光动力疗法联合中药治疗脉络膜新生血管性黄斑病变的长期疗效观察及体质调查

发布时间：2018-03-20 07:55

本文选题：脉络膜新生血管　切入点：光动力疗法　出处：《南京中医药大学》2010年硕士论文　论文类型：学位论文

【摘要】： 研究背景：脉络膜新生血管(choroidal neovascularization,CNV)造成的黄斑部病变是目前一类常见的难治性眼病。CNV所引起的出血、渗出、视网膜色素上皮(retinal pigment epithelium,RPE)脱离及视网膜神经感觉层脱离,以致最终的瘢痕形成是导致湿性老年性黄斑变性(age-related macular degeneration, AMD)、中心性渗出性脉络膜视网膜病变(central exduative chorioretinopathy,CEC)、病理性近视(pathological myopia,PM)等常见CNV性疾病致盲的主要原因。针对CNV发病机理及治疗的研究是目前国内外眼科的热点。光动力疗法(photodynamic therapy,PDT)是该病一种较为有效的治疗手段,已逐步推广应用。PDT治疗CNV主要机制是：注入机体内的光敏剂特异性地与新生血管内皮细胞结合而较多滞留于CNV管腔中,在经特定波长激光照射后发生光化学反应,杀伤CNV内皮细胞而致CNV封闭,阻止或减少了血液成分的渗漏,从而控制CNV对光感受器细胞的进一步损害。PDT极大地拓展了CNV的治疗领域,使得安全有效地治疗中心凹下CNV成为可能,国内外诸多研究表明其在短期内对维持或延缓视力下降等具有一定优势。但PDT不能从根本上杜绝CNV的发生,因而存在着对CNV的治疗不彻底,不能使之长时间完全消失,易复发等缺点。中国传统医学认为黄斑病变与脾密切相关,黄斑疾病的辨证应从脾入手。脾气虚弱、脾失健运是黄斑病变的发病基础,是为本；水湿内生、痰瘀互结是其基本的病理改变,是为标,因此,临床诊治黄斑病变时,健脾、益气为治本之法,利水渗湿、化痰消瘀、软坚散结为常用治标之法。体质是一种客观存在的生命现象,是个体生命过程中,在先天遗传和后天获得的基础上,表现出的形态结构、生理机能以及心理状态等方面综合的、相对稳定的特质。这种特质决定着人体对某种致病因子的易感性及其病变类型的倾向性。辨体论治对与体质因素具有明显相关性疾病的诊治具有重要意义。导师运用PDT及健脾化浊方治疗CNV已有多年,积累了一定的经验,但以往的研究主要是集中观察治疗后三个月的短期疗效,缺乏对长期疗效的观察。研究目的： 1.观察PDT及PDT联合健脾化浊方治疗脉络膜新生血管性黄斑病变的长期疗效。 2.观察脉络膜新生血管性疾病患者中医体质类型分布特点,初步观察体质类型与疾病发病及预后的相关性,以期找出一定规律,为CNV性疾病的防治提供经验。研究方法： 1.回访自2005年5月至2009年2月曾在我院接受PDT及PDT联合健脾化浊方治疗的CNV黄斑病变患者,共收集病例80例88眼,最长随访时间为56个月,最短12个月。其中湿性老年性黄斑变性27例33眼,病理性近视17例18眼,中心性渗出性脉络膜视网膜病变36例37眼。根据是否联合健脾化浊方将病人分为两组：PDT组和PDT联合健脾化浊方组(简称中药干预组)。详细记录患者自发病以来的病情发展及治疗情况,测最佳矫正视力、散瞳查眼底,结合既往影像学检查资料(FFA和OCT),根据视力、眼底情况评价其长期疗效。 2.根据2009年实施的《中华中医药学会标准-中医体质分类与判定标准》(ZYYXH/T157-2009)制定体质调查表,每位随访患者填写《中医体质分类与判定表》,计算原始分及转化分,依标准判定体质类型。 3.应用SPSS16.0统计软件,将上述资料进行统计学分析,得出结果。结果： 1.首次治疗后,PDT组38眼,复发13眼,复发率为34.21%,复发时间间隔最短3个月,最长26个月,平均9.9个月。中药干预组44眼,复发6眼,复发率为13.64%,复发时间间隔最短6个月,最长15个月,平均10.8个月。 2.在视力改善及稳定方面,PDT组和中药干预组无统计学差异；三种疾病相比有差异：CEC患者预后最好,其次是PM患者,再次是AMD患者。 3.中医体质调查显示,80例CNV患者体质分布差异显著,有统计学意义。各体质类型所占比例由高到低为：平和质(27.5%)、气虚质(23.75%)、阳虚质(18.75%)、痰湿质(8.75%)、湿热质(7.5%)、血瘀质(6.25%)、阴虚质和气郁质(均为6.25%)。预后方面,相对于偏颇体质来说,平和质患者复发率较低。结论：从目前随访到的这部分患者来看,中药干预组的复发率相对低于单纯PDT组。在视力改善及稳定方面,CEC患者预后最好,其次是PM患者,再次是AMD患者。平和质患者经治疗后稳定率高,偏颇体质复发率高于平和质。
[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.

【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R774.5

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