原发性青光眼与“血瘀”的关系及“血瘀”症候特征的探讨

发布时间：2018-08-11 18:08

【摘要】：目的：分析原发性青光眼患者“血瘀”症候的出现频率及特征,探讨原发性青光眼与“血瘀”的关系,为临床应用活血化瘀治疗青光眼提供依据。方法：收集成都中医药大学附属医院眼科2007年12月至2010年12月原发性青光眼患者240例(453眼),对其型别、性别、年龄、病程、眼部及全身“血瘀”症状体征、全血粘度等进行回顾性分析,总结出原发性青光眼“血瘀”证的特征性症候及出现频率。结果：①患者年龄分布集中在61-70岁者(共101例,占240例原发性青光眼患者的42.08%),其中,急性闭角型青光眼28例,占27.72%；慢性闭角型青光眼45例,占44.55%；开角型青光眼28例,占27.72%。②急性闭角型青光眼病程较短,慢性闭角型和开角型病程较长。③不同型别原发性青光眼年龄、病程频数分布统计结果显示：AACG的年龄频数呈负偏态分布,而CACG和POAG呈正态分布；AACG、CACG和POAG的病程频数均呈正偏态分布。④眼部常见“血瘀”症候为球结膜血管扩张、视网膜静脉迂曲/动脉变细、视盘苍白。其中,球结膜血管扩张202例,占病例总数的84.17%；视网膜静脉迂曲/动脉变细者201例,占83.75%；视盘苍白者194例,占80.83%。而伴高血压病者75例,占31.25%；糖尿病者33例,占13.75%。统计结果显示：不同型别原发性青光眼“血瘀”症候出现频数无明显差异(P0.05)。⑤不同型别原发性青光眼与性别、年龄、病程之间均有统计学意义的“血瘀”指标有：伴视网膜静脉阻塞、视网膜动脉阻塞者(P0.05)；与性别之间有统计学意义的“血瘀”指标有：伴视网膜静脉阻塞、动脉阻塞、高血压病者(P0.05)；与年龄之间有统计学意义的“血瘀”指标有：视盘苍白、网膜静脉迂曲/动脉变细,伴视网膜静脉阻塞、视网膜动脉阻塞、糖尿病者(P0.05)；与病程之间有统计学意义的“血瘀”指标有：球结膜下出血、视盘苍白、网膜静脉迂曲／动脉变细,伴视网膜静脉阻塞、视网膜动脉阻塞、高血压病、糖尿病病者(P0.05)；而不同型别患者球结膜血管扩张与性别、年龄、病程之间均无明显统计学意义(P0.05)⑥全身“血瘀”症状最常见的有：舌下静脉曲张者199例,占82.92%；脉弦涩或结代者163例,占67.92%；舌质紫暗或舌体有瘀斑者121例,占50.42%。统计结果显示：不同型别的患者有脉弦涩或结代者与病程之间有统计学意义(P0.05),而伴舌质紫暗或舌体有瘀斑者与性别、年龄、病程之间均无明显统计学意义(P0.05)；⑦检查了血液流变学者有52例,占21.67%。其中升高最明显的为血浆粘度和红细胞聚集指数,前者50例,占20.83%,后者49例,占20.42%。不同型别原发性青光眼与升高的血流变各指标出现频数间有统计学意义(P0.05)。结论：①原发性青光眼与“血瘀”关系密切；②原发性青光眼“血瘀”症候出现频率由高到低依次为球结膜血管扩张,视网膜静脉迂曲／动脉变细,视盘苍白,脉弦涩或结代、舌质紫暗或舌体有瘀斑、球结膜下出血,伴高血压、视网膜静脉阻塞、视网膜动脉阻塞、糖尿病者。同时,不同型别原发性青光眼伴有视网膜静脉阻塞、视网膜动脉阻塞者与性别、年龄、病程之间均有统计学意义(P0.05)。表现为,AACG男女比例相差不大,而CACG和POAG的女性明显多于男性；AACG的年龄51-60岁居多,而CACG和POAG 61-70岁者为多；AACG患者病程大多在半年以下,而CACG和POAG则半年到四年者居多。而球结膜血管扩张和伴舌质紫暗或舌体有瘀斑者与性别、年龄、病程之间无明显统计学意义(P0.05)③球结膜血管扩张、舌质紫暗或舌体有瘀斑者可作为原发性青光眼“血瘀”特征性症候。
[Abstract]:Objective: To analyze the frequency and characteristics of blood stasis syndrome in patients with primary glaucoma, and to explore the relationship between blood stasis and primary glaucoma, so as to provide evidence for clinical application of promoting blood circulation and removing blood stasis in the treatment of glaucoma. 53 eyes were retrospectively analyzed in terms of type, sex, age, course of disease, symptoms and signs of blood stasis in eyes and whole body, and blood viscosity. The characteristic symptoms and frequency of occurrence of blood stasis syndrome in primary glaucoma were summarized. Among them, 28 cases (27.72%) were acute angle closure glaucoma, 45 cases (44.55%) were chronic angle closure glaucoma, 28 cases (27.72%) were open angle glaucoma. The frequency distribution was negative skewness, while the CACG and POAG were normal distribution. The frequency distribution of AACG, CACG and POAG were positive skewness. 