本文關(guān)鍵詞：益氣養(yǎng)陰活血法治療糖尿病性干眼的臨床與相關(guān)基礎(chǔ)研究　出處：《錦州醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 益氣養(yǎng)陰活血法 糖尿病 干眼 IL-1β TNF-α

【摘要】：目的干眼是糖尿病患者中發(fā)病率很高的一類眼表疾病,近年來在臨床上得到越來越多的關(guān)注。治療方面,西醫(yī)治療以長期使用人工淚液以緩解癥狀為主,難以從根本上治療。中醫(yī)在辨證論治理論指導(dǎo)下,治療上有一定的優(yōu)勢。本研究旨在觀察益氣養(yǎng)陰活血法在改善臨床癥狀、淚膜穩(wěn)定性、減輕糖尿病性干眼慢性微炎癥狀態(tài)等方面的作用,同時探索IL-1β、TNF-α與糖尿病性干眼的相關(guān)性。以期發(fā)揮中醫(yī)整體觀念與辨證論治在糖尿病性干眼的治療優(yōu)勢。方法一、臨床實驗本課題收集中國中醫(yī)科學(xué)院眼科醫(yī)院消渴目病科2016年4月至2016年12月糖尿病性干眼并符合氣陰兩虛、目絡(luò)瘀阻證的患者84例(168眼)。采用隨機對照的研究方法,將病例隨機分為兩組,治療組42例(84眼),對照組42例(84眼)。治療組予益氣養(yǎng)陰活血方聯(lián)合瞼板腺按摩治療,對照組予局部人工淚液點眼聯(lián)合瞼板腺按摩治療,兩組均治療1個月。觀察治療前后兩組眼部主觀癥狀積分、中醫(yī)證候積分、淚液分泌試驗(SIT)、淚膜破裂時間(BUT)、角膜知覺分級、瞼板腺功能分級、角膜熒光素染色(FL)評分等相關(guān)指標(biāo),并進行整理分析。二、基礎(chǔ)實驗收集糖尿病性干眼、糖尿病、非糖尿病性干眼、正常人各20例,檢測血清甘油三酯、總膽固醇含量及IL-1β、TNF-α濃度,判斷其與糖尿病性干眼及OSI(客觀散射指數(shù))值的相關(guān)性,進行數(shù)據(jù)整理分析。結(jié)果一、臨床實驗本課題共納入經(jīng)過中醫(yī)辨證篩選符合氣陰兩虛、目絡(luò)瘀阻證糖尿病性干眼患者84例(168只眼),男性38例,女性46例。治療后治療組眼部癥狀積分(P0.01)、中醫(yī)癥候積分(P0.01)、SIT評分(P0.01)、角膜熒光素染色評分(P0.01)及角膜知覺評分(P0.01)治療組低于對照組,BUT值治療組高于對照組(P0.05),瞼板腺功能異常情況治療組低于對照組(P0.01),兩組療效比較,治療組的有效率為90.5%,對照組的有效率為66.7%,治療組療效優(yōu)于對照組(P0.01)。二、基礎(chǔ)實驗靜脈血清甘油三酯及總膽固醇含量在4組中無組間差異(P0.05),差異無統(tǒng)計學(xué)意義。IL-1β在糖尿病性干眼組(P0.01)、糖尿病組(P0.01)、干眼組(P0.05),濃度均高于正常人組;TNF-α在糖尿病性干眼組(P0.01)、干眼組(P0.05)、糖尿病組(P0.01),濃度高于正常人組�？陀^散射指數(shù)(OSI)與IL-1β、TNF-α濃度的關(guān)系:1、糖尿病性干眼患者中OSI值與IL-1β濃度呈正相關(guān),相關(guān)系數(shù)r=0.771,P0.01,決定系數(shù)R2=0.594,說明OSI值與IL-1β濃度相關(guān),OSI值隨IL-1β濃度增加而增加;2、糖尿病性干眼患者OSI值與TNF-α濃度呈正相關(guān),相關(guān)系數(shù)r=0.762,P0.01,決定系數(shù)R2=0.581,說明OSI值與TNF-α濃度相關(guān),OSI值隨TNF-α濃度增加而增加。結(jié)論益氣養(yǎng)陰活血法對于改善糖尿病性干眼的臨床癥狀、改善瞼板腺功能障礙、保護角膜完整性、減輕微炎癥狀態(tài)具有一定的作用,但其具體作用途徑、作用環(huán)節(jié)仍需從藥代動力學(xué)、藥理學(xué)方面深入探討。IL-1β及TNF-α的濃度變化與淚膜不穩(wěn)定程度呈正相關(guān),表明炎癥反應(yīng)在糖尿病性干眼的發(fā)生、發(fā)展過程中起重要的作用。因此,通過對眼表炎癥的抑制,可以有效地控制病程的發(fā)展,改善臨床癥狀。甘油三酯和膽固醇與糖尿病性干眼無明顯相關(guān)性。
[Abstract]:The purpose of dry eye is the incidence of diabetes is very high for a class of ocular surface disease, has gained more and more attention in recent years. In clinical treatment, western medicine treatment with long-term use of artificial tears to alleviate the symptoms, the treatment is difficult to fundamentally. Traditional Chinese medicine based on syndrome differentiation theory to guide, there are certain advantages the treatment. This study aimed to investigate the effect of Yiqi Yangyin Huoxue Method in improving clinical symptoms, tear film stability, reduce diabetic dry eye chronic micro inflammation and other aspects of the role, while exploring the IL-1 beta, TNF- alpha and diabetic dry eye patients. In order to play the whole concept and dialectical treatment of TCM in diabetic dry treatment eye. Methods a clinical trial, the collection of Chinese ophthalmic hospital Chinese Academy of Sciences from April 2016 to December 2016 xiaokeeye disease diabetes dry eye and 84 patients with Qi and yin deficiency, blood stasis syndrome (mesh network 168 eyes). A randomized control study, the patients were randomly divided into two groups, the treatment group of 42 cases (84 eyes), the control group of 42 cases (84 eyes). The treatment group was treated with Yiqi Yangyin Huoxue Decoction Combined with meibomian gland massage therapy, the control group treated with artificial tears combined with meibomian gland massage therapy. The two groups were treated for 1 months. The two