蒸发过强型干眼的中医辨证分型及相关性研究

发布时间：2018-01-26 03:35

  本文关键词： 蒸发过强型干眼 眼表疾病 中医辨证 前瞻性研究 相关性分析　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:蒸发过强型干眼(evaporative dry eye,EDE)是眼科常见眼表疾病,它是泪液质的异常或动力学异常导致的泪膜稳定性下降,并伴有眼部不适,和(或)眼表损害的一类疾病。脂质层的异常是该病产生发展的核心,凡是会引起脂质层异常的因素都可能会导致蒸发过强型干眼的发生。中医学认为本病是由于五脏失于气血津液的濡养不能上荣于目、目失润泽而引起。但是,目前仅有干眼的辨证研究分析,而对蒸发过强型干眼没有辨证分型研究。基于以上,笔者开展这项研究,旨在通过前瞻性研究,探讨EDE的中医辨证分型,研究年龄、性别、视频终端使用时间、屈光不正、睡眠时间、角膜屈光手术、空调房时间、睑板腺功能情况等因素与中医各证型之间的相关性,为中西医结合防治EDE提供客观依据。方法:以2016年4月到2017年2月在江苏省中医院经门诊诊断为蒸发过强型干眼的102例患者为研究对象,记录其年龄、性别、视频终端使用时间、屈光不正、睡眠时间、角膜屈光手术史、空调房使用时间、泪液分泌试验(SIt)、泪膜破裂时间(BUT)、角膜荧光素染色(FL)、睑板腺功能评分,并根据其局部及全身症状,结合舌苔脉象,四诊合参,辨证分型,并分析各证型与各临床资料之间的相关性。运用SPSS 20.0进行统计分析。结果:(1)本病中医证型血虚风燥证最多,共25例,占24.5%,其次依次为阴虚夹湿证肝肾阴虚证脾胃湿热证风热外袭证邪热留恋证,分别为23例、18例、16例、12例、和8例。肺阴不足证无病例。(2)本病女性多发,男性29例,女性73例,男女比例为1:2.52。性别与中医证型无关。(3)本病年龄分布以20～35岁及45～50岁为主。年龄与中医证型有统计学差异,P=0.008(P0.01),脾胃湿热证、阴虚夹湿证主要集中在壮年组和中年组,而肝肾阴虚证集中在中年组和老年组,血虚风燥证和风热外袭证集中在青年组。(4)蒸发过强型干眼患者的眼部自觉症状出现的频率由高到低依次为是干涩96例(94.1%)、视物疲劳89例(87.3%)、异物感74例(72.5%)、痒68例(66.7%)、畏光56例(54.9%)、上眼皮沉重56例(54.9%)、眼红55例(53.9%)、刺痛 55 例(53.9%)、流泪 51 例(50.0%)、视力波动 48 例(47.1%)、烧灼45例(44.1%)、双目频眨43例(42.2%)、炎性分泌物38例(37.3%)。流泪与证型有统计学差异,P=0.017(P0.05),肝肾阴虚证中,88.8%的病人无流泪症状。眼红与证型有统计学差异,P=0.028(P0.05),邪热留恋证中,87.5%的病人有眼红症状。炎性分泌物与证型有统计学差异,P=0.042(P0.05),脾胃湿热证中,68.75%的病人有炎性分泌物。上眼皮沉重与证型有统计学差异,P=0.003(P0.01),阴虚夹湿证中,82.6%的病人有上眼皮沉重症状。其他症状无统计学差异(P0.05)。(5)睡眠时间和中医证型有统计学差异,P=0.002(P0.01),邪热留恋证患者睡眠时间长,一般大于8.5小时。(6)SIt、BUT、FL与中医证型无统计学差异,P均0.05。(7)灰线位置与中医证型有统计学差异,P=0.003(P0.01),脾胃湿热证中,灰线位置评分最高,血虚风燥证灰线评分最低。睑板腺分泌物性质与中医证型有统计学差异,P=0.000(P0.01),脾胃湿热证和肝肾阴虚证中,睑板腺分泌物评分较高,而风热外袭证与血虚风燥证评分较低。(8)症状分级与中医辨证分型无统计学差异,P=0.410(P0.05)。结论:蒸发过强型干眼辨证分型有一定的规律,主要分为血虚风燥证、阴虚夹湿证、肝肾阴虚证、脾胃湿热证、风热外袭证和邪热留恋证,病因病机多为阴血不足,风湿燥热上扰,目失濡养而发病。脏腑累及肝肾脾胃。本病女性多发,性别与中医证型无关。年龄与中医分型有关。流泪、眼红、炎性分泌物、上眼皮沉重与中医分型有关。睡眠时间与中医证型有关。SIt、BUT、FL与中医证型无关。睑板腺功能情况与中医证型有关。症状分级与中医分型无关。
[Abstract]:Objective: evaporative dry eye (evaporative dry, eye, EDE) is a common eye ocular surface disease, it is falling tears or abnormal tear film stability dynamics caused by abnormal, and accompanied by eye discomfort, and (or) a disease of ocular surface damage. The lipid layer is the disease caused abnormal development the core, usually caused by abnormal lipid layer factors may lead to evaporative dry eye. Traditional Chinese medicine believes that this disease is due to loss of blood and body fluid in five Ruyang not on the wing in the head, the eye loses moisture and cause. However, the only dry eye syndrome research and analysis, and to evaporative dry eye syndrome differentiation type no research. Based on the above, this study aims to carry out the prospective study to explore TCM EDE type, age, gender, time use video terminal, ametropia, sleep time, corneal refractive surgery, air conditioning room Time, the correlation between meibomian gland function and other factors and TCM syndrome type, provide an objective basis for the combination of TCM and Western medicine prevention and treatment of EDE. Methods: from April 2016 to February 2017 in Jiangsu Province Traditional Chinese Medicine Hospital, 102 cases diagnosed as evaporative dry eye patients as the research object, recording the age, sex, the use of video terminal time. Ametropia, sleep time, corneal refractive surgery, the use of air conditioning in real time, Schirmer test (SIt), tear break-up time (BUT), corneal fluorescein staining (FL), meibomian gland function score, and according to the local and systemic symptoms, tongue and pulse combination, four diagnostic methods, syndrome differentiation, and analysis the correlation between the syndrome and the clinical data. The use of SPSS 20 for statistical analysis. Results: (1) the TCM syndrome type of blood deficiency and wind dryness, at most, a total of 25 cases, accounting for 24.5%, the secondary are yin deficiency with dampness syndrome of liver and kidney yin deficiency syndrome of spleen and stomach 婀跨儹璇侀�庣儹澶栬��璇侀偑鐑�鐣欐亱璇，

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