本文選題：脈絡(luò)膜新生血管　切入點：光動力療法　出處：《南京中醫(yī)藥大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 研究背景： 脈絡(luò)膜新生血管(choroidal neovascularization,CNV)造成的黃斑部病變是目前一類常見的難治性眼病。CNV所引起的出血、滲出、視網(wǎng)膜色素上皮(retinal pigment epithelium,RPE)脫離及視網(wǎng)膜神經(jīng)感覺層脫離,以致最終的瘢痕形成是導(dǎo)致濕性老年性黃斑變性(age-related macular degeneration, AMD)、中心性滲出性脈絡(luò)膜視網(wǎng)膜病變(central exduative chorioretinopathy,CEC)、病理性近視(pathological myopia,PM)等常見CNV性疾病致盲的主要原因。針對CNV發(fā)病機理及治療的研究是目前國內(nèi)外眼科的熱點。 光動力療法(photodynamic therapy,PDT)是該病一種較為有效的治療手段,已逐步推廣應(yīng)用。PDT治療CNV主要機制是：注入機體內(nèi)的光敏劑特異性地與新生血管內(nèi)皮細胞結(jié)合而較多滯留于CNV管腔中,在經(jīng)特定波長激光照射后發(fā)生光化學(xué)反應(yīng),殺傷CNV內(nèi)皮細胞而致CNV封閉,阻止或減少了血液成分的滲漏,從而控制CNV對光感受器細胞的進一步損害。PDT極大地拓展了CNV的治療領(lǐng)域,使得安全有效地治療中心凹下CNV成為可能,國內(nèi)外諸多研究表明其在短期內(nèi)對維持或延緩視力下降等具有一定優(yōu)勢。但PDT不能從根本上杜絕CNV的發(fā)生,因而存在著對CNV的治療不徹底,不能使之長時間完全消失,易復(fù)發(fā)等缺點。 中國傳統(tǒng)醫(yī)學(xué)認為黃斑病變與脾密切相關(guān),黃斑疾病的辨證應(yīng)從脾入手。脾氣虛弱、脾失健運是黃斑病變的發(fā)病基礎(chǔ),是為本；水濕內(nèi)生、痰瘀互結(jié)是其基本的病理改變,是為標,因此,臨床診治黃斑病變時,健脾、益氣為治本之法,利水滲濕、化痰消瘀、軟堅散結(jié)為常用治標之法。 體質(zhì)是一種客觀存在的生命現(xiàn)象,是個體生命過程中,在先天遺傳和后天獲得的基礎(chǔ)上,表現(xiàn)出的形態(tài)結(jié)構(gòu)、生理機能以及心理狀態(tài)等方面綜合的、相對穩(wěn)定的特質(zhì)。這種特質(zhì)決定著人體對某種致病因子的易感性及其病變類型的傾向性。辨體論治對與體質(zhì)因素具有明顯相關(guān)性疾病的診治具有重要意義。 導(dǎo)師運用PDT及健脾化濁方治療CNV已有多年,積累了一定的經(jīng)驗,但以往的研究主要是集中觀察治療后三個月的短期療效,缺乏對長期療效的觀察。研究目的： 1.觀察PDT及PDT聯(lián)合健脾化濁方治療脈絡(luò)膜新生血管性黃斑病變的長期療效。 2.觀察脈絡(luò)膜新生血管性疾病患者中醫(yī)體質(zhì)類型分布特點,初步觀察體質(zhì)類型與疾病發(fā)病及預(yù)后的相關(guān)性,以期找出一定規(guī)律,為CNV性疾病的防治提供經(jīng)驗。研究方法： 1.回訪自2005年5月至2009年2月曾在我院接受PDT及PDT聯(lián)合健脾化濁方治療的CNV黃斑病變患者,共收集病例80例88眼,最長隨訪時間為56個月,最短12個月。其中濕性老年性黃斑變性27例33眼,病理性近視17例18眼,中心性滲出性脈絡(luò)膜視網(wǎng)膜病變36例37眼。根據(jù)是否聯(lián)合健脾化濁方將病人分為兩組：PDT組和PDT聯(lián)合健脾化濁方組(簡稱中藥干預(yù)組)。詳細記錄患者自發(fā)病以來的病情發(fā)展及治療情況,測最佳矯正視力、散瞳查眼底,結(jié)合既往影像學(xué)檢查資料(FFA和OCT),根據(jù)視力、眼底情況評價其長期療效。 2.根據(jù)2009年實施的《中華中醫(yī)藥學(xué)會標準-中醫(yī)體質(zhì)分類與判定標準》(ZYYXH/T157-2009)制定體質(zhì)調(diào)查表,每位隨訪患者填寫《中醫(yī)體質(zhì)分類與判定表》,計算原始分及轉(zhuǎn)化分,依標準判定體質(zhì)類型。 3.應(yīng)用SPSS16.0統(tǒng)計軟件,將上述資料進行統(tǒng)計學(xué)分析,得出結(jié)果。結(jié)果： 1.首次治療后,PDT組38眼,復(fù)發(fā)13眼,復(fù)發(fā)率為34.21%,復(fù)發(fā)時間間隔最短3個月,最長26個月,平均9.9個月。中藥干預(yù)組44眼,復(fù)發(fā)6眼,復(fù)發(fā)率為13.64%,復(fù)發(fā)時間間隔最短6個月,最長15個月,平均10.8個月。 