活血化瘀中药对非动脉炎性前部缺血性视神经病变眼血流的影响研究
发布时间：2018-07-24 17:08
【摘要】：临床研究一、非动脉炎性前部缺血性视神经病变(AION)患者流行病学及眼血流动力学特征分析 目的：通过回顾分析既往病历资料获得AION的临床流行病学资料。方法：选择2010年1月至2013年12月我院眼科住院的AION患者108例,将病历中的相关资料填写入预先设计好的电子表格中后进行统计学分析。结果：纳入研究的AION患者中,男57例(52.8%),女51例(47.2%),平均年龄57.23±11.95岁,单眼发病50例(46.3%),双眼发病58例(53.7%),两眼平均间隔时间为15.3±25.1m；72例(66.7%)患者能描述确切的发病时间,其中61例(56.5%)为突然发病,78例(72.2%)否认存在诱发因素,66例(61.1%)患者有高血压.高血脂、糖尿病、心脏病、脑梗塞或者颈椎病病史,62例(57.4%)早期就诊患者被诊断为AION,45例(41.7%)早期给予了糖皮质激素治疗；来我院就诊时患眼的平均病程为21.2±51.1m,平均视力为：0.35±0.36,平均眼压为15.0±2.8mmHg;166眼中,138眼曾进行视野检查,最常见的视野缺损类型为下方半盲(18.8%)、中央管状或者近管状视野(14.5%)、扇形视野缺损(10.9%)；55例住院期间接受了影像学检查,36例(65.5%)患者发现缺血、梗塞、脱髓鞘等异常病灶,62例患者接受了眼动脉彩超检查,27例发现动脉硬化、流速减低等异常,,47例住院期间接受了颈动脉彩超检查,其中29例(61.7%)检出颈动脉硬化、狭窄或者斑块,患者心率74.7±6.8次/分,收缩压为124.8±15.1mmHg,舒张压为77.9±8.7mmHg,29例(26.9%)血压高于正常值；患者的血生化指标中,静脉血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇偏高的比例分别为：23.5%、26.3%、40.4%及31.6%；患者最常见的异常刻下症为眠差(22%),典型的舌象为舌质淡红或者暗红、苔薄白或者少苔,典型的脉象为弦脉或者细脉,最常见的证侯特点为气虚血瘀、气滞血瘀、气血两虚及肝郁气滞,银杏叶提取物、灯盏花素、川芎嗪的使用频率最高的中药注射剂。结论：AION具有较典型的流行病学特征,这些特点可对提高对疾病的认识、为疾病的预防乃至治疗策略提供一定的参考价值。 临床研究二、活血化瘀治疗对AION患者眼血流动力学的影响 目的：研究活血化瘀中药治疗对AION患者血流动力学的影响。方法：回顾性分析AION病例22例33眼,患者均给予活血化瘀中药治疗14天以上,治疗前后均接受眼部血管的彩色多普勒超声血管检查,测量眼动脉、视网膜中央动脉、鼻侧睫状后短动脉的收缩期峰值血流速度(peak systolic velocit, PSV)、阻力指数(resistance index, RI),并对眼动脉的直径进行测量,同时记录患者治疗前后最佳矫正视力、视野等.结果：患者平均治疗23.7±8.2天,治疗前后的视力分别为：3.67+1.32及3.91±1.18,经比较差异具有统计学意义(t=-2.328,P=0.039),治疗前后视野MS分别为12.93±6.27及13.37±5.49dB,经比较差异不显著(t=-1.361,P=0.198)；治疗前后眼动脉内径、PSV、RI,视网膜中央动脉PSV、RI,睫状后短动脉PSV、RI等均无显著差异(P均0.05)。结论：本研究纳入的22例AION患者33眼经治疗后视力、视野有所改善,但活血化瘀药物治疗未能改善眼动脉、视网膜中央动脉、睫状后短动脉的血流动力学指标。 临床研究三、活血化瘀中药制剂治疗AION患者的疗效评价 目的：评价活血化瘀中药制剂银杏叶提取物、灯盏花素注射液用于治疗AION的疗效。方法：选取我院住院治疗的AION患者50例,随机分组为三组,均给予针灸、复方樟柳碱穴位注射等基础治疗,银杏叶提取物组(A组)增加银杏叶提取物注射液87.5mg Qd静点,灯盏花素组(B组)增加灯盏花素注射液100ml Qd静点,对照组(C组)不予中药注射剂治疗,各组均连续治疗2周,以治疗前后患者最佳矫正视力、视野平均敏感度的改变作为疗效评价依据。结果：各组治疗前一般资料无统计学差异,三组患者治疗后视力均高于治疗前,其中银杏叶组视力改善幅度最大,灯盏花素组和银杏叶组治疗前后视力比较均具有显著差异(P0.05),对照组治疗前后视力比较差异不明显(P0.05),三组患者治疗后视力改善幅度之间无显著差异(P0.05),灯盏花素组和银杏叶组治疗后MS高于治疗前,其中灯盏花素组治疗后视野改善幅度最大,治疗前后比较差异具有显著差异(P0.05),而对照组治疗后MS反而有所减少,但差异不明显(P0.05)；按照人数计算总有效率,灯盏花素组和银杏叶组有效率均为65%,对照组有效率仅为40%,组间比较均无统计学差异,按照眼数计算有效率,灯盏花素组有效率为46.7%,银杏叶组有效率为45.2%,对照组有效率仅为26.7%,组间比较均无统计学差异。结论：灯盏花素、银杏叶提取物参与治疗AION的疗效相当,均略高于对照组,活血化瘀中药在AION的治疗中有较好的应用前景,但目前尚无足够证据证实灯盏花素、银杏叶提取物的确切疗效。
[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.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R774
本文编号：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.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R774
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