驻景丸加减方治疗肝肾不足型干性AMD的临床疗效观察  

Clinical Efficacy of Zhujing Pill with Modifications in the Treatment of Dry Agerelated Macular Degeneration and Its Antioxidant Effects

作　　者：李敏 陈春明 徐新荣[2] 杨宁[2] 张元钟 邵雁 LI Min;CHEN Chunming;XU Xinrong;YANG Ning;ZHANG Yuanzhong;SHAO Yan(Liyang Hospital of Chinese Medicine,Liyang 213300,China)

机构地区：[1]溧阳市中医医院,溧阳213300 [2]南京中医药大学附属医院,南京210029

出　　处：《中国中医眼科杂志》2024年第12期1120-1125,1188,共7页China Journal of Chinese Ophthalmology

基　　金：国家自然科学基金项目(82074177);江苏省卫生健康委指导性项目(Z2022052);溧阳市科技局接轨南京专项(LC2021002)。

摘　　要：目的研究驻景丸加减方治疗干性年龄相关性黄斑变性(AMD)临床疗效及其抗氧化作用。方法纳入2021年3月—2023年3月江苏省溧阳市中医医院就诊的肝肾不足型干性AMD患者48例(74只眼),随机分为治疗组24例(38只眼)和对照组24例(36只眼)。治疗组予驻景丸加减方口服,对照组予叶黄素胶囊口服,均连续用药3个月。分别于治疗前及治疗后3个月,检测并记录患者视力、眼底自发荧光强度、血清氧化指标[丙二醛(MDA)、核转录因子(Nrf2)、活性氧(ROS)、谷氨酸半胱氨酸连接酶(GCL)、I型血红素氧化酶(HO-1)、NAD(P)H醌氧化还原酶1(NQO-1)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSHPx)、过氧化氢酶(CAT)]及中医临床证候评分等情况。结果(1)视力:治疗组治疗后视力较治疗前提高,差异有统计学意义(t=3.443,P=0.001);对照组治疗后视力与治疗前比较,差异无统计学意义(P>0.05)。治疗后2组间比较,差异无统计学意义(P>0.05)。(2)眼底自发荧光强度:治疗后2组眼底自发荧光强度与治疗前比较及治疗后2组间比较,差异均无统计学意义(P>0.05)。(3)血清氧化指标:2组治疗后ROS、MDA水平均低于治疗前,Nrf2、GSHPx、SOD2、GCL、CAT、HO-1、NQO-1水平均高于治疗前,差异均有统计学意义(治疗组:t_(ROS)=-3.594,P=0.002;t_(MDA)=-3.395,P=0.002;t_(Nrf2)=3.146,P=0.005;t_(GSH-Px)=2.081,P=0.049;t_(SOD2)=2.335,P=0.029;t_(GCL)=3.173,P=0.004;t_(CAT)=3.086,P=0.005;t_(HO-1)=3.526,P=0.002;t_(NQO-1)=6.195,P=0.000。对照组:t_(ROS)=-2.225,P=0.036;t_(MDA)=-3.037,P=0.006;t_(Nrf2)=2.245,P=0.035;t_(GSH-Px)=3.714,P=0.001;t_(SOD2)=2.852,P=0.009;t_(GCL)=2.248,P=0.034;t_(CAT)=2.649,P=0.014;t_(HO-1)=2.121,P=0.045;t_(NQO-1)=2.792,P=0.010)。治疗后治疗组HO-1、NQO-1水平均高于对照组、GSH-Px水平低于对照组,差异均有统计学意义(t_(HO-1)=2.242,P=0.030;t_(NQO-1)=3.544,P=0.001;t_(GSH-Px)=-2.127,P=0.039);余指标治疗后2组间比较,差异无统计学意义(P>0.05)。(4)�OBJECTIVE To evaluate the clinical efficacy and antioxidant effects of Zhujing Pill with modifications in the treatment of dry age-related macular degeneration(AMD).METHODS A total of 48 patients(74 eyes)with dry AMD and liver-kidney deficiency syndrome,who visited Liyang Hospital of Chinese Medicine between March 2021 and March 2023 were enrolled in the study.The patients were randomly divided into a treatment group(24 cases,38 eyes)and a control group(24 cases,36 eyes).The treatment group received oral Zhujing Pill with modifications,while the control group received oral Lutein.Both groups underwent continuous treatment for three months.Visual acuity,fundus autofluorescence intensity,serum oxidative markers[malondialdehyde(MDA),nuclear factor erythroid 2-related factor 2(Nrf2),reactive oxygen species(ROS),glutamate-cysteine ligase(GCL),heme oxygenase-1(HO-1),NAD(P)H quinone oxidoreductase 1(NQO-1),superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),catalase(CAT)],and Traditional Chinese Medicine(TCM)clinical syndrome scores were measured and recorded before and after the three-month treatment period.RESULTS(1)Visual acuity:The treatment group showed a statistically significant improvement in visual acuity after treatment(t=3.443,P=0.001),while the control group did not show a statistically significant difference(P>0.05).However,there was no significant difference between the two groups after treatment(P>0.05).(2)Fundus autofluorescence intensity:There were no statistically significant differences in fundus autofluorescence intensity within or between the groups before and after treatment(P>0.05).(3)Serum oxidative markers:Post-treatment,the levels of ROS and MDA were significantly lower,while the levels of Nrf2,GSH-Px,SOD2,GCL,CAT,HO-1,and NQO-1 were significantly higher in both groups compared to pre-treatment levels(treatment group:t_(ROS)=-3.594,P=0.002;t_(MDA)=-3.395,P=0.002;t_(Nrf2)=3.146,P=0.005;t_(GSH-Px)=2.081,P=0.049;t_(SOD2)=2.335,P=0.029;t_(GCL)=3.173,P=0.004;t_(CAT)=3.086,P=0.005;t_(HO-1)=3.526

关 键 词：干性年龄相关性黄斑变性 驻景丸加减方 抗氧化 Nrf2信号通路 

分 类 号：R774.13[医药卫生—眼科] R276.7[医药卫生—临床医学]