自拟清目汤治疗肝经风热型干眼的临床疗效及对泪液中相关指标的影响  

Clinical efficacy of self-designed Qingmu decoction in treating wind-heat in liver meridian dry eye cases and its influence on related indexes in tear

作　　者：武雪松 李巧林 Wu Xuesong;Li Qiaolin(Guangdong Cadre Sanatorium,Guangzhou 510970,China)

机构地区：[1]广东省干部疗养院,广州510970

出　　处：《中国中医眼科杂志》2021年第10期708-711,716,共5页China Journal of Chinese Ophthalmology

摘　　要：目的探讨玻璃酸钠滴眼液联合自拟清目汤治疗肝经风热型干眼的临床疗效及对泪液中IL-1β、TNF-α及MMP-9水平的影响。方法选取2017年4月—2018年8月确诊为干眼的患者94例(188只眼),随机分为对照组和观察组各47例(94只眼)。对照组给予玻璃酸钠滴眼液治疗,观察组在对照组基础上加用中药清目汤治疗,治疗4周。观察患者眼部指征、泪液相关指标改善情况及不良反应出现情况。结果(1)眼部指征:治疗后,观察组泪液分泌试验(SIT)、泪膜破裂时间(BUT)均高于对照组(t_(SIT)=31.501,t_(BUT)=10.736,均P=0.000),角膜表面不规则指数(SAI)、角膜地形图角膜表面规则指数(SRI)均低于对照组(t_(SAI)=15.330,t_(SRI)=30.924,均P=0.000);与治疗前比较,2组患者BUT(t_(对照组)=21.773,t_(观察组)=37.150,均P=0.000)、SIT(t_(对照组)=89.889,t_(观察组)=110.24,均P=0.000)均提高,SAI(t_(对照组)=21.666,t_(观察组)=21.646,均P=0.000)、SRI(t_(对照组)=11.078,t_(观察组)=13.606,均P=0.000)均降低,差异均具有统计学意义。(2)泪液中炎症因子:治疗后,观察组TNF-α、IL-1β及MMP-9水平均低于对照组(t_(TNF-α)=21.170、t_(IL-1β)=22.423、t_(MMP-9)=23.457,均P=0.000);与治疗前比较,2组患者TNF-α(t_(对照组)=33.141,t_(观察组)=51.106,均P=0.000)、IL-1β(t_(对照组)=16.875,t_(观察组)=21.274,均P=0.000)及MMP-9(t_(对照组)=21.488,t_(观察组)=37.365,均P=0.000)均降低,差异均具有统计学意义。(3)临床疗效:观察组治疗总有效率(95.74%)高于对照组(82.97%),差异有统计学意义(χ^(2)=4.029,P=0.045)。(4)不良反应:2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论玻璃酸钠滴眼液联合自拟清目汤治疗肝经风热型干眼,可有效改善患者的眼部症状及泪液中炎症因子水平,提高总体疗效,且无明显不良反应。OBJECTIVE To evaluate the clinical effect of sodium hyaluronate combined with self-designed Qingmu decoction(QMT)in treating dry eye patients with wind-heat in liver meridian syndrome and its influence on the levels of IL-1β,TNF-a and MMP-9 in tear.METHODS Ninety-four patients(188 eyes)with dry eye diagnosed from April 2017 to August 2018 were randomly divided into control group(47 cases,94 eyes)and observation group(47 cases,94 eyes).The cases in control group(CG)were treated with sodium hyaluronate eye drops,and the cases in the observation group(OG)were intervened with Qingmu decoction for 4 weeks.Tear related indexes,ocular signs and the occurrence of adverse reactions were observed.RESULTS(1)Eye signs:After treatment,SIT,BUT in the observation group were higher than those in the control group(t_(SIT)=31.501,t_(BUT)=10.736,all P=0.000);SAI and SRI were lower than control group(t_(SAI)=15.330,t_(SRI)=30.924,all P=0.000);BUT(t_(CG)=21.773,t_(OG)=37.150,all P=0.000)and SIT(t_(CG)=89.889,t_(OG)=110.24,all P=0.000)both increased in two groups;SAI(t_(CG)=21.666,t_(OG)=21.646,both P=0.000)and SRI(t_(CG)=11.078,t_(OG)=13.606,all P=0.000)decreased in both groups and the difference was statistically significant.(2)Inflammatory factor in tear:After treatment,the levels of TNF-α,IL-1β and MMP-9 in the observation group were lower than those in the control group(t_(TNF-α)=21.170,t_(IL-1β)=22.423,t_(MMP-9)=23.457,all P=0.000);compared with the result before treatment,TNF-α(t_(CG)=33.141,t_(OG)=51.106,all P=0.000),IL-1β(t_(CG)=16.875,t_(OG)=21.274,all P=0.000)and MMP-9(t_(CG)=21.488,t_(OG)=37.365,all P=0.000)were significantly decreased in both groups.(3)Efficacy:The total effective rate(95.74%)of the observation group was higher than that of the control group(82.97%)(χ^(2)=4.029,P=0.045).(4)Adverse reactions:There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).CONCLUSIONS On the basis of Western Medicine treatment,Qingmu decoction,a Traditional Chinese Medicine de

关 键 词：干眼 清目汤 玻璃酸钠 不良反应 

分 类 号：R777.34[医药卫生—眼科]