活血化瘀中藥對非動脈炎性前部缺血性視神經(jīng)病變眼血流的影響研究
發(fā)布時間：2018-07-24 17:08
【摘要】：臨床研究一、非動脈炎性前部缺血性視神經(jīng)病變(AION)患者流行病學(xué)及眼血流動力學(xué)特征分析 目的：通過回顧分析既往病歷資料獲得AION的臨床流行病學(xué)資料。方法：選擇2010年1月至2013年12月我院眼科住院的AION患者108例,將病歷中的相關(guān)資料填寫入預(yù)先設(shè)計好的電子表格中后進(jìn)行統(tǒng)計學(xué)分析。結(jié)果：納入研究的AION患者中,男57例(52.8%),女51例(47.2%),平均年齡57.23±11.95歲,單眼發(fā)病50例(46.3%),雙眼發(fā)病58例(53.7%),兩眼平均間隔時間為15.3±25.1m；72例(66.7%)患者能描述確切的發(fā)病時間,其中61例(56.5%)為突然發(fā)病,78例(72.2%)否認(rèn)存在誘發(fā)因素,66例(61.1%)患者有高血壓.高血脂、糖尿病、心臟病、腦梗塞或者頸椎病病史,62例(57.4%)早期就診患者被診斷為AION,45例(41.7%)早期給予了糖皮質(zhì)激素治療；來我院就診時患眼的平均病程為21.2±51.1m,平均視力為：0.35±0.36,平均眼壓為15.0±2.8mmHg;166眼中,138眼曾進(jìn)行視野檢查,最常見的視野缺損類型為下方半盲(18.8%)、中央管狀或者近管狀視野(14.5%)、扇形視野缺損(10.9%)；55例住院期間接受了影像學(xué)檢查,36例(65.5%)患者發(fā)現(xiàn)缺血、梗塞、脫髓鞘等異常病灶,62例患者接受了眼動脈彩超檢查,27例發(fā)現(xiàn)動脈硬化、流速減低等異常,,47例住院期間接受了頸動脈彩超檢查,其中29例(61.7%)檢出頸動脈硬化、狹窄或者斑塊,患者心率74.7±6.8次/分,收縮壓為124.8±15.1mmHg,舒張壓為77.9±8.7mmHg,29例(26.9%)血壓高于正常值；患者的血生化指標(biāo)中,靜脈血糖、總膽固醇、甘油三酯、低密度脂蛋白膽固醇偏高的比例分別為：23.5%、26.3%、40.4%及31.6%；患者最常見的異�？滔掳Y為眠差(22%),典型的舌象為舌質(zhì)淡紅或者暗紅、苔薄白或者少苔,典型的脈象為弦脈或者細(xì)脈,最常見的證侯特點(diǎn)為氣虛血瘀、氣滯血瘀、氣血兩虛及肝郁氣滯,銀杏葉提取物、燈盞花素、川芎嗪的使用頻率最高的中藥注射劑。結(jié)論：AION具有較典型的流行病學(xué)特征,這些特點(diǎn)可對提高對疾病的認(rèn)識、為疾病的預(yù)防乃至治療策略提供一定的參考價值。 臨床研究二、活血化瘀治療對AION患者眼血流動力學(xué)的影響 目的：研究活血化瘀中藥治療對AION患者血流動力學(xué)的影響。方法：回顧性分析AION病例22例33眼,患者均給予活血化瘀中藥治療14天以上,治療前后均接受眼部血管的彩色多普勒超聲血管檢查,測量眼動脈、視網(wǎng)膜中央動脈、鼻側(cè)睫狀后短動脈的收縮期峰值血流速度(peak systolic velocit, PSV)、阻力指數(shù)(resistance index, RI),并對眼動脈的直徑進(jìn)行測量,同時記錄患者治療前后最佳矯正視力、視野等.結(jié)果：患者平均治療23.7±8.2天,治療前后的視力分別為：3.67+1.32及3.91±1.18,經(jīng)比較差異具有統(tǒng)計學(xué)意義(t=-2.328,P=0.039),治療前后視野MS分別為12.93±6.27及13.37±5.49dB,經(jīng)比較差異不顯著(t=-1.361,P=0.198)；治療前后眼動脈內(nèi)徑、PSV、RI,視網(wǎng)膜中央動脈PSV、RI,睫狀后短動脈PSV、RI等均無顯著差異(P均0.05)。結(jié)論：本研究納入的22例AION患者33眼經(jīng)治療后視力、視野有所改善,但活血化瘀藥物治療未能改善眼動脈、視網(wǎng)膜中央動脈、睫狀后短動脈的血流動力學(xué)指標(biāo)。 臨床研究三、活血化瘀中藥制劑治療AION患者的療效評價 目的：評價活血化瘀中藥制劑銀杏葉提取物、燈盞花素注射液用于治療AION的療效。方法：選取我院住院治療的AION患者50例,隨機(jī)分組為三組,均給予針灸、復(fù)方樟柳堿穴位注射等基礎(chǔ)治療,銀杏葉提取物組(A組)增加銀杏葉提取物注射液87.5mg Qd靜點(diǎn),燈盞花素組(B組)增加燈盞花素注射液100ml Qd靜點(diǎn),對照組(C組)不予中藥注射劑治療,各組均連續(xù)治療2周,以治療前后患者最佳矯正視力、視野平均敏感度的改變作為療效評價依據(jù)。結(jié)果：各組治療前一般資料無統(tǒng)計學(xué)差異,三組患者治療后視力均高于治療前,其中銀杏葉組視力改善幅度最大,燈盞花素組和銀杏葉組治療前后視力比較均具有顯著差異(P0.05),對照組治療前后視力比較差異不明顯(P0.05),三組患者治療后視力改善幅度之間無顯著差異(P0.05),燈盞花素組和銀杏葉組治療后MS高于治療前,其中燈盞花素組治療后視野改善幅度最大,治療前后比較差異具有顯著差異(P0.05),而對照組治療后MS反而有所減少,但差異不明顯(P0.05)；按照人數(shù)計算總有效率,燈盞花素組和銀杏葉組有效率均為65%,對照組有效率僅為40%,組間比較均無統(tǒng)計學(xué)差異,按照眼數(shù)計算有效率,燈盞花素組有效率為46.7%,銀杏葉組有效率為45.2%,對照組有效率僅為26.7%,組間比較均無統(tǒng)計學(xué)差異。結(jié)論：燈盞花素、銀杏葉提取物參與治療AION的療效相當(dāng),均略高于對照組,活血化瘀中藥在AION的治療中有較好的應(yīng)用前景,但目前尚無足夠證據(jù)證實(shí)燈盞花素、銀杏葉提取物的確切療效。
