从系统性疾病到原发性开角型青光眼机制。

文献信息

中文摘要

背景： 原发性开角型青光眼（POAG）是一种复杂的神经退行性疾病，涉及遗传易感性、环境因素和全身异常，其发病机制尚未完全阐明。根据基线眼压（IOP），POAG分为两种亚型：高眼压性青光眼（HTG）和正常眼压性青光眼（NTG）。本综述从眼-脑-体轴整合视角，总结并整合了近期研究进展，重点关注包括心血管、内分泌、神经退行性和自身免疫性疾病以及阻塞性睡眠呼吸暂停低通气综合征（OSAHS）在内的全身性疾病在POAG发生和进展中的作用。当前证据表明，POAG中的视神经损伤涉及多种相互关联的病理通路，如IOP相关机械应力、血流动力学紊乱、神经血管耦合受损、微血管功能障碍、氧化应激和慢性炎症。其中，眼-脑轴、肠-眼轴和眼淋巴-类淋巴系统的功能障碍是介导和整合上述病理过程的关键调控网络。两种亚型表现出不同的致病特征：HTG主要由IOP升高驱动，而NTG更依赖于非IOP机制，且更易受全身性影响。这一整合视角加深了我们对POAG发病机制的理解，并为早期诊断、多维干预和精准治疗提供了新的理论基础。

英文摘要

Primary open angle glaucoma (POAG) is a complex neurodegenerative disorder involving genetic susceptibility, environmental factors, and systemic abnormalities, whose pathogenesis has not been fully elucidated. Based on baseline intraocular pressure (IOP), POAG is classified into two subtypes: high-tension glaucoma (HTG) and normal-tension glaucoma (NTG). This review summarizes and integrates recent research advances, focusing on the roles of systemic disorders including cardiovascular, endocrine, neurodegenerative, and autoimmune diseases, as well as obstructive sleep apnea-hypopnea syndrome (OSAHS), in the onset and progression of POAG from an integrated eye-brain-body axis perspective. Current evidence suggests that optic nerve damage in POAG involves multiple interconnected pathological pathways, such as IOP-related mechanical stress, hemodynamic disturbances, impaired neurovascular coupling, microvascular dysfunction, oxidative stress, and chronic inflammation. Among them, dysfunctions of the eye-brain axis, gut-eye axis, and ocular lymphatic-glymphatic system serve as key regulatory networks that mediate and integrate the aforementioned pathological processes. The two subtypes display distinct pathogenic features: HTG is primarily driven by elevated IOP, whereas NTG relies more on IOP-independent mechanisms and is more susceptible to systemic influences. This integrative perspective deepens our understanding of POAG pathogenesis and provides a novel theoretical foundation for early diagnosis, multidimensional intervention, and precision therapy.