睑板腺功能障碍的证候分析及外用洗剂的疗效观察
发布时间：2018-07-26 21:13
【摘要】：目的:应用隐结构法进行中老年睑板腺功能障碍的证候分析,并运用全身辨证结合局部辨证指导临床研究,从临床检查、微生物检验、睑酯成分分析等方面观察外洗剂的治疗作用,对睑板腺功能障碍及相关干眼的中医规范诊疗进行较深入探讨。内容:1.应用隐结构法揭示中老年MGD疾病的中医辨证分型,并明确患者的中医基本证候要素和筛选对该病有明确意义的症状,为该病患者的辨证分型建立客观和定量的诊断标准提供了可能性。2.以局部辨证为主,参考初期数据分析结果,对门诊睑板腺功能障碍合并干眼病人拟外洗方进行局部外用熏洗,观察治疗效果,探讨作用机制。3.对比治疗前后症状、体征、睑板腺功能障碍分度、睑板腺缺失情况、泪膜稳定性等,进行临床疗效评价。4.通过质谱法进行睑酯成分分析,分析患者的睑酯质的变化,以明确治疗后的改善情况及敏感性。5.通过治疗前后睑缘微生物检验分析局部微环境变化并分析损伤机制,以期找到临床更有效、实用的治疗方法。6.根据隐结构明确的辨证分型,指导患者的长期中医调理,延缓病情发展,尤其对于无症状或轻微症状的MGD患者具有积极意义,并利于MGD患者长期治疗指导。方法:1.门诊问卷调查,收集数据,分析临床常见证型分析了近5年的中医文献,结合临床经验,建立了 MGD患者的问卷调查表。选择临床出现频率较高的症状变量录入数据库。筛选了 2015年1月至2017年5月来中国中医科学院眼科医院就诊的及北京各三级医院眼科医师的网络问卷调查纳入的MGD患者561例。通过数据分析得出临床常见中医证型。2.以局部辨证为主,拟外用熏洗方参照前期部分病例分析结果,临床初步总结发现该病中老年人群更以肝肾阴虚及阴虚湿热两型常见,这部分病人局部多见湿热蕴结之象,结合该病西医病理学基础,同时参照文献及结合现代药理,课题采用苦参、百部、蒲公英、薄荷、野菊花等为主方清热利湿杀虫兼疏风,进行睑缘局部外用熏洗,观察治疗效果,探讨作用机制。3.观察临床疗效对比治疗前后患者的症状评分、睑缘异常评分及干眼分析,进行临床疗效评价。其中干眼分析通过非接触的红外透射技术观察睑板腺的丢失率,观察睑板腺改善情况,视频分析功能观察泪膜破裂时间。4.观察MGD病人睑酯细菌情况MGD与睑板腺细菌感染关系密切,细菌的胆固醇脂酶和脂肪蜡脂酶在睑板腺功能障碍的发病中起很大作用。通过治疗前后睑酯细菌分析,检测细菌阳性率及细菌种类,并观察治疗效果。5.观察治疗前后睫毛根部及睑酯的螨虫情况螨虫的直接损伤、引起的免疫反应都是老年人MGD的发病原因。螨虫对于睑板腺功能障碍致病机制尚未十分明确,但是研究发现,检出率与年龄呈正相关,尤其对于合并MGD患者,更容易检出,且治疗有临床意义。我们观察部分中老年MGD病人,大量病人睫毛根部及睑酯分泌物发现螨虫滋生,甚至少量能发现皮脂螨。我们同时观察治疗前后睫毛及睑酯螨虫数量、种类,分析治疗效果。6.分析睑酯成分及治疗前后变化各种内源或外源性因素导致睑酯成分变化,导致睑酯熔点增高,课题旨在通过检测硬脂酸、十六酸、角鲨烯等含量变化,来衡量脂肪酸变化情况,并以此判定治疗效果。但具体实验过程中,可能因MGD病人角鲨烯含量降低,其响应值本身也较低,该实验未能明确检测出角鲨烯含量。结果:1.证候观察:睑板腺功能障碍中医证候分析选取2015年1月至2017年5月来中国中医科学院眼科医院门诊就诊的中老年MGD患者561例。以隐结构法进行分析,最后,根据分布特点,优选出本问卷调查最优隐树模型的BIC评分为-20656.24,即考虑症状(1～44)的模型结构图。2.临床试验:选取2016年2月至2017年1月来中国中医科学院眼科医院门诊就诊的MGD患者共64例,随机分组,进行辨证分型及治疗前后各指标检测。3.临床疗效评价:睑板腺功能障碍分度治疗组及对照组治疗后均无统计学差异(P0.05);干眼症状评分治疗组治疗前后有显著统计学差异(P0.01),对照组治疗后也有统计学差异(P0.05),治疗组改善更明显;睑缘异常评分治疗组治疗前后有显著统计学差异(P0.01),对照组治疗后也有统计学差异(P0.05),治疗组改善更明显;干眼分析:睑板腺功能分级治疗组及对照组治疗后均无统计学差异(P0.05),泪膜破裂时间治疗组治疗前后有统计学差异(P0.05),对照组无统计学差异。4.睑酯分析:软脂酸治疗前后:治疗组治疗前后有统计学差异(P0.05),对照组治疗后也略有改善,但无统计学差异。硬脂酸治疗前后.:治疗组有统计学差异(P0.05),对照组治疗后也略有改善,但无统计学差异。5.螨虫检测:治疗组治疗前后有显著统计学差异(P0.01),对照组治疗后也有统计学差异(P0.05),治疗组效果更显著。6.细菌检测:治疗组治疗前后有显著统计学差异(P0.01),对照组治疗后有统计学差异(P0.05),治疗组效果更显著。结论:1.根据隐树结构分析初步得出中老年睑板腺功能障碍的临床常见证型为肝肾阴虚、阴虚湿热、心脾两虚型。2.本病多以阴虚为基础,临床局部辨证以湿热为主,兼有风邪,本虚标实,拟清热利湿杀虫为主,兼以疏风中药外洗方。本外洗方可减轻临床症状,改善睑板腺功能,并可改善睑酯成分,在抗螨虫、抗菌方面都有显著疗效,较眼药组明显。初步该外洗方组方有效,可用于中老年睑板腺功能障碍的治疗。3.本病以局部辨证与全身辨证的结合应用指导临床治疗,发挥了中医治疗外眼病的优势,急而治标;后期根据证型分析结果,指导调摄,减缓复发,缓而治本,进行了慢病管理模式的初步探索。
[Abstract]:Objective: to analyze the syndrome of palpebral gland dysfunction in middle and old age by using the implicit structure method, and use the whole body syndrome differentiation combined with local syndrome differentiation to guide the clinical study, observe the therapeutic effect of the external lotion from clinical examination, microorganism test and the analysis of palpebral ester composition, and make a deeper diagnosis and treatment on the function of the palpebral gland function disorder and the related dry eyes. Contents: 1. use the implicit structure method to reveal the TCM syndrome differentiation of MGD disease in middle and old age, and make clear the basic syndrome factors of the patients and select the symptoms that have definite meaning for the disease. It provides the possible.2. for the establishment of the objective and quantitative diagnostic criteria for the syndrome differentiation of the patients. Analysis of the results of palpebral palpebral gland dysfunction combined with dry eye patients for external use of external use of fumigation to observe the effect of treatment, to explore the mechanism.3. before and after the treatment of symptoms, signs, meibomian gland dysfunction degree, tartaric gland loss, tear film stability and so on, the clinical effect evaluation of.4. by mass spectrometry of the palpebral composition component Analysis and analysis of patients' palpebral ester changes in order to clarify the improvement and sensitivity