2.在視力改善及穩(wěn)定方面,PDT組和中藥干預(yù)組無統(tǒng)計學(xué)差異；三種疾病相比有差異：CEC患者預(yù)后最好,其次是PM患者,再次是AMD患者。 3.中醫(yī)體質(zhì)調(diào)查顯示,80例CNV患者體質(zhì)分布差異顯著,有統(tǒng)計學(xué)意義。各體質(zhì)類型所占比例由高到低為：平和質(zhì)(27.5%)、氣虛質(zhì)(23.75%)、陽虛質(zhì)(18.75%)、痰濕質(zhì)(8.75%)、濕熱質(zhì)(7.5%)、血瘀質(zhì)(6.25%)、陰虛質(zhì)和氣郁質(zhì)(均為6.25%)。預(yù)后方面,相對于偏頗體質(zhì)來說,平和質(zhì)患者復(fù)發(fā)率較低。 結(jié)論： 從目前隨訪到的這部分患者來看,中藥干預(yù)組的復(fù)發(fā)率相對低于單純PDT組。在視力改善及穩(wěn)定方面,CEC患者預(yù)后最好,其次是PM患者,再次是AMD患者。平和質(zhì)患者經(jīng)治療后穩(wěn)定率高,偏頗體質(zhì)復(fù)發(fā)率高于平和質(zhì)。
[Abstract]:Research background:
Choroidal neovascularization (choroidal neovascularization, CNV) caused by macular degeneration is a common type of bleeding, the refractory disease caused by.CNV exudation of retinal pigment epithelium (retinal pigment, epithelium, RPE) detachment and retinal detachment, eventually scar formation is the result of wet amd (age-related macular degeneration, AMD degeneration), central exudative chorioretinopathy (central exduative chorioretinopathy, CEC), pathological myopia (pathological myopia, PM) the main reasons of blindness common CNV diseases. To study the pathogenesis and treatment of CNV is the hotspot of Ophthalmology.
Photodynamic therapy (photodynamic therapy, PDT) of the disease is an effective treatment method, has been gradually applied.PDT treatment of CNV is the main mechanism: photosensitizer specific injection machine body combined with neovascular endothelial cells and more stagnated in the CNV lumen, the specific wavelength of laser irradiation after the photochemical reaction. Killer CNV endothelial cells and CNV closed, to prevent or reduce the leakage of blood components, so as to control the further damage of photoreceptor cells by CNV.PDT CNV greatly expand the treatment area, the safe and effective treatment of subfoveal CNV possible, many domestic and foreign research shows that in the short term to maintain or delay the decrease of visual acuity have certain advantages. But PDT can not fundamentally prevent the occurrence of CNV, so there is a treatment for CNV is not complete, a long time can not be eliminated, the lack of easy recurrence Point.
