthalmology, Traditional Chinese Medicine Hospital affiliated to Xinjiang Medical Universtity, Wulumuqi 830000, China; Department of Ophthalmology, Xinjiang Uygur Autonomous Region Institute of Traditional Chinese Medicine, Wulumuqi 830000, China
^3. Master′s degree 2018, The Fourth Clinical College of Xinjiang Medical University, Wulumuqi 830000, China

Received:2021-02-08 Published:2021-04-28
Corresponding author: Yunxian Gao

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引用本文：

慕璟玉, 王雁, 张芮, 杨依宁, 高云仙. 自主神经控制与近视眼发病机制的研究进展[J]. 中华眼科医学杂志(电子版), 2021, 11(02): 119-123.

Jingyu Mu, Yan Wang, Rui Zhang, Yining Yang, Yunxian Gao. Advances on the autonomic nerve control and pathogenesis of myopia[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2021, 11(02): 119-123.

近年来，近视眼的发病率逐年提高且有低龄化趋势。儿童青少年近视眼的防控问题，已得到全社会和国家主管部门的广泛关注。有关近视眼发病机制的研究，已成为当前的研究热点。眼部的自主神经影响着眼的调节功能、血流微循环及眼内压的变化，在近视眼的发生与发展中扮演了十分重要的角色。本文中笔者就眼部自主神经影响近视眼的作用机制进行综述。

关键词: 近视眼, 自主神经, 调节, 眼血流微循环, 眼内压, 非血管平滑肌张力

In recent years, the incidence rate of myopia has been increasing year by year and has a trend of younger age. The prevention and control of myopia in children and adolescents has been widely concerned by the whole society and national authorities. The pathogenesis of myopia was focused on recently. Ocular autonomic nerve plays an important role in the occurrence and development of myopia. In this paper, the mechanism of ocular autonomic nerve affecting myopia was reviewed.

Key words: Myopia, Autonomic nerve, Accommodation, Ocular blood flow microcirculation, Intraocular pressure, Non-vascular smooth muscle fibre

图1 眼的交感和副交感神经支配示意图　括号中为通常存在于神经节后神经元中的神经递质和神经肽。*，示迄今为止仅在鸟类的研究中可见(图转自2015年，McDougal等^[6]的参考文献)

表1 不同干预措施对屈光不正调节指标的影响

文献	地域或种族	年龄(岁)	人数	屈光不正度数	干预措施	调节力指标改变
Cheng X，2019^[14]	美国	8~11	109人	-0.75 D~-4.00 D	佩戴软性接触镜	AC/A降低
Mutti DO，2017^[13]	美洲印第安人、非洲裔、亚裔、白人和西班牙裔	6~14	1128人	正视-0.25 D~+1.00 D近视眼>-0.75 D	睫状肌麻痹自动验光	AC/A升高是近视眼的早期迹象
Han X，2018^[15]	中国汉族	9~14	140人	1.00 D~2.30 D	佩戴角膜塑形镜	AF增加
Yang Y，2018^[16]	中国汉族	8~15	83人	-0.50 D~-6.00 D散光-0.25 D~-1.25 D	佩戴角膜塑形镜	AMP、AF及PRA均升高
Fu A，2020^[17]	中国汉族	6~12	400人	-1.25 D~-6.00 D散光<2.00 D，屈光参差<1.00 D	0.01%和0.02%的阿托品滴眼液	AMP显著降低
Yam JC，2019^[18]	中国香港	4~12	438人	>-1.00 D，散光<-2.50 D	0.05%、0.025%和0.01%的阿托品滴眼液	AMP显著降低

表1 不同干预措施对屈光不正调节指标的影响

文献	地域或种族	年龄(岁)	人数	屈光不正度数	干预措施	调节力指标改变
Cheng X，2019^[14]	美国	8~11	109人	-0.75 D~-4.00 D	佩戴软性接触镜	AC/A降低
Mutti DO，2017^[13]	美洲印第安人、非洲裔、亚裔、白人和西班牙裔	6~14	1128人	正视-0.25 D~+1.00 D近视眼>-0.75 D	睫状肌麻痹自动验光	AC/A升高是近视眼的早期迹象
Han X，2018^[15]	中国汉族	9~14	140人	1.00 D~2.30 D	佩戴角膜塑形镜	AF增加
Yang Y，2018^[16]	中国汉族	8~15	83人	-0.50 D~-6.00 D散光-0.25 D~-1.25 D	佩戴角膜塑形镜	AMP、AF及PRA均升高
Fu A，2020^[17]	中国汉族	6~12	400人	-1.25 D~-6.00 D散光<2.00 D，屈光参差<1.00 D	0.01%和0.02%的阿托品滴眼液	AMP显著降低
Yam JC，2019^[18]	中国香港	4~12	438人	>-1.00 D，散光<-2.50 D	0.05%、0.025%和0.01%的阿托品滴眼液	AMP显著降低

表2 虹膜和睫状体结构中受体的类型及作用

自主分支	神经递质	受体类型	受体亚型	受体分布	激动剂对调节的作用
副交感神经系统	乙酰胆碱	毒蕈碱	M₁	睫状肌、虹膜及睫状上皮	睫状肌收缩(调节力增加)并增加防水流出量^[19,20]
			M₂	睫状肌的纵向部分、虹膜及睫状体^[19,20]
			M₃	虹膜括约肌、睫状肌、睫状突和小梁网^[20,21,22]
			M₄	睫状突^[22]
			M₅	睫状体^[23]
交感神经系统	去甲肾上腺素	β肾上腺素受体	β₁	β₁亚型约占虹膜睫状体的β肾上腺素能受体总数的10%	睫状肌松弛(调节力下降)^[24]
			β₂	虹膜睫状体约90%β肾上腺素能受体属于β₂亚型非色素性睫状上皮细胞和小梁网细胞^[24,25]
		α肾上腺素受体	α₁	虹膜括约肌、睫状上皮^[26]及血管平滑肌	血管改变导致睫状体体积改变(调节力轻微下降)
			α₂	睫状体、虹膜^[27]及血管平滑肌

表2 虹膜和睫状体结构中受体的类型及作用

自主分支	神经递质	受体类型	受体亚型	受体分布	激动剂对调节的作用
副交感神经系统	乙酰胆碱	毒蕈碱	M₁	睫状肌、虹膜及睫状上皮	睫状肌收缩(调节力增加)并增加防水流出量^[19,20]
			M₂	睫状肌的纵向部分、虹膜及睫状体^[19,20]
			M₃	虹膜括约肌、睫状肌、睫状突和小梁网^[20,21,22]
			M₄	睫状突^[22]
			M₅	睫状体^[23]
交感神经系统	去甲肾上腺素	β肾上腺素受体	β₁	β₁亚型约占虹膜睫状体的β肾上腺素能受体总数的10%	睫状肌松弛(调节力下降)^[24]
			β₂	虹膜睫状体约90%β肾上腺素能受体属于β₂亚型非色素性睫状上皮细胞和小梁网细胞^[24,25]
		α肾上腺素受体	α₁	虹膜括约肌、睫状上皮^[26]及血管平滑肌	血管改变导致睫状体体积改变(调节力轻微下降)
			α₂	睫状体、虹膜^[27]及血管平滑肌

图2 房水形成和通过小梁网和葡萄膜巩膜途径流出示意图　(图转自2015年，McDougal等^[6]的参考文献)

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Advances on the autonomic nerve control and pathogenesis of myopia

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Advances on the autonomic nerve control and pathogenesis of myopia