of.5. after treatment and to analyze the local microenvironment changes before and after treatment and analyze the mechanism of local microenvironment, so as to find a more effective and practical treatment method,.6., to guide the patient's long-term TCM conditioning according to the distinct classification of the implicit structure. Delay the development of the disease, especially for the patients with asymptomatic or mild symptoms of MGD, which is of positive significance, and is beneficial to the long-term treatment guidance of MGD patients. Methods: 1. outpatient questionnaire survey, data collection, analysis of clinical common syndrome type analysis of the recent 5 years of traditional Chinese medicine literature, combined with clinical experience, the establishment of a questionnaire of MGD patients. A high rate of symptom variables entered the database. 561 cases of MGD patients were selected from January 2015 to May 2017 in the ophthalmology hospital of the Chinese Academy of traditional Chinese medicine (Chinese Academy of science of traditional Chinese Medicine) and the network questionnaire survey of ophthalmologists in each of the three level hospitals in Beijing. Through data analysis, the clinical common TCM syndrome type.2. was based on the local syndrome differentiation. Early part of the case analysis results, preliminary clinical summary found that the elderly people in the disease are more common with liver kidney yin deficiency and yin deficiency and damp heat type two. This part of the patients mostly see the image of damp heat, combined with the pathological basis of Western medicine, referring to Literature and modern pharmacology, using Sophora flavescens, hundred Department, dandelion, menthol, chrysanthemum, etc. The main side of clearing heat, dampness, killing insects and wind, carrying out local external use of blepharius and washing, observing the effect of treatment, and exploring the effect mechanism.3. to observe the symptom score of the patients before and after contrast treatment, palpebral margin abnormality score and dry eye analysis, and evaluate the clinical efficacy. Loss rate, observation of improvement of palpebral gland gland, video analysis function observation of tear film rupture time.4. observation of MGD patients with palpebral ester bacteria condition MGD closely related to bacterial infection of palpebral gland, bacteria cholesterol lipase and fat wax lipase play a great role in the pathogenesis of palpebral gland dysfunction. The positive rate and the species of bacteria, and observe the therapeutic effect of.5., and observe the direct damage of mite in the eyelash root and the mites before and after treatment. The immune response is the cause of MGD in the elderly. The mechanism of the mites is not clear for the pathogenesis of the palpebral gland dysfunction, but it is found that the detection rate is positively related to the age. It is easier to detect and treat the patients with MGD, and the treatment has clinical significance. We observe some middle-aged and old MGD patients, a large number of patients with eyelash roots and eyelid exudates to find mites, and even a small amount of sebaceous mites. We also observe the number and type of eyelashes and palpebral mites before and after treatment, and analyze the effect of.6. for the analysis of palpepalate composition. And the changes of various endogenous or exogenous factors before and after treatment lead to the changes in the composition of palpebral ester, which leads to the increase of the melting point of palpebral ester. The aim is to measure the change of fatty acids by detecting the changes of stearic acid, sixteen acid, squalene and so on, and to determine the effect of the treatment. The response value itself is also low, the