4 The common symptoms of blood stasis in eyes were bulbar conjunctival vasodilation, tortuous retinal veins/arteries thinning, and pale optic disc. There were 201 cases (83.75%), 194 cases (80.83%) with pale optic disc, 75 cases (31.25%) with hypertension, 33 cases (13.75%) with diabetes mellitus. The statistical results showed that there was no significant difference in the frequency of blood stasis syndrome among different types of primary glaucoma (P 0.05). _Different types of primary glaucoma and gender, age, course of disease. The blood stasis indices were: retinal vein occlusion, retinal artery occlusion (P 0.05); and the blood stasis indices were: retinal vein occlusion, arterial occlusion, hypertension (P 0.05); and the blood stasis indices were: optic disc. Paleness, retinal vein tortuosity/arterial thinning, retinal vein occlusion, retinal artery occlusion, diabetes mellitus (P 0.05); and the course of the disease between the statistical significance of the "blood stasis" indicators are: subconjunctival hemorrhage, pale optic disc, retinal vein tortuosity/arterial thinning, with retinal vein occlusion, retinal artery occlusion, hypertension, sugar Urinary disease patients (P 0.05); and different types of patients with bulbar conjunctival vasodilation and gender, age, course of disease were not statistically significant (P 0.05)Systemic "blood stasis" symptoms were most common: hypoglossal varices in 199 cases, accounting for 82.92%; pulse strings or stagnation in 163 cases, accounting for 67.92%; tongue purple dark or tongue with ecchymosis in 121 cases, accounting for 50.4%. Statistical results showed that there was statistical significance between patients with different types of pulse strings or stagnation and the course of disease (P Viscosity and erythrocyte aggregation index were 50 cases (20.83%) and 49 cases (20.42%) respectively. There was statistical significance between the frequency of primary glaucoma and the increased hemorheological indexes (P 0.05).
Conclusion: There is a close relationship between primary glaucoma and blood stasis, and the frequency of "blood stasis" syndrome in primary glaucoma is from high to low: bulbar conjunctival vasodilation, tortuosity of retinal veins / arteries thinning, pale optic disc, astringent pulse strings or metaplasia, purple or dark tongue with stasis, subconjunctival hemorrhage, hypertension, retinal quiescence. At the same time, different types of primary glaucoma with retinal vein occlusion, retinal artery occlusion and gender, age, course of disease were statistically significant (P 0.05). Performance, AACG male and female ratio is not significantly different, but CACG and POAG female significantly more than men; AACG age 51-60 years old living in Most of the patients with AACG were under half a year, while those with CACG and POAG were between half a year and four years. It can be used as a characteristic symptom of "blood stasis" in primary glaucoma.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R775

【相似文献】