中西医结合治疗湿性老年性黄斑变性临床研究
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摘要
目的:探讨加味温胆汤联合玻璃体腔内注射康柏西普治疗湿性老年性黄斑变性(Age-related macular degeneration,ARMD或AMD)的有效性和安全性。方法:回顾性分析湿性AMD患者64例(64眼),根据其治疗方案可分为中西药联合组(33眼)和对照组(31眼)。对照组:给予玻璃体腔内注射康柏西普1次,间隔1个月再注射1次,共3次。中西药联合组:在对照组基础上,加服加味温胆汤1个月。检测所有入选者术前、术后1周、术后1个月、术后3个月的最佳矫正视力、黄斑中心凹神经上皮层厚度以及血管渗漏情况。结果:两组患者术前及术后初期(术后1周～1个月)最佳矫正视力、黄斑中心凹神经上皮厚度的平均值差异无统计学意义(P>0.05);术后3个月,中西药联合组最佳矫正视力视力高于对照组(P<0.05),而黄斑中心凹神经上皮厚度小于对照组(P<0.05)。而两组患者术后1个月及术后3个月血管渗漏情况差异无统计学意义(P>0.05)。治疗3个月后中西药联合组和对照组患者在总有效率(显著+有效数,%)方面存在显著性差异,分别为90.3%和75.8%,χ~2值=5.4,P值=0.017。结论:加味温胆汤联合玻璃体腔内注射康柏西普治疗湿性AMD安全、有效。加味温胆汤可以减轻黄斑水肿、提高预后视力,但并不能减少AMD新生血管渗漏。
Objective: To explore the efficacy and safety of Modified Wendan Decoction combined with intravitreal injection of Conbercept to treat the damp age-related macular degeneration(age-related macular degeneration(ARMD or AMD).Methods: Sixty-four patients(64 eyes) of damp AMD were involved in this study. Thirty-three eyes were included in the combined group and 31 eyes in the control group. The control group was given basic medicine treatment and intravitreal injection of Conbercept. One month after fluorescein administration, another dose of injection would be performed immediately. Then the third injection would be performed after another month. The combined group was treated as well as the control group, but with additional Modified Wendan Decoction for 1 month. The best corrected visual acuity and the thickness of the macular fovea neuroepithelial layer were detected before the first injection, 1 week later, 1 and 3 months later. The leakage rates of FFA and ICGA were detected before the first injection, 1 and 3 months later.Results: There was no significant difference of the best corrected visual acuity or the thickness of the macular fovea neuroepithelial layer between two groups before the first injection,1 week and 1 month later(P>0.05). The best corrected visual acuity of the combined group was better than that of the control group(P<0.05), and the thickness of the macular fovea neuroepithelial layer was less than that of the control group 3 months after the first injection(P<0.05). There was no significant difference of vascular leakage between the two groups 1 and 3 months after the first injection(P>0.05). After treatment for 3 months, there was a significant difference in the total effective rate(significant+effective) between the combined group and the control group, which were 90.3% and 75.8%(χ~2=5.4, P=0.017).Conclusion: Modified Wendan Decoction combined with intravitreal injection of Conbercept is effective and safe to treat the damp AMD. Modified Wendan Decoction can relieve macular edema and improve visual acuity, but it can not reduce the leakage of neovascularization.
Objective: To explore the efficacy and safety of Modified Wendan Decoction combined with intravitreal injection of Conbercept to treat the damp age-related macular degeneration(age-related macular degeneration(ARMD or AMD).Methods: Sixty-four patients(64 eyes) of damp AMD were involved in this study. Thirty-three eyes were included in the combined group and 31 eyes in the control group. The control group was given basic medicine treatment and intravitreal injection of Conbercept. One month after fluorescein administration, another dose of injection would be performed immediately. Then the third injection would be performed after another month. The combined group was treated as well as the control group, but with additional Modified Wendan Decoction for 1 month. The best corrected visual acuity and the thickness of the macular fovea neuroepithelial layer were detected before the first injection, 1 week later, 1 and 3 months later. The leakage rates of FFA and ICGA were detected before the first injection, 1 and 3 months later.Results: There was no significant difference of the best corrected visual acuity or the thickness of the macular fovea neuroepithelial layer between two groups before the first injection,1 week and 1 month later(P>0.05). The best corrected visual acuity of the combined group was better than that of the control group(P<0.05), and the thickness of the macular fovea neuroepithelial layer was less than that of the control group 3 months after the first injection(P<0.05). There was no significant difference of vascular leakage between the two groups 1 and 3 months after the first injection(P>0.05). After treatment for 3 months, there was a significant difference in the total effective rate(significant+effective) between the combined group and the control group, which were 90.3% and 75.8%(χ~2=5.4, P=0.017).Conclusion: Modified Wendan Decoction combined with intravitreal injection of Conbercept is effective and safe to treat the damp AMD. Modified Wendan Decoction can relieve macular edema and improve visual acuity, but it can not reduce the leakage of neovascularization.
