益气养阴活血法治疗糖尿病性干眼的临床与相关基础研究

发布时间：2018-01-01 08:00

本文关键词：益气养阴活血法治疗糖尿病性干眼的临床与相关基础研究　出处：《锦州医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的干眼是糖尿病患者中发病率很高的一类眼表疾病,近年来在临床上得到越来越多的关注。治疗方面,西医治疗以长期使用人工泪液以缓解症状为主,难以从根本上治疗。中医在辨证论治理论指导下,治疗上有一定的优势。本研究旨在观察益气养阴活血法在改善临床症状、泪膜稳定性、减轻糖尿病性干眼慢性微炎症状态等方面的作用,同时探索IL-1β、TNF-α与糖尿病性干眼的相关性。以期发挥中医整体观念与辨证论治在糖尿病性干眼的治疗优势。方法一、临床实验本课题收集中国中医科学院眼科医院消渴目病科2016年4月至2016年12月糖尿病性干眼并符合气阴两虚、目络瘀阻证的患者84例(168眼)。采用随机对照的研究方法,将病例随机分为两组,治疗组42例(84眼),对照组42例(84眼)。治疗组予益气养阴活血方联合睑板腺按摩治疗,对照组予局部人工泪液点眼联合睑板腺按摩治疗,两组均治疗1个月。观察治疗前后两组眼部主观症状积分、中医证候积分、泪液分泌试验(SIT)、泪膜破裂时间(BUT)、角膜知觉分级、睑板腺功能分级、角膜荧光素染色(FL)评分等相关指标,并进行整理分析。二、基础实验收集糖尿病性干眼、糖尿病、非糖尿病性干眼、正常人各20例,检测血清甘油三酯、总胆固醇含量及IL-1β、TNF-α浓度,判断其与糖尿病性干眼及OSI(客观散射指数)值的相关性,进行数据整理分析。结果一、临床实验本课题共纳入经过中医辨证筛选符合气阴两虚、目络瘀阻证糖尿病性干眼患者84例(168只眼),男性38例,女性46例。治疗后治疗组眼部症状积分(P0.01)、中医症候积分(P0.01)、SIT评分(P0.01)、角膜荧光素染色评分(P0.01)及角膜知觉评分(P0.01)治疗组低于对照组,BUT值治疗组高于对照组(P0.05),睑板腺功能异常情况治疗组低于对照组(P0.01),两组疗效比较,治疗组的有效率为90.5%,对照组的有效率为66.7%,治疗组疗效优于对照组(P0.01)。二、基础实验静脉血清甘油三酯及总胆固醇含量在4组中无组间差异(P0.05),差异无统计学意义。IL-1β在糖尿病性干眼组(P0.01)、糖尿病组(P0.01)、干眼组(P0.05),浓度均高于正常人组;TNF-α在糖尿病性干眼组(P0.01)、干眼组(P0.05)、糖尿病组(P0.01),浓度高于正常人组。客观散射指数(OSI)与IL-1β、TNF-α浓度的关系:1、糖尿病性干眼患者中OSI值与IL-1β浓度呈正相关,相关系数r=0.771,P0.01,决定系数R2=0.594,说明OSI值与IL-1β浓度相关,OSI值随IL-1β浓度增加而增加;2、糖尿病性干眼患者OSI值与TNF-α浓度呈正相关,相关系数r=0.762,P0.01,决定系数R2=0.581,说明OSI值与TNF-α浓度相关,OSI值随TNF-α浓度增加而增加。结论益气养阴活血法对于改善糖尿病性干眼的临床症状、改善睑板腺功能障碍、保护角膜完整性、减轻微炎症状态具有一定的作用,但其具体作用途径、作用环节仍需从药代动力学、药理学方面深入探讨。IL-1β及TNF-α的浓度变化与泪膜不稳定程度呈正相关,表明炎症反应在糖尿病性干眼的发生、发展过程中起重要的作用。因此,通过对眼表炎症的抑制,可以有效地控制病程的发展,改善临床症状。甘油三酯和胆固醇与糖尿病性干眼无明显相关性。
[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.

【学位授予单位】：锦州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R276.7

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