Изменение состава слезной жидкости при синдроме сухого глаза (обзор литературы)

Актуальность. Распространенность синдрома сухого глаза (ССГ) нарастает во всем мире. Нарушение состава слезной пленки является основной причиной развития этого заболевания. В  последние годы появилось много новых данных о механизмах, участвующих в патогенезе ССГ, что связано с возросшим интересом к слезе как материалу для проведения клинико-диагностических исследований. Цель: представить основные направления исследований биомаркеров ССГ в слезе, их роль в прогнозе, разработке новых методов лечения и мониторинге эффективности терапии ССГ. Материалы и методы. Проведен поиск статей в PubMed с 2000 по 2024 г. Публикации отбирались методом сплошной выборки с использованием ключевых слов: слеза, синдром сухого глаза, синдром Шегрена, биомаркеры, цитокины, окислительный стресс, ферменты, экстраклеточные везикулы, микроРНК, нетоз. В обзор вошло 60 статей. Результаты. Литературные данные об изменении состава слезы при ССГ свидетельствуют о том, что наряду с изменениями, характерными для воспалительного процесса любой этиологии, имеются и специфические особенности. В обзоре представлены сведения об изменениях содержания в слезе маркеров окислительного стресса, апоптоза, протеиназ и их ингибиторов, цитокинов, липидов и нуклеиновых кислот. Характерной чертой ССГ является гиперосмолярность слезы, которая способствует усилению воспаления, активизирует миграцию в слезу нейтрофилов и образование нейтрофильных внеклеточных ловушек. На тяжесть заболевания указывает повышение уровня таких маркеров воспаления, как металлопротеиназа‑9, лактоферрин, миелопероксидаза, эластаза. Есть различия в составе слезы при ССГ, сопровождающем синдром Шергена и без него, которые могут быть использованы для дифференциальной диагностики. Представлены данные о перспективности определения микроРНК в слезе в качестве маркеров тяжести ССГ и с целью дифференциальной диагностики. Заключение. Литературные данные объективно свидетельствуют о том, что компоненты слезы могут быть использованы в качестве биомаркеров в диагностических, прогностических целях и для мониторинга эффективности терапии синдрома сухого глаза. Исследование биомаркеров ССГ позволит осуществлять персонализированный подход к лечению этого заболевания.

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