experiment failed to detect the content of squalene. Results: 1. syndromes: 561 cases of middle and old MGD patients in the outpatient department of the ophthalmology hospital of China Academy of traditional Chinese medicine (Chinese Academy of Chinese Medicine) from January 2015 to May 2017 were selected to be analyzed by the method of hidden knot structure. Finally, according to the distribution characteristics, the optimal selection was selected. The BIC score of the optimal hidden tree model was -20656.24, that is, the model structure map of the symptoms (1~44) was considered as.2. clinical trial: 64 cases of MGD patients in the ophthalmology hospital of China Academy of Ophthalmology from February 2016 to January 2017 were selected and randomly divided into different types of syndrome differentiation and the evaluation of the clinical efficacy of.3. before and after the treatment. There was no significant difference between the treatment group and the control group (P0.05), and there was significant difference in the treatment group (P0.01) before and after treatment (P0.05), and the improvement of the treatment group was more obvious, and there was significant difference before and after treatment in the treatment group (P0 .01), the control group was also statistically different after treatment (P0.05), the treatment group improved more obviously; dry eye analysis: the palpebral gland function group and the control group had no statistical difference after treatment (P0.05), the tear film rupture time treatment group had statistical difference before and after treatment (P0.05), there was no statistical difference between the control group and the.4. palpepalate analysis: before and after the palpebric acid treatment The treatment group had statistical difference before and after treatment (P0.05), and the control group was also slightly improved after treatment, but there was no statistical difference. Before and after stearic acid treatment, the treatment group had statistical difference (P0.05), and the control group was also slightly improved after treatment, but there was no statistical difference of.5. mites detection: the treatment group had significant statistical difference before and after treatment (P0.01), control group treatment. After treatment, there was also statistical difference (P0.05), the effect of the treatment group was more significant.6. bacteria detection: the treatment group had significant statistical difference before and after treatment (P0.01), the control group had statistical difference after treatment (P0.05), and the effect of the treatment group was more significant. Conclusion: 1. according to the structural analysis of hidden tree, the clinical common syndrome type of the middle and old age eyelid gland dysfunction is the liver. Kidney yin deficiency, yin deficiency and damp heat, heart and spleen two deficiency type.2. based on Yin deficiency as the basis, clinical local syndrome differentiation with damp heat mainly, both wind evil, this deficiency is the main, and the traditional Chinese herbal medicine outside washing prescription. The external washing prescription can alleviate the clinical symptoms, improve the palpebral gland function, and can improve the eyelid ester composition, anti mite, antibacterial aspects of the skin The curative effect, compared with the eye medicine group, is effective and effective. It can be used in the treatment of paltaral gland dysfunction in the middle and old age. The treatment of.3. is guided by the combination of the local syndrome differentiation and the whole body syndrome differentiation, which exerts the advantages of the treatment of the external ophthalmopathy in Chinese medicine. The management mode of chronic diseases was explored preliminarily.