[Abstract]:Clinical study 1. Epidemiological and ocular hemodynamic characteristics of patients with non arteritis anterior ischemic optic neuropathy (AION)
Objective: To review the clinical epidemiological data of AION by retrospective analysis of medical records. Methods: 108 cases of AION patients in the Department of Ophthalmology of our hospital from January 2010 to December 2013 were selected, and the related data in the medical records were filled in the pre designed spreadsheet and analyzed. Results: among the AION patients enrolled in the study, 57 men were included in the study. Cases (52.8%), female 51 (47.2%), average age 57.23 + 11.95 years, monocular disease 50 cases (46.3%), double eyes 58 cases (53.7%), the average interval time is 15.3 + 25.1m; 72 cases (66.7%) can describe the exact onset time, 61 cases (56.5%) denying the existence of induced factors, patients have hypertension. In the history of hyperlipidemia, diabetes, heart disease, cerebral infarction, or cervical spondylosis, 62 cases (57.4%) were diagnosed as AION and 45 cases (41.7%) were treated with glucocorticoid in early period. The average course of the patients in our hospital was 21.2 + 51.1m, the average vision was 0.35 + 0.36 and the mean intraocular pressure was 15 + 2.8mmHg; 138 eyes were treated in 166 eyes. The most common types of field examination were lower half blind (18.8%), central tubular or near tubular vision (14.5%) and fan-shaped visual field defect (10.9%); 55 patients received imaging examinations during hospitalization, 36 cases (65.5%) found ischemia, infarction, demyelination and other abnormal lesions, 62 patients received color Doppler ultrasonography of the ophthalmic artery and 27 cases of arteriosclerosis. 47 patients received carotid color Doppler ultrasound during hospitalization, of which 29 cases (61.7%) detected carotid atherosclerosis, stenosis or plaque, heart rate 74.7 + 6.8 / min, systolic pressure of 124.8 15.1mmHg, diastolic pressure 77.9 + 8.7mmHg, 29 (26.9%) blood pressure higher than normal value; blood biochemical indexes of patients, venous blood glucose, general The high proportion of cholesterol, triglyceride and low density lipoprotein cholesterol are 23.5%, 26.3%, 40.4% and 31.6%, the most common abnormality of the patients is