目的：分析环孢素联合泪点栓塞治疗原发性干燥综合征患者干眼患者的临床效果。

方法：回顾性分析2022-06/2023-09就诊于保定市第一中心医院经眼科与风湿免疫科多学科会诊后确诊为原发性干燥综合征干眼患者60例120眼临床资料。所有患者均进行原发性干燥综合征常规治疗，根据干眼治疗方法不同分为三组：A组20例40眼使用0.3%玻璃酸钠滴眼液治疗； B组20例40眼使用0.3%玻璃酸钠滴眼液+0.05%环孢素滴眼液治疗； C组20例40眼使用0.3%玻璃酸钠滴眼液+0.05%环孢素滴眼液联合双眼上下泪点行泪点栓塞治疗。比较三组患者治疗前，治疗后4、8、12 wk眼表疾病评分指数(OSDI)评分、结膜充血评分、泪膜破裂时间(BUT)、泪河高度(TMH)、 角膜荧光素染色(FL)评分和泪液分泌量，治疗前及治疗后12 wk检测泪液中炎性因子白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和白介素-1β(IL-1β)含量，观察不良反应发生情况。

结果：治疗后4、8、12 wk，三组患者OSDI评分、结膜充血评分和 FL评分均低于治疗前，BUT、TMH和泪液分泌量均高于治疗前(均P<0.001)，C组患者OSDI评分均低于A组和B组，B组低于A组(均P<0.001)，C组患者BUT、TMH和泪液分泌量均高于A组和B组， B组均高于A组(均P<0.001)。治疗后12 wk，三组患者泪液中IL-6、TNF-α和IL-1β水平均较治疗前降低，且C组低于A组和B组，B组低于A组(均P<0.001)。治疗随访期间三组患者不良反应发生率比较无差异(P>0.05)。

结论：联合应用环孢素和泪点栓塞治疗可改善中重度干眼患者临床症状，提高其泪膜和角膜功能，增加泪液分泌量，降低泪液炎症因子水平，安全有效。

METHODS: The clinical data of 60 patients(120 eyes)who were admitted to the ophthalmology department and rheumatology and immunology department of Baoding No.1 Central Hospital and were diagonosed with siogren's syndrome dry eye after multidisciplinary consultation from June 2022 to September 2023 were retrospectively analyzed. All the patients received regular treatment of primary Sjögren's syndrome, and they were divided into three groups according to treatment methods: A, B and C, with 20 cases(40 eyes)in each group. The group A received 0.3% sodium hyaluronate eyedrops, the group B received 0.3% sodium hyaluronate eyedrops plus 0.05% cyclosporine eyedrops, and the group C received 0.3% sodium hyaluronate eyedrops plus 0.05% cyclosporine eyedrops combined with binocular lacrimal plugs. The ocular surface disease index(OSDI)score, conjunctival hyperemia score, tear film breakup time(BUT), tear meniscus height(TMH), corneal fluorescein staining(FL)score and tear secretion of the three groups of patients were compared before and at 4, 8 and 12 wk after treatment. The contents of inflammatory factors such as interleukin-6(IL-6), tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β)in tears were detected before and at 12 wk after treatment.

RESULTS: At 4, 8 and 12 wk after treatment, the scores of OSDI, conjunctival hyperemia score and FL in the three groups of patients were lower than those before treatment, and the BUT, TMH and tear secretion were higher than those before treatment(all P<0.001). The OSDI score of the group C was lower than that of the group A and B, and the group B was lower than the group A(all P<0.001). The BUT, TMH and tear secretion of the group C were higher than those of the group A and B, with the group B higher than the group A(all P<0.001). At 12 wk after treatment, the levels of IL-6, TNF-α and IL-1β in the tears of the three groups of patients were lower than those before treatment, with the group C lower than the group A and B, and the group B lower than the group A(all P<0.001). There was no statistical significant difference in the incidence of adverse reactions among the three groups of patients(P>0.05).

CONCLUSION: The combined use of cyclosporine and lacrimal plug is safe and effective in improving the clinical symptoms of patients with moderate and severe dry eye, promoting the function of tear film and cornea, increasing tears secretion, and reducing the level of tear inflammatory factors.