目的：分析氯雷他定联合双氯芬酸钠滴眼液治疗过敏性结膜炎的疗效及对泪膜稳定性和泪液相关指标的影响。

方法：前瞻性选择2019-01/2020-01我院收治的过敏性结膜炎患者93例186眼，随机分为观察组(47例94眼，采用氯雷他定联合双氯芬酸钠滴眼液治疗)与对照组(46例92眼，采用氯雷他定治疗)，均连续治疗2wk。治疗前、治疗2wk均评估眼部症状、体征改善情况； 进行基础泪液分泌试验(SⅠt)，检测泪膜破裂时间(BUT)，评估泪膜稳定性； 采用眼前节相干光断层扫描仪测定泪河高度、泪河深度、泪河横截面面积； 留取泪液标本，检测泪液透明质酸(HA)、ⅡA型分泌型磷脂酶A2(sPLA2-Ⅱa)、嗜酸性细胞阳离子蛋白(ECP)等指标的变化； 统计治疗不良反应发生情况。

结果：治疗2wk，两组患者主要症状、体征积分均较同组治疗前降低(P<0.05)，且观察组均低于对照组(P<0.05)； 两组患者SⅠt、BUT均较同组治疗前增加(P<0.05)，且观察组均长于对照组(P<0.05)； 与同组治疗前比较，两组患者泪河高度均上升，泪河深度均增加，泪河横截面面积均增加(P<0.05)，且观察组泪河高度、泪河深度、泪河横截面积均高于对照组(均P<0.05)； 两组患者泪液HA、ECP、sPLA2-Ⅱa水平均较同组治疗前降低(P<0.05)，且观察组均低于对照组(P<0.05)。治疗期间，两组治疗不良反应发生率比较无差异(12.8% vs 10.9%，P>0.05)。

结论：氯雷他定联合双氯芬酸钠滴眼液治疗过敏性结膜炎整体疗效优于单纯应用氯雷他定，可改善患者症状及体征，提高泪膜稳定性，降低泪液炎性介质浓度，促进泪膜功能恢复，安全可行。

METHODS: A prospective study was conducted among 93 patients(186 eyes)with allergic conjunctivitis admitted to the hospital between January 2019 and January 2020. They were randomly divided into observation group(n=47, 94 eyes, treated with loratadine and diclofenac sodium eye drops)and control group(n=46, 48 eyes, treated with loratadine). All patients received 2wk of treatment. The improvement of ocular symptoms and signs after treatment was evaluated. Schirmer I test(SⅠt)and break up time(BUT)were used to evaluate the tear film stability. The height, depth and cross-sectional area of lacrimal rivus were measured by anterior segment related optical coherence tomography. Tear specimens were collected to detect changes in tear hyaluronic acid(HA), group ⅡA secretory phospholipase A2(sPLA2-Ⅱa and eosinophil cationic protein(ECP). The occurrence of adverse reactions was counted.

RESULTS: After 2wk of treatment, the scores of main symptoms and signs were reduced in the two groups(P<0.05), and the observation group had lower scores than the control group(P<0.05). SⅠt and BUT were increased in the two groups(P<0.05), which were longer in the observation group than in the control group(P<0.05). The height of lacrimal rivus increased, depth increased, and cross-sectional area were increased in the two groups(P<0.05). Besides, the above indexes in observation group were higher than those in the control group(P<0.05). Meanwhile, HA, ECP and sPLA2-Ⅱa were decreased in the two groups(P<0.05), which were lower in the observation group than in the control group(P<0.05). No significant differences were found between the 2 groups in the incidence of adverse reactions(12.8% vs 10.9%, P>0.05).

CONCLUSION: The overall effect of loratadine combined with diclofenac sodium eye drops is better than that of loratadine alone in the treatment of allergic conjunctivitis. The combined treatment can improve symptoms, signs and tear film stability, reduce inflammatory mediators in tears, and promote recovery of tear film function. Besides, it is safe and feasible.