疼痛知觉改变可能是造成乾眼症的原因


  【24drs.com】英国约有一成妇女患有乾眼症(dry eye disease,DED),盛行率随年龄增加。一篇探讨乾眼症可能风险因素的研究发现,慢性疼痛症状,如骨盆痛、肠激躁症候群、纤维肌痛等,皆和乾眼症有强烈关联;另外,忧郁也与出现乾眼症有强烈关联。
  
  英国圣汤玛士医院、伦敦国王学院、双胞胎研究与遗传流行病学部;荷兰Groningen大学医学中心眼科暨流行病学部Jelle Vehof博士等人,在9月3日的英国眼科学期刊在线发表了横断面关联性研究的结果,研究者使用问卷搜集病患的乾眼症资料和风险因素,研究对象是2,410个家庭的3,824名女性双胞胎,这是英国第一篇以人口为基础的乾眼症研究。
  
  这些研究对象中,9.6%诊断有乾眼症且使用人工泪液,20.8%在过去3个月内有乾眼症症状。
  
  这篇研究确认了以前被提出的许多乾眼症风险因素,包括免疫调节疾病,如类风湿关节炎、甲状腺疾病和过敏;过敏性疾病,如哮喘和湿疹,也与乾眼症有关。
  
  问卷结果中,不意外的是,曾动过眼科手术的妇女比较可能诊断有乾眼症,或许是因为她们在接受眼科医师的照护而发现。
  
  作者们写道,我们发现乾眼症和白内障手术强烈有关,曾进行白内障手术者的乾眼症盛行率高出70%。曾经有人探讨眼科手术后的乾眼症,特别是屈光手术后。白内障手术之超音波晶体乳化术后,也曾发现角膜感觉减弱且泪液生理学改变。白内障手术后,杯状细胞密度也显著降低。
  
  许多已确立的乾眼症风险因素皆指向一个潜在病因,包括易患慢性疼痛或身心症,这促使研究者结论指出,在这具有英国人口代表性的妇女中,乾眼症是相常见的问题,随年龄增加而更盛行,对自我认知健康有显著影响。除了确认一些已知的风险因素,这篇研究还发现乾眼症的新关联,提出痛觉认知改变和心理与身体因素影响乾眼症及其症状的可能性。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7114&x_classno=0&x_chkdelpoint=Y
  

Altered Pain Perception May Underlie Some Dry Eye Disease

By Lara C. Pullen, PhD
Medscape Medical News

Approximately 1 in 10 women in the United Kingdom have dry eye disease (DED), with prevalence increasing with age. An investigation of possible risk factors for DED has found that the strongest associations were between chronic pain syndromes such as pelvic pain, irritable bowel syndrome, and fibromyalgia and DED. Depression was also strongly associated with the presence of DED.

Jelle Vehof, PhD, from the Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, United Kingdom, and the Department of Ophthalmology and Epidemiology, University Medical Center Groningen, The Netherlands, and colleagues published the results of their cross-sectional association study online September 3 in the British Journal of Ophthalmology. They used a questionnaire to collect patient-provided information on DED and risk factors from 3824 female twins from 2410 families. Theirs is the first population-based study of DED in the United Kingdom.

Of the women surveyed, 9.6% had been diagnosed with DED and used artificial tears, and 20.8% reported DED symptoms in the past 3 months.

The study confirmed many of the previously described risk factors for DED, including immune-mediated diseases such as rheumatoid arthritis, thyroid diseases, and allergies. Atopic disorders such as asthma and eczema were also associated with DED.

Unsurprisingly, the questionnaires revealed that women who had ophthalmic surgery were more likely to be diagnosed with DED, perhaps because they were under the care of an ophthalmologist.

"We have found a strong significant association between DED and cataract surgery, showing a 70% higher prevalence of DED in subjects who had undergone cataract surgery. DED after ophthalmic surgery has been described, particularly after refractive surgery. Decreased corneal sensation and changes in tear physiology after phacoemulsification have been found, as well as a significantly decreased goblet cell density after cataract surgery," the authors write.

Several of the identified risk factors for DED point toward an underlying etiology that involves a predisposition to chronic pain or somatization, leading the investigators to conclude "that DED is a very common problem among women in a population-representative cohort in the UK, becomes more prevalent with advancing age and has a significant effect on self-perceived health. Besides confirming some well-known risk factors, this study has found new associations of DED, raising the possibility that altered pain perception and psychological and somatisation factors influence DED and its symptomatology."

TwinsUK receives support from the Wellcome Trust, European Union, and the National Institute for Health Research funded BioResource, Clinical Research Facility and Biomedical Research Centre based at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. One coauthor is a Fight for Sight Early Career Investigator Award holder. The other authors have disclosed no relevant financial relationships.

Br J Ophthalmol. Published online September 3, 2014.

    
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