groups were observed before and after treatment of ocular subjective symptom score, TCM syndrome score, Schirmer test (SIT), tear break-up time (BUT), corneal sensation grading, meibomian gland function classification, corneal fluorescein staining (FL) score and other related indicators, and analyzed two. Based on experimental diabetic collection, dry eye, diabetes and non diabetes dry eye, normal 20 cases, serum triglyceride, total cholesterol and IL-1 beta, TNF- alpha concentration, and judge the diabetic dry eye and OSI (objective scattering index) values of the correlation data and analyzed results. A clinical experiments of this project were included after TCM screening with Qi and yin deficiency, 84 cases of eye patients. Blood - stasis syndrome of diabetic stem (168 eyes), male 38 cases, female 46 cases. The treatment group after treatment of ocular symptoms integral (P0.01), TCM syndrome score (P0.01), SIT score (P0.01). Corneal fluorescein staining score (P0.01) and corneal sensation score (P0.01) treatment group than the control group, BUT treatment group than in control group (P0.05), meibomian gland function abnormalities in the treatment group than the control group (P0.01), to compare the effects of two groups, the treatment group was 90.5%, the effective rate of control group was 66.7%, the treatment group than the control group (P0.01). Two, there was no difference between groups in experimental vein serum triglycerides and total cholesterol levels in the 4 groups (P0.05), the difference was not statistically significant.IL-1 beta in diabetic dry eye group (P0.01), diabetic group (P0.01), dry eye group (P0.05). Concentration Higher than the normal group; the TNF- alpha in diabetic dry eye group (P0.01), dry eye group (P0.05), diabetic group (P0.01), the concentration is higher than the normal group. The objective scatter index (OSI) and IL-1 beta, TNF- alpha concentration relationship: 1 diabetic patients with dry eye OSI positive correlation. With the concentration of IL-1 beta, P0.01, correlation coefficient r=0.771, coefficient of determination R2=0.594, OSI value and IL-1 beta concentration, OSI value increases with increasing concentration of IL-1 beta; 2, diabetic patients with dry eye OSI value was positively correlated with TNF- concentrations, the correlation coefficient r=0.762, P0.01, coefficient of determination R2= 0.581, OSI value related to the TNF- concentration, the OSI value increased with the increase of TNF- concentration. Conclusion bvqnyabc to improve diabetic clinical symptoms of dry eye, improving meibomian gland dysfunction, protect corneal integrity, has a certain effect to reduce inflammation, but the concrete mechanism, role still needs from medicine Pharmacokinetics, pharmacology to study the concentration changes and tear film.IL-1 beta and TNF- alpha instability were positively correlated, indicating that the inflammatory response in diabetes and the occurrence of dry eye, plays an important role in the process of development. Therefore, through inhibition of ocular surface inflammation, can effectively control the development of disease, improve the clinical symptoms of triglycerides. Dry eye and cholesterol and diabetes have no significant correlation.

【學(xué)位授予單位】：錦州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R276.7

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