【学位授予单位】：中国中医科学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R276.7
本文编号：2147305
[Abstract]:Objective: to analyze the syndrome of palpebral gland dysfunction in middle and old age by using the implicit structure method, and use the whole body syndrome differentiation combined with local syndrome differentiation to guide the clinical study, observe the therapeutic effect of the external lotion from clinical examination, microorganism test and the analysis of palpebral ester composition, and make a deeper diagnosis and treatment on the function of the palpebral gland function disorder and the related dry eyes. Contents: 1. use the implicit structure method to reveal the TCM syndrome differentiation of MGD disease in middle and old age, and make clear the basic syndrome factors of the patients and select the symptoms that have definite meaning for the disease. It provides the possible.2. for the establishment of the objective and quantitative diagnostic criteria for the syndrome differentiation of the patients. Analysis of the results of palpebral palpebral gland dysfunction combined with dry eye patients for external use of external use of fumigation to observe the effect of treatment, to explore the mechanism.3. before and after the treatment of symptoms, signs, meibomian gland dysfunction degree, tartaric gland loss, tear film stability and so on, the clinical effect evaluation of.4. by mass spectrometry of the palpebral composition component Analysis and analysis of patients' palpebral ester changes in order to clarify the improvement and sensitivity of.5. after treatment and to analyze the local microenvironment changes before and after treatment and analyze the mechanism of local microenvironment, so as to find a more effective and practical treatment method,.6., to guide the patient's long-term TCM conditioning according to the distinct classification of the implicit structure. Delay the development of the disease, especially for the patients with asymptomatic or mild symptoms of MGD, which is of positive significance, and is beneficial to the long-term treatment guidance of MGD patients. Methods: 1. outpatient questionnaire survey, data collection, analysis of clinical common syndrome type analysis of the recent 5 years of traditional Chinese medicine literature, combined with clinical experience, the establishment of a questionnaire of MGD patients. A high rate of symptom variables entered the database. 561 cases of MGD patients were selected from January 2015 to May 2017 in the ophthalmology hospital of the Chinese Academy of traditional Chinese medicine (Chinese Academy of science of traditional Chinese Medicine) and the network questionnaire survey of ophthalmologists in each of the three level hospitals in Beijing. Through data analysis, the clinical common TCM syndrome type.2. was based on the local syndrome differentiation. Early part of the case analysis results, preliminary clinical summary found that the elderly people in the disease are more common with liver kidney yin deficiency and yin deficiency and damp heat type two. This part of the patients mostly see the image of damp heat, combined with the pathological basis of Western medicine, referring to Literature and modern pharmacology, using Sophora flavescens, hundred Department, dandelion, menthol, chrysanthemum, etc. The main side of clearing heat, dampness, killing insects and wind, carrying out local external use of blepharius and washing, observing the effect of treatment, and exploring the effect mechanism.3. to observe the symptom score of the patients before and after contrast treatment, palpebral margin abnormality score and dry eye analysis, and evaluate the clinical efficacy. Loss rate, observation of improvement of palpebral gland gland, video analysis function observation of tear film rupture time.4. observation of MGD patients with palpebral ester bacteria condition MGD closely related to bacterial infection of palpebral gland, bacteria cholesterol lipase and fat wax lipase play a great role in the pathogenesis of palpebral gland dysfunction. The positive rate and the species of bacteria, and observe the therapeutic effect of.5., and observe the direct damage of mite in the eyelash root and the mites before and after treatment. The immune response is the cause of MGD in the elderly. The mechanism of the mites is not clear for the pathogenesis of the palpebral gland dysfunction, but it is found that the detection rate is positively related to the age. It is easier to detect and treat the patients with MGD, and the treatment has clinical significance. We observe some middle-aged and old MGD