抑火清肝退翳汤加减治疗肝经风热型单纯疱疹性角膜炎的临床疗效及作用机制  

Clinical Efficacy and Mechanism of Modified Yihuo Qinggan Tuiyi Tang in Treating Herpes Simplex Keratitis with Liver Meridian and Wind-heat

作　　者：孙志毅 宋继科[1,2] 毕宏生[1,2] SUN Zhi-yi;SONG Ji-ke;BI Hong-sheng(The Affiliated Ophthalmology Hospital of Shandong University of Traditional Chinese Medicine(TCM),Ji'nan 250001,China;Shandong University of TCM,Ji'nan 250355,China)

机构地区：[1]山东中医药大学附属眼科医院,济南250001 [2]山东中医药大学,济南250355

出　　处：《中国实验方剂学杂志》2020年第11期124-129,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金面上项目(81173440);国家自然科学基金青年基金项目(81403438);山东省自然科学基金项目(ZR2014HQ074)。

摘　　要：目的:观察抑火清肝退翳汤加减治疗肝经风热型单纯疱疹性角膜炎的临床疗效,并探讨其作用机制。方法:将130例肝经风热型单纯疱疹性角膜炎患者随机分为对照组和观察组,每组65例。对照组给予常规西医治疗,观察组在对照组基础上给予抑火清肝退翳汤加减口服治疗,连续治疗4周。比较两组患者的临床疗效、中医证候积分、症状体征、不良反应及复发率,采用酶联免疫吸附实验(ELISA)检测血清γ-干扰素(IFN-γ)、白细胞介素-6(IL-6)和白细胞介素-8(IL-8)炎症因子及丙二醛(MDA)、抗氧化活力(TAC)、谷胱甘肽过氧化物酶(GSH-Px)等氧化应激指标水平,采用流式细胞仪检测组CD4+和CD8+水平,随访1年观察复发情况。结果:经秩和检验,观察组患者临床疗效总有效率优于对照组(Z=2.161,P<0.05);治疗后观察组眼痛羞明、畏光流泪、视物下降、胞睑红肿积分均明显低于对照组(P<0.05);经秩和检验,观察组中医证候总有效率优于对照组(Z=2.540,P<0.05);治疗后观察组眼部疼痛、眼睑红肿、结膜充血、角膜点状星翳、角膜生翳和角膜生翳深度症状体征积分明显低于对照组(P<0.05);观察组血清IFN-γ水平高于对照组,IL-6,IL-8水平低于对照组(P<0.05);观察组MDA水平低于对照组,TAC及GSH-Px水平高于对照组(P<0.05);观察组CD4+和CD4+/CD8+水平高于对照组,CD8+水平低于对照组(P<0.05);停药后6个月和12个月观察组的复发率明显低于对照组(P<0.05)。结论:在常规西医治疗基础上给予抑火清肝退翳汤加减治疗肝经风热型单纯疱疹性角膜炎具有较好的临床疗效,可降低中医证候积分,改善症状体征,降低复发率,可能与降低炎症反应,改善氧化应激指标和免疫功能有关。Objective:To observe the clinical efficacy of modified Yihuo Qnggan Tuiyi Tang on herpes simplex keratitis with liver meridian and wind-heat,so as to explore its mechanism of action.Method:Totally 130 patients with herpes simplex keratitis with liver meridian and wind-heat were randomly divided into control group and observation group,with 65 cases in each group.The control group was treated with conventional western medicine,while the observation group was treated with modified Yihuo Qinggan Tuiyi Tang in addition to the therapy of the control group for 4 weeks.The clinical efficacy,traditional Chinese medicine(TCM)syndrome score,symptoms and signs,adverse reactions and recurrence rate of the two groups were compared.The levels of serum interferon gamma(IFN-γ),interleukin-6(IL-6),interleukin-8(IL-8)inflammatory factors,malondialdehyde(MDA),antioxidant activity(TAC),glutathione peroxidase(GSH-PX)of oxidative stress indexes were detected by enzyme linked immunosorbent assay(ELISA).The levels of CD4+and CD8+were measured by flow cytometry.The recurrence rate was observed during 1-year follow-up visit.Result:The total effective rate of observation group was better than that of control group(Z=2.161,P<0.05).After treatment,the scores of eye pain,shame,photophobia,tears,vision loss,redness and total eyelid swelling were significantly lower than those of control group(P<0.05).The total effective rate of TCM syndrome in the observation group was better than that of control group(Z=2.540,P<0.05).After treatment,the scores of pain,eyelid redness,conjunctival congestion,corneal punctate pannus,corneal pannus and corneal pannus depth of symptoms and signs in observation group were better than those of control group(P<0.05).The level of serum IFN-γin observation group was higher than that of control group,and the levels of IL-6 and IL-8 were lower than those of control group(P<0.05).Levels of MDA in the observation group was higher than that of control group(P<0.05).The levels of CD4^+and CD4^+/CD8^+in observation group we

关 键 词：单纯疱疹性角膜炎 肝经风热 抑火清肝退翳汤 炎症因子 氧化应激指标 免疫功能 

分 类 号：R772.2[医药卫生—眼科] R22[医药卫生—临床医学]