the difference of sleep (22%), the typical tongue is pale red or dark red, the moss thin white or little moss, the typical pulse is the chord vein or the fine vein, the most common syndrome characteristics are Qi deficiency and blood stasis, Qi. Stagnation of blood stasis, Qi and blood two deficiency and stagnation of liver qi and qi stagnation, ginkgo leaf extract, breviscapine, ligustrazine with the highest frequency of traditional Chinese medicine injection. Conclusion: AION has a typical epidemiological characteristics, these characteristics can improve the understanding of the disease, and provide a certain reference value for the prevention and treatment of the disease.
Clinical research two. Effect of promoting blood circulation and removing blood stasis on ocular hemodynamics in AION patients
Objective: To study the effect of traditional Chinese medicine for activating blood and removing stasis on the hemodynamics of AION patients. Methods: a retrospective analysis of 33 eyes of 22 cases of AION was reviewed. All the patients were treated with Chinese medicine for activating blood and removing stasis for more than 14 days. The color Doppler ultrasound angiography of the ocular vessels was performed before and after the treatment, and the ocular artery, the central retinal artery and the nasal ciliary post were measured. The peak systolic blood flow velocity (peak systolic velocit, PSV), the resistance index (resistance index, RI), and the diameter of the ophthalmic artery were measured, and the best corrected visual acuity and visual field were recorded before and after treatment. The average treatment was 23.7 + 8.2 days, and the visual acuity before and after treatment were 3.67+1.32 and 3.91 + 1.18 respectively. The difference was statistically significant (t=-2.328, P=0.039). The visual field MS was 12.93 + 6.27 and 13.37 + 5.49dB before and after treatment. The difference was not significant (t=-1.361, P=0.198). There were no significant differences between the ophthalmic artery diameter, PSV, RI, the central retinal artery PSV, RI, the post ciliary short pulse PSV, RI and so on before and after treatment (0.05). Conclusion: 22 The visual field was improved in 33 cases of AION patients after treatment. However, the hemodynamic indexes of the ocular artery, the central retinal artery and the ciliary short artery were not improved by the treatment of activating blood and removing blood stasis.