China traditional medicine macular degeneration and the spleen is closely related to the differentiation of macular diseases from the spleen. The spleen deficiency, spleen is the basic pathogenesis of macular disease, is this; water and dampness, phlegm and blood stasis is the basic pathological change, is the standard, therefore, the clinical diagnosis and treatment of macular lesions when the spleen, replenishing qi to cure, dampness, eliminating phlegm and blood stasis, Ruanjiansanjie as a temporary solution.
The constitution is a kind of objective existence of the phenomenon of life, is the individual life course, based in the congenital and acquired genetic, morphological manifestation, physiological function and psychological status such as an integrated, relatively stable characteristics. This characteristic determines the body's susceptibility to certain pathogens and disease type tendency the theory of style. Treatment is of great significance to the diagnosis and treatment was significantly correlated with the disease and physical factors.
The tutor used PDT and Jianpi Hua Zhuo Fang to treat CNV for many years, and accumulated some experience. However, previous studies mainly focused on short-term efficacy after three months of treatment, and lack of long-term efficacy.
1. to observe the long-term effect of PDT and PDT combined with Jianpi Zhuo Fang in the treatment of choroidal neovascular macular lesions.
2., we observed the distribution characteristics of TCM Constitution Types in patients with choroidal neovascularization disease, and observed the correlation between physical type and the onset and prognosis of disease. We hope to find out a certain rule and provide experience for the prevention and treatment of CNV disease.
1. visits from May 2005 to February 2009 in our hospital CNV patients with macular diseases PDT and PDT combined with Jianpi Huazhuo prescription, collected a total of 80 eyes of 88 cases, the longest follow-up time was 56 months, the shortest 12 months. The wet amd 27 cases 33 eyes with pathological myopia 17 eyes of 18 cases of central exudative chorioretinopathy in 36 eyes of 37 patients. According to whether with jianpihuazhuofang patients were divided into two groups: PDT group and PDT with jianpihuazhuofang group (traditional Chinese medicine intervention group). The development and treatment of the patients were recorded since since the onset of the illness, the best test the corrected visual acuity, dilated fundus inspection, combined with previous imaging data (FFA and OCT), according to the visual acuity, fundus conditions to evaluate its long-term efficacy.
2., according to the 2009 Chinese Academy of traditional Chinese medicine standard "TCM constitution classification and decision standard" (ZYYXH/T157-2009), the physical fitness questionnaire was formulated, and each follow-up patient filled in the constitution classification and decision table of TCM, calculated the original score and transformation score, and judged the physical type according to the standard.
3. using SPSS16.0 statistical software, the above data were statistically analyzed and the results were obtained.
1. after the first treatment, 38 eyes in group PDT, 13 eyes recurred, the recurrence rate was 34.21%, the recurrence interval was the shortest 3 months, the longest 26 months, the average 9.9 months.
2., in terms of vision improvement and stability, there was no statistical difference between PDT group and Chinese medicine intervention group. There were differences between three kinds of diseases: CEC patients had the best prognosis, followed by PM patients, and AMD patients again.
3. Chinese Medicine physique survey, 80 cases of CNV patients with physical distribution difference was statistically significant. For each type of constitution ratio from high to low: normal constitution (27.5%), Qi deficiency (23.75%), Yang deficiency (18.75%), phlegm (8.75%), damp heat (7.5%), blood blood stasis constitution (6.25%), yin deficiency and stagnation (6.25%). The prognosis, compared with the biased constitution, the recurrence rate is low and quality of patients.
Conclusion:
These patients were followed up from the current point of view, the traditional Chinese medicine group the recurrence rate was lower than that of the pure PDT group. The visual acuity and the stability, the prognosis of patients with CEC was the best, followed by PM patients, AMD patients. Once again, flat and quality after treatment in patients with stable high rate, high recurrence rate in the biased constitution and quality.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R774.5

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