伐尼克兰鼻喷雾剂在干眼症治疗中的作用机制及临床进展

Mechanisms of Action and Clinical Advances of Varenicline Nasal Spray in the Treatment of Dry Eye Disease

摘要: 干眼症是眼科常见的慢性眼表疾病，其发生与泪膜稳态破坏、泪液分泌不足、眼表炎症及神经感觉异常等因素密切相关。现有治疗手段虽可改善部分症状，但仍存在起效较慢、依从性不足及长期眼表用药负担较重等问题。伐尼克兰鼻喷雾剂是一种新型促泪液分泌药物，可通过经鼻给药激活鼻腔黏膜感觉神经末梢，调控三叉神经–副交感神经反射通路，促进泪腺分泌自身天然泪液，从而改善干眼相关体征和症状。近年来，系列研究均证实其可增加Schirmer试验泪液分泌量，并具有较好的安全性和耐受性。与传统滴眼治疗相比，伐尼克兰鼻喷雾剂不直接作用于眼表，可减少眼表刺激及防腐剂暴露，为水液缺乏型及混合型干眼患者提供了新的治疗选择。本文就伐尼克兰鼻喷雾剂的作用机制、临床疗效、安全性、适用人群及研究展望进行综述，以期为其眼科临床应用提供参考。

Abstract: Dry eye disease is a common chronic ocular surface disorder closely associated with disruption of tear film homeostasis, insufficient tear secretion, ocular surface inflammation, and neurosensory abnormalities. Although currently available therapies can alleviate some symptoms, several limitations remain, including a relatively slow onset of action, suboptimal treatment adherence, and the substantial burden associated with long-term topical ocular therapy. Varenicline nasal spray is a novel tear-stimulating agent that activates sensory nerve endings in the nasal mucosa following intranasal administration and modulates the trigeminal-parasympathetic reflex pathway, thereby promoting lacrimal gland secretion of natural tears and improving the signs and symptoms of dry eye disease. In recent years, a series of studies have demonstrated that varenicline nasal spray increases tear production as measured by the Schirmer test and has a favorable safety and tolerability profile. Unlike conventional topical eye drops, varenicline nasal spray does not act directly on the ocular surface, which may reduce ocular surface irritation and exposure to preservatives, providing a new therapeutic option for patients with aqueous-deficient or mixed dry eye disease. This review summarizes the mechanisms of action, clinical efficacy, safety, appropriate patient populations, and future research perspectives of varenicline nasal spray, with the aim of providing a reference for its clinical application in ophthalmology.