剔络养血明目方对青光眼患者视功能改善的疗效分析及对视神经血流密度的影响  

Effect of Tiluo Yangxue Mingmu Prescription on Visual Function,Vessel Density and Thickness of Retinal Nerve Fiber Layer of Optic Nerve in Glaucoma Patients

作　　者：侯文博 冯俊[1] 陈杰[1] 王玮[1] HOU Wen-bo;FENG Jun;CHEN Jie;WANG Wei(Eye Hospital,China Academy of Chinese Medical Sciences,Beijing 100040,China)

机构地区：[1]中国中医科学院眼科医院,北京100040

出　　处：《中国实验方剂学杂志》2020年第24期108-115,共8页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：首都临床特色应用研究项目(Z181100001718045)。

摘　　要：目的:探讨剔络养血明目方对青光眼患者最佳矫正视力(the best corrected visual acuity,BCVA),视野等改善的作用,分析该方剂对视神经血流密度(vessel density,VD)和视网膜神经纤维层厚度(retinal nerve fiber layer thickness,RNFL thickness)的影响。方法:回顾分析2017年1月至2020年7月采用剔络养血明目方治疗的117例原发性青光眼患者共计234只眼的临床数据;回顾剔络养血明目方治疗的57只眼作为治疗组,另选取性别、年龄、疗程相匹配的未行该方治疗的57只眼作为对照组。分析治疗前后BCVA,视野平均敏感度(value and mean sensitivity,MS),平均缺损(mean deviation,MD)的变化。利用光学相干断层扫描血管成像技术(optical coherence tomography angiography,OCTA)分析治疗前后视神经VD及RNFL厚度的变化。结果:治疗后较治疗前BCVA提升(P=0),MS值增加(P=0),MD值减小(P=0.001),整个视盘扫描区域(P=0),视盘内(P=0.004)及盘周各分区(P<0.05)的VD增加,RNFL厚度(除视盘下方鼻侧区外)无明显变化。治疗组治疗后较治疗前,MS增加(P=0.003),MD减少(P=0.024),对照组视野各指标治疗后较治疗前变化无统计学差异。结论:对于眼压稳定在目标眼压范围内的青光眼患者,剔络养血明目方能够改善其视功能和视神经VD,但对RNFL厚度无明显影响。Objective:To investigate the effect of Tiluo Yangxue Mingmu prescription on the improvement of visual function,and to analyze the effect on the vessel density and the thickness of retinal nerve fiber layer(RNFL)of optic nerve in glaucoma patients.Method:The clinical data of 234 eyes of 117 patients of primary glaucoma treated with Tiluo Yangxue Mingmu prescription from January 2017 to July 2020 were retrospectively analyzed.Fifty-seven eyes treated with the Tiluo Yangxue Mingmu prescription were reviewed as the treatment group,and 57 eyes that were not treated with the prescription matched in gender,age and course of treatment were selected as the control group.The changes of BCVA,mean sensitivity(MS)and mean deviation(MD)of visiual field before and after treatment were analyzed.Optical coherence tomography(OCTA)was used to analyze the changes of VD and thickness of RNFL of potic nerve before and after treatment.Result:After treatment,compared with that before treatment,BCVA was increased(P=0),MS was increased(P=0),MD was decreased(P=0.001),VD of the whole image(P=0),VD of the inside disc(P=0.004)and all subdivisions of peripapillary(P<0.05)was increased,the RNFL thickness(except inferior nasal area)was not significantly changed.After treatment,MS was increased(P=0.003)and MD was decreased(P=0.024)in treatment group compared with those before treatment.In the control group,there was no statistical difference in the changes of visual field indicators after treatment compared with that before treatment.Conclusion:For glaucoma patients whose intraocular pressure is stable within the range of target intraocular pressure,Tiluo Yangxue Mingmu prescription can improve the visual function and VD of optic nerve,but has no significant effect on RNFL thickness.

关 键 词：剔络养血明目方 青光眼 血流密度 光学相干断层扫描血流成像技术 盘周毛细血管 

分 类 号：R276.7[医药卫生—中医五官科学] R289[医药卫生—中医学]