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

【作者】 廖良；

【导师】 韦企平；

【作者基本信息】 北京中医药大学 ， 中西医结合临床， 2014， 博士

【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(P<0.05),对照组治疗前后视力比较差异不明显(P>0.05),三组患者治疗后视力改善幅度之间无显著差异(P>0.05),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(P<0.05),而对照组治疗后MS反而有所减少,但差异不明显(P>0.05)；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。更多还原

【Abstract】 Clinical research, Part I, epidemiology and hemodynamic characteristics of non-arteritic anterior ischemic optic neuropathy(AION)patientsObjective Get clinical epidemiological data of AION patients through the previous medical materials s were reviewed.Methods108cases of AION patients from our hospital within January2010and December2010were collected in this research, all the medical records about epidemiology and hemodynamic characteristics were be used to fill the preliminary designed casesheet and then statistical analysis done.Results Of the108AION patients in this study, there were57(52.8%) male patients and51(47.2%) female patients, the average age was57.23+/-11.95years old, there were50Unilateral cases (46.3%) and58bilateral cases (53.7%)with an average interval time of15.3+/-25.1m,72patients (66.7%) can describe the exact onset time, among them61cases (56.5%) aware it sudenly,78cases (72.2%) denied the existence of the inducing factors,66cases (61.1%) patients with history of cerebral infarction, hypertension, hyperlipidemia, diabetes, heart disease or cervical spondylosis.62cases (57.4%) patients were initially diagnosed AION,45cases (41.7%) of them accepted glucocorticoid therapy. Patients came to our hosptial21.2+/-51.1m after onset, with an average vision acuity0.35+/-0.36and intraocular pressure15.0+/-2.8mmHg.138eyes were accepted examination of visual field, the most common type of visual field loss were below half defect (18.8%), the central tube or nearly tubular vision (14.5%), wedge-Shaped defect(10.9%).55(65.5%) patients accepted imaging examination, amon them36cases were labeled "abnormal" with ischemia, infarction, or demyelinating lesions.62patients were examined ophthalmic artery(OA), central retinal artery (CRA), or short posterior ciliary artery(sPCA) with color doppler flow imaging(CDFI),27cases found arteriosclerosis or flow reduction.47cases examined carotid artery with CDFI,29cases (61.7%) detected carotid atherosclerosis, stenosis or plaque. The average heart rate was74.7+/-6.8prm, systolic blood pressure was124.8+/-15.1mmHg, diastolic blood pressure was77.9+/-8.7mmHg,29cases (26.9%) were higher than normal blood pressure. The proportion of patients with abnormal venous blood glucose, total cholesterol, triglyceride, and low density lipoprotein cholesterol were23.5%,26.3%,40.4%and31.6%, respectively. Patients with the most commonly complaint about poor sleep (22%). The typical tongue obeserved were pink or dim red tongue, thin white moss, typical pulse detected were string or fine pulse. The most common traditional Chinese medicine (TCM) syndrome were qi deficiency and blood stasis, Qi-stagnancy and blood stasis, qi-blood deficiency, liver Qi stagnation. Qinkgo biloba extract, breviscapines, and ligustrazine were the most frequently used TCM injection.Conclusion AION has a typical epidemiological characteristics, these characteristics can be used to promot the understanding of AION pathological mechanism, prevention of the disease and finding treatment strategies.Clinical research, Part II, The effect of activating blood circulation by TCM medicine for hemodynamics of AION patientsObjective to study the influence of activating blood circulation by TCM medicine for hemodynamics of AION patients.Methods A retrospective analysis of33defected eyes of22AION cases given the treatment of TCM medicine for activating blood circulation more than14days. Patients were examined with CDFI before and after treatment, peak systolic velocit(PSV) and resistance index(RI) of OA, CRA, sPCA and diameter of OA were measured, as well as the visual acuity(Va), mean sensitivity(MS) of visual field.Results Patients were treated for23.7+/-8.2days, Va were3.67+/-1.32and3.91+/-1.18before and after treatment respectively, with significant differences (t=2.328, P=0.039) by comparison. MS were12.93+/-6.27dB and13.37+/-5.49dB respectively, no significant difference by comparison (t=1.361, P=0.198). PSV and RI of OA, CRA, sPCA and diameter of OA had no significant difference (P>0.05) before and after treatment.Conclusion33eyes of22AION cases treated with TCM medicine for activating blood circulation in this study showed an significant impiovement of acuity (Va) and a possible improvement of mean sensitivity (MS) of visual field, but there were no evidence supported that AION patients get benefit from treatment of TCM medicine for activating blood circulation.Clinical research, Part Ⅲ, The curative effect of TCM injection treatment on AION by activating blood circulationObjective To evaluate the The curative effect of ginkgo biloba extract injection and breviscapines indection on AION.Methods50cases of AION patients were randomly grouped into three groups, Group A treated with ginkgo biloba extract injection,87.5mg Qd, Group B treated with breviscapines injection,50ml Qd, and Group C with no TCM injection treatment, each of the patients from3groups were treated with acupuncture, compound anisodine and ohter supporting treatment. Best corrected Va and MS of visual field were detected before and after2weeks continuous treatment to evaluation the efficacy.Results General data of each group had no statistical difterence before treatment. Va of all the three groups were higher than before treatment, the difference were significant (P<0.05) in Group A and Group B but no significant (P>0.05) in Group C. But the vision improvement were no significant (P>0.05) difference between the three Groups. MS ofGroup A and Group C were higher after treatment than before, the difference in Group B was significant (P>0.05). While the MS of control group(Group C) after treatment has decreased, although there was no significant difference (P>0.05).The total effective rate based on the patients number of the three groups were65%,65%,40%respectively, while the effective rate based on the eyes number of the three groups were46.7%,45.2%,26.7%respectively. The effective rate had no any statistical difference between the three groups (P>0.05).Conclusion breviscapines injection, and ginkgo biloba extract injection had an similer curative effect on AION treatment, both were slightly higher than the control group with no TCM injection, which suggests that TCM injection by activating blood circulation of AION patients may have a good application prospect in the future, but there are still no enough evidence to confirm it.更多还原