泪液渗透压在干眼发生机制和临床应用中的研究进展

doi:10.3877/cma.j.issn.2095-2007.2021.05.009

泪液渗透压升高是干眼发生与发展的核心机制，作为一项诊断和监测干眼的客观指标，泪液渗透压有重要的临床意义。有研究结果表明，泪液渗透压在干眼的发生机制中有重要作用，并在临床诊断与治疗中有广泛应用。本文中笔者就泪液渗透压在干眼发生机制和临床应用中的研究进展进行综述。

关键词: 泪膜, 泪液渗透压, 干眼

The increase of tear osmolarity is the core mechanism in the development of dry eye. As an objectively measurable indicator for the diagnosis and monitoring of dry eye, tear osmolarity has been widely used in clinic. It has been demonstrated that the tear osmolarity linked with dry eye, and has been used widely in clinical diagnosis and other aspects for dry eye. The research progress of tear osmolarity of mechanism and clinical application in dry eye were reviewed in this article.

Key words: Tear film, Tear osmolarity, Dry eye

表1 泪液渗透压与不同类型干眼间联系的文献汇总

干眼类型	所得结论	参考文献
水液缺乏型干眼	干燥综合征患者泪液渗透压平均值为(311.1±16.4)mOsm/L	[20]
	干燥综合征患者的泪液渗透压与疾病活动性相关性较强	[21]
	所需样本量小；检测时间短；原位测量避免泪液转移	[22]
	类风湿性关节炎患者泪液渗透压普遍高于正常值，且与类风湿性关节炎活动评分呈正相关	[23]
脂质异常型干眼	睑板腺出现损伤或阻塞时患者泪液渗透压明显高于正常人群	[24]
	将患者按睑板腺分泌能力分组，睑板腺低分泌组和睑板腺阻塞组患者的泪液渗透压超过308 mOsm/L	[25]
黏蛋白异常型干眼	干燥综合征患者泪液中的黏蛋白5AC含量降低，且与泪液渗透压值相关	[26]
泪液动力学异常型干眼	瞬目频率下降越多，泪液渗透压越高	[28]
混合型干眼	职业计算机使用者平均泪液渗透压明显高于未使用者，且增长值与计算机使用时间存在一定相关性	[32]
	配戴角膜接触镜患者的泪液渗透压和白介素-8、白介素-13及白介素-15等炎症因子的含量明显高于未配戴者	[34]

表1 泪液渗透压与不同类型干眼间联系的文献汇总

干眼类型	所得结论	参考文献
水液缺乏型干眼	干燥综合征患者泪液渗透压平均值为(311.1±16.4)mOsm/L	[20]
	干燥综合征患者的泪液渗透压与疾病活动性相关性较强	[21]
	所需样本量小；检测时间短；原位测量避免泪液转移	[22]
	类风湿性关节炎患者泪液渗透压普遍高于正常值，且与类风湿性关节炎活动评分呈正相关	[23]
脂质异常型干眼	睑板腺出现损伤或阻塞时患者泪液渗透压明显高于正常人群	[24]
	将患者按睑板腺分泌能力分组，睑板腺低分泌组和睑板腺阻塞组患者的泪液渗透压超过308 mOsm/L	[25]
黏蛋白异常型干眼	干燥综合征患者泪液中的黏蛋白5AC含量降低，且与泪液渗透压值相关	[26]
泪液动力学异常型干眼	瞬目频率下降越多，泪液渗透压越高	[28]
混合型干眼	职业计算机使用者平均泪液渗透压明显高于未使用者，且增长值与计算机使用时间存在一定相关性	[32]
	配戴角膜接触镜患者的泪液渗透压和白介素-8、白介素-13及白介素-15等炎症因子的含量明显高于未配戴者	[34]

表2 泪液渗透压的测量方法

测量方法	原理	优点	缺点
凝固点降低法	溶液的凝固点随溶质浓度增加而降低	所需样本量小；检测时间短	操作费时；转移泪液过程存在泪液蒸发的问题；需主观判断融化时刻
蒸汽压法	溶液的蒸汽压随溶质浓度增加而降低	准确度高；检测时间短	所需样本量大；转移泪液过程中泪液有蒸发
电阻抗法	溶液的电阻随溶质浓度增加而降低	所需样本量小；检测时间短；原位测量避免泪液转移	价格昂贵

表2 泪液渗透压的测量方法

测量方法	原理	优点	缺点
凝固点降低法	溶液的凝固点随溶质浓度增加而降低	所需样本量小；检测时间短	操作费时；转移泪液过程存在泪液蒸发的问题；需主观判断融化时刻
蒸汽压法	溶液的蒸汽压随溶质浓度增加而降低	准确度高；检测时间短	所需样本量大；转移泪液过程中泪液有蒸发
电阻抗法	溶液的电阻随溶质浓度增加而降低	所需样本量小；检测时间短；原位测量避免泪液转移	价格昂贵

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Advances on the tear osmolarity of mechanism and clinical application in dry eye

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Advances on the tear osmolarity of mechanism and clinical application in dry eye