目的：观察中药杞精明目汤联合人工泪液治疗对肝肾阴虚型结膜松弛症(CCH)患者泪液中Th17相关细胞因子的改变。

方法：收集56例56眼Ⅱ-Ⅲ级肝肾阴虚型CCH患者，随机分为治疗组(杞精明目汤联合人工泪液)26例26眼和对照组(单纯人工泪液)30例30眼，疗程1 mo，观察治疗前后患者的国际眼表疾病指数(OSDI)、泪膜破裂时间(BUT)、泪河高度(TMH)、球结膜充血指数。采集治疗前后CCH患者的泪液，通过流式免疫荧光发光法对患者泪液中Th17相关细胞因子进行检测和分析。

结果：治疗组与对照组CCH患者治疗后OSDI、BUT、球结膜充血指数均较治疗前均明显改善(均P<0.01)； 治疗后治疗组患者TMH较治疗前显著降低(P<0.01)，对照组患者治疗前后TMH无差异(P=0.41)。治疗组CCH患者在治疗后泪液中Th17相关细胞因子IL-17A、IL-22、IFN-γ、IL-17F、IL-1β水平较治疗前明显降低(均P<0.01)，且治疗组的变化更为显著(均P<0.05)； 而对照组治疗前后泪液中Th17相关细胞因子无差异(均P>0.05)。治疗后两组CCH患者泪液中IL-6、TNF-α均较治疗前降低(均P<0.05)，但治疗组的变化更为显著(均P<0.01)。

结论：杞精明目汤联合人工泪液治疗可有效改善肝肾阴虚型结膜松弛症患者眼表微环境，提高泪膜稳定性，抑制眼表炎症，可能与其降低泪液中Th17相关细胞因子的分泌相关。

METHODS:A total of 56 CCH patients(56 eyes)with liver-kidney yin deficiency of grade Ⅱ to Ⅲ were collected and randomly divided into treatment group(treated with Qi Jing Mingmu decoction combined with artificial tears)of 26 cases(26 eyes)and control group(treated with pure artificial tears)of 30 cases(30 eyes). The treatment course was 1 mo, and international ocular surface disease index(OSDI), tear film break-up time(BUT), tear meniscus height(TMH)and conjunctival congestion index of the patients were observed before and after treatment. The patients' tears were collected before and after treatment, and Th17 related cytokines in tears were detected using flow cytometry immunofluorescence luminescence method.

RESULTS:After treatment, the OSDI, BUT and conjunctival congestion index of CCH patients in the treatment group and control group were significantly improved(all P<0.01). After treatment, the TMH of CCH patients in the treatment group was significantly reduced(P<0.01), while there was no statistically significant difference in TMH of the control group before and after treatment(P=0.41). After treatment, the levels of Th17 related cytokines IL-17A, IL-22, IFN-γ, IL-17F, and IL-1β in tears of CCH patients in the treatment group were significantly reduced after treatment(all P<0.01), and the changes in the treatment group were more significant(all P<0.05). There was no significant difference in the control group before and after treatment(all P>0.05). After treatment, the levels of IL-6 and TNF-α in the tears of both groups of CCH patients decreased compared to those before treatment(both P<0.05), but the changes in the treatment group were more significant(both P<0.01).

CONCLUSION:Qi Jing Mingmu decoction combined with artificial tears can effectively improve the ocular surface microenvironment, enhance tear film stability, and inhibit ocular surface inflammation in CCH patients with liver-kidney yin deficiency. This may be related to its reduction in the secretion of Th17 related cytokines in tears.