Clinical research three. Evaluation of the efficacy of Chinese medicine for promoting blood circulation and removing blood stasis in the treatment of AION patients
Objective: To evaluate the effect of ginkgo leaf extract and Breviscapine Injection in the treatment of AION. Methods: 50 patients with AION in our hospital were randomly divided into three groups, all were treated with acupuncture, compound anisodine acupoint injection and other basic treatments, and the extract group of ginkgo leaf extract (group A) increased Extract of Ginkgo Biloba Leaves Injection 8 7.5mg Qd static point, breviscapine group (group B) to increase Breviscapine Injection 100ml Qd static point, the control group (C group) without traditional Chinese medicine injection treatment, all groups were treated for 2 weeks, with the best corrected visual acuity before and after treatment, the change of the average sensitivity of visual field as the basis of evaluation. The visual acuity of the three groups was higher than that before the treatment, and the visual acuity improvement of the ginkgo leaf group was the greatest. The visual acuity before and after the treatment of breviscapine group and ginkgo leaf group had significant difference (P0.05), and the difference of visual acuity before and after treatment in the control group was not obvious (P0.05), and there was no significant difference between the three groups after treatment (P0.05). After the treatment of scigeron group and ginkgo leaf group, MS was higher than before treatment, and the improvement of visual field was the greatest after treatment in breviscapine group, and there was significant difference (P0.05) before and after treatment (P0.05), but the difference was not obvious after treatment in the control group, but the difference was not obvious (P0.05). The total effective rate was calculated according to the number of people. The efficiency of breviscapine group and ginkgo leaf group was effective. The efficiency of the control group was only 65%, the effective rate of the control group was only 40%, there was no statistical difference between the groups. The effective rate of the breviscapine group was 46.7%, the effective rate of the ginkgo leaf group was 45.2%, the control group was only 26.7%, and there was no statistical difference between the groups. Conclusion: the curative effect of scutellarin and Ginkgo biloba extract in the treatment of AION was quite effective. It is slightly higher than the control group. The Chinese medicine for activating blood and removing stasis has a good prospect in the treatment of AION, but there is not enough evidence to confirm the exact effect of breviscapine and ginkgo leaf extract.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R774
本文編號：2142067
[Abstract]:Clinical study 1. Epidemiological and ocular hemodynamic characteristics of patients with non arteritis anterior ischemic optic neuropathy (AION)
Objective: To review the clinical epidemiological data of AION by retrospective analysis of medical records. Methods: 108 cases of AION patients in the Department of Ophthalmology of our hospital from January 2010 to December 2013 were selected, and the related data in the medical records were filled in the pre designed spreadsheet and analyzed. Results: among the AION patients enrolled in the study, 57 men were included in the study. Cases (52.8%), female 51 (47.2%), average age 57.23 + 11.95 years, monocular disease 50 cases (46.3%), double eyes 58 cases (53.7%), the average interval time is 15.3 + 25.1m; 72 cases (66.7%) can describe the exact onset time, 61 cases (56.5%) denying the existence of induced factors, patients have hypertension. In the history of hyperlipidemia, diabetes, heart disease, cerebral infarction, or cervical spondylosis, 62 cases (57.4%) were diagnosed as AION and 45 cases (41.7%) were treated with glucocorticoid in early period. The average course of the patients in our hospital was 21.2 + 51.1m, the average vision was 0.35 + 0.36 and the mean intraocular pressure was 15 + 2.8mmHg; 138 eyes were treated in 166 eyes. The most common types of field examination were lower half blind (18.8%), central tubular or near tubular vision (14.5%) and fan-shaped visual field defect (10.9%); 55 patients received imaging examinations during hospitalization, 36 cases (65.5%) found ischemia, infarction, demyelination and other abnormal lesions, 62 patients received color Doppler ultrasonography of the ophthalmic artery and 27 cases of arteriosclerosis. 47 patients received carotid color Doppler ultrasound during hospitalization, of which 29 cases (61.7%) detected carotid atherosclerosis, stenosis or plaque, heart rate 74.7 + 6.8 / min, systolic pressure of 124.8 15.1mmHg, diastolic pressure 77.9 + 8.7mmHg, 29 (26.9%) blood pressure higher than normal value; blood biochemical indexes of patients, venous blood glucose, general The high proportion of cholesterol, triglyceride and low density lipoprotein cholesterol are 23.5%, 26.3%, 40.4% and 31.6%, the most common abnormality of the patients is the difference of sleep (22%), the typical tongue is pale red or dark red, the moss thin white or little moss, the typical pulse is the chord vein or the fine vein, the most common syndrome characteristics are Qi deficiency and blood stasis, Qi. Stagnation of blood stasis, Qi and blood two deficiency and stagnation of liver qi and qi stagnation, ginkgo leaf extract, breviscapine, ligustrazine with the highest frequency of traditional Chinese medicine injection. Conclusion: AION has a typical epidemiological characteristics, these characteristics can improve the understanding of the disease, and provide a certain reference value for the prevention and treatment of the disease.