patients, a large number of patients with eyelash roots and eyelid exudates to find mites, and even a small amount of sebaceous mites. We also observe the number and type of eyelashes and palpebral mites before and after treatment, and analyze the effect of.6. for the analysis of palpepalate composition. And the changes of various endogenous or exogenous factors before and after treatment lead to the changes in the composition of palpebral ester, which leads to the increase of the melting point of palpebral ester. The aim is to measure the change of fatty acids by detecting the changes of stearic acid, sixteen acid, squalene and so on, and to determine the effect of the treatment. The response value itself is also low, the experiment failed to detect the content of squalene. Results: 1. syndromes: 561 cases of middle and old MGD patients in the outpatient department of the ophthalmology hospital of China Academy of traditional Chinese medicine (Chinese Academy of Chinese Medicine) from January 2015 to May 2017 were selected to be analyzed by the method of hidden knot structure. Finally, according to the distribution characteristics, the optimal selection was selected. The BIC score of the optimal hidden tree model was -20656.24, that is, the model structure map of the symptoms (1~44) was considered as.2. clinical trial: 64 cases of MGD patients in the ophthalmology hospital of China Academy of Ophthalmology from February 2016 to January 2017 were selected and randomly divided into different types of syndrome differentiation and the evaluation of the clinical efficacy of.3. before and after the treatment. There was no significant difference between the treatment group and the control group (P0.05), and there was significant difference in the treatment group (P0.01) before and after treatment (P0.05), and the improvement of the treatment group was more obvious, and there was significant difference before and after treatment in the treatment group (P0 .01), the control group was also statistically different after treatment (P0.05), the treatment group improved more obviously; dry eye analysis: the palpebral gland function group and the control group had no statistical difference after treatment (P0.05), the tear film rupture time treatment group had statistical difference before and after treatment (P0.05), there was no statistical difference between the control group and the.4. palpepalate analysis: before and after the palpebric acid treatment The treatment group had statistical difference before and after treatment (P0.05), and the control group was also slightly improved after treatment, but there was no statistical difference. Before and after stearic acid treatment, the treatment group had statistical difference (P0.05), and the control group was also slightly improved after treatment, but there was no statistical difference of.5. mites detection: the treatment group had significant statistical difference before and after treatment (P0.01), control group treatment. After treatment, there was also statistical difference (P0.05), the effect of the treatment group was more significant.6. bacteria detection: the treatment group had significant statistical difference before and after treatment (P0.01), the control group had statistical difference after treatment (P0.05), and the effect of the treatment group was more significant. Conclusion: 1. according to the structural analysis of hidden tree, the clinical common syndrome type of the middle and old age eyelid gland dysfunction is the liver. Kidney yin deficiency, yin deficiency and damp heat, heart and spleen two deficiency type.2. based on Yin deficiency as the basis, clinical local syndrome differentiation with damp heat mainly, both wind evil, this deficiency is the main, and the traditional Chinese herbal medicine outside washing prescription. The external washing prescription can alleviate the clinical symptoms, improve the palpebral gland function, and can improve the eyelid ester composition, anti mite, antibacterial aspects of the skin The curative effect, compared with the eye medicine group, is effective and effective. It can be used in the treatment of paltaral gland dysfunction in the middle and old age. The treatment of.3. is guided by the combination of the local syndrome differentiation and the whole body syndrome differentiation, which exerts the advantages of the treatment of the external ophthalmopathy in Chinese medicine. The management mode of chronic diseases was explored preliminarily.
【学位授予单位】：中国中医科学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R276.7
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