Clinical research two. Effect of promoting blood circulation and removing blood stasis on ocular hemodynamics in AION patients
Objective: To study the effect of traditional Chinese medicine for activating blood and removing stasis on the hemodynamics of AION patients. Methods: a retrospective analysis of 33 eyes of 22 cases of AION was reviewed. All the patients were treated with Chinese medicine for activating blood and removing stasis for more than 14 days. The color Doppler ultrasound angiography of the ocular vessels was performed before and after the treatment, and the ocular artery, the central retinal artery and the nasal ciliary post were measured. The peak systolic blood flow velocity (peak systolic velocit, PSV), the resistance index (resistance index, RI), and the diameter of the ophthalmic artery were measured, and the best corrected visual acuity and visual field were recorded before and after treatment. The average treatment was 23.7 + 8.2 days, and the visual acuity before and after treatment were 3.67+1.32 and 3.91 + 1.18 respectively. The difference was statistically significant (t=-2.328, P=0.039). The visual field MS was 12.93 + 6.27 and 13.37 + 5.49dB before and after treatment. The difference was not significant (t=-1.361, P=0.198). There were no significant differences between the ophthalmic artery diameter, PSV, RI, the central retinal artery PSV, RI, the post ciliary short pulse PSV, RI and so on before and after treatment (0.05). Conclusion: 22 The visual field was improved in 33 cases of AION patients after treatment. However, the hemodynamic indexes of the ocular artery, the central retinal artery and the ciliary short artery were not improved by the treatment of activating blood and removing blood stasis.
Clinical research three. Evaluation of the efficacy of Chinese medicine for promoting blood circulation and removing blood stasis in the treatment of AION patients
Objective: To evaluate the effect of ginkgo leaf extract and Breviscapine Injection in the treatment of AION. Methods: 50 patients with AION in our hospital were randomly divided into three groups, all were treated with acupuncture, compound anisodine acupoint injection and other basic treatments, and the extract group of ginkgo leaf extract (group A) increased Extract of Ginkgo Biloba Leaves Injection 8 7.5mg Qd static point, breviscapine group (group B) to increase Breviscapine Injection 100ml Qd static point, the control group (C group) without traditional Chinese medicine injection treatment, all groups were treated for 2 weeks, with the best corrected visual acuity before and after treatment, the change of the average sensitivity of visual field as the basis of evaluation. The visual acuity of the three groups was higher than that before the treatment, and the visual acuity improvement of the ginkgo leaf group was the greatest. The visual acuity before and after the treatment of breviscapine group and ginkgo leaf group had significant difference (P0.05), and the difference of visual acuity before and after treatment in the control group was not obvious (P0.05), and there was no significant difference between the three groups after treatment (P0.05). After the treatment of scigeron group and ginkgo leaf group, MS was higher than before treatment, and the improvement of visual field was the greatest after treatment in breviscapine group, and there was significant difference (P0.05) before and after treatment (P0.05), but the difference was not obvious after treatment in the control group, but the difference was not obvious (P0.05). The total effective rate was calculated according to the number of people. The efficiency of breviscapine group and ginkgo leaf group was effective. The efficiency of the control group was only 65%, the effective rate of the control group was only 40%, there was no statistical difference between the groups. The effective rate of the breviscapine group was 46.7%, the effective rate of the ginkgo leaf group was 45.2%, the control group was only 26.7%, and there was no statistical difference between the groups. Conclusion: the curative effect of scutellarin and Ginkgo biloba extract in the treatment of AION was quite effective. It is slightly higher than the control group. The Chinese medicine for activating blood and removing stasis has a good prospect in the treatment of AION, but there is not enough evidence to confirm the exact effect of breviscapine and ginkgo leaf extract.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R774
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