引文
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[8] 周尚昆, 唐由之, 冯俊, 等. 明睛颗粒治疗湿性老年性黄斑变性的临床研究[J]. 眼科新进展, 2014, 34(2): 155-157.
[9] 魏伟, 赵越娟. 健脾化浊法治疗湿性老年性黄斑变性25例临床观察[J]. 浙江中医杂志, 2005, 40(12): 521-522.
[10] 崔红培, 周尚昆, 毛海燕. 益气复明汤治疗湿性脾气虚弱型老年性黄斑变性37例观察[J]. 四川中医, 2006, 24(2): 94-95.
[11] 曾平, 欧阳芳, 李晓霞. 中药为主治疗湿性老年性黄斑变性[J]. 中国中医眼科杂志, 2006, 16(2): 112-113.
[12] 李波, 张波涛, 李传课, 等. 滋阴明目丸治疗湿性老年性黄斑变性的临床观察[J]. 中国中医眼科杂志, 2007, 17(6): 311-314.
[13] 张励, 唐由之, 冯俊. 中药治疗湿性老年性黄斑变性临床观察[J]. 中国中医眼科杂志, 2005, 15(1): 2-4.
[14] 贾洪亮,邓续旺,袁灵梅.加味温胆汤治青光眼睫状体炎综合征临床体会[J].江西中医药,2008,12(39):17.
[15] 陈金红.加味温胆汤治疗椎-基底动脉供血不足46例临床观察[J].中国校医,2006,20(6):669-670.
[16] 汪月红,徐盈.温胆汤合明目地黄汤治疗复发性中心性浆液性脉络膜视网膜病变68例[J].浙江中医杂志, 2011,46(5):353-354.
[17] 姚大莉,王明芳.用内眼辨证治疗老年性黄斑变性[J].四川中医,2002,20(6):7-8.
[18] 朱金华,孙昊鑫,熊迎秋,等.温胆汤对精神分裂症模型鼠血清TNF-α、IL-6及海马组织Glu活性表达的影响[J].中国实验方剂学杂志,2014,20(14):160-164.
[19] 周海虹,陆汎,陈艳玲,等.柴郁温胆汤对大鼠抑郁模型行为学及脑内单胺类神经递质的影响[J].中华中医药杂志,2008,23(10):931-934.
[20] 皮明钧,刘莺,陈力,等.加味温胆汤对亚急性衰老大鼠血GSH-Px及肝、脑MAO、LPF的影响[J].中国中医基础医学杂志,1999,5(2):14-16.
[21] 马伯艳,宋颖星,郑慧娟,等.温胆汤对高脂饮食诱导的糖耐量受损大鼠脂代谢的影响[J].中医杂志,2015,56(10):874-876.
[22] 汪月红,徐盈.温胆汤合明目地黄汤治疗复发性中心性浆液性脉络膜视网膜病变68例[J].浙江中医杂志,2011,46(5):353-354.
[23] 舒智宇.黄连温胆汤联合噻吗洛尔滴眼液治疗青光眼睫状体炎综合征的临床疗效[J].中药药理与临床,2015,31(4):275-277.
[2] Folkman J. Angiogenesis: an organizing principle for drug discovery?[J]. Nat Rev Drug, 2007,6(4):273-286.
[3] Baluk P, Hashizume H, McDonald DM. Cellular abnormalities of blood vessels as targets in cancer[J]. Curr Opin Genet Dev, 2005,15(1):102-111.
[4] Carmeliet P, Jain RK. Angiogenesis in cancer and other diseases[J]. Nature, 2000,407(6801):249-257.
[5] Danis P. Imaging data from the phase 3 clinical trial of conbercept in neovascular AMD[M]. Miami:Angiogenesis, Exudation, and Degeneration USA:Miami. FL 2014.
[6] 王婷芝. 玻璃体腔注射康柏西普对湿性老年性黄斑变性患者视力及生活质量的影响[J]. 河南医学研究, 2017, 26(16): 3028-3029.
[7] 唐由之, 周尚昆, 冯俊, 等. 中药治疗湿性晚期老年性黄斑变性临床疗效观察[J]. 中国中医眼科杂志, 2009, 19(6): 340-341.
[8] 周尚昆, 唐由之, 冯俊, 等. 明睛颗粒治疗湿性老年性黄斑变性的临床研究[J]. 眼科新进展, 2014, 34(2): 155-157.
[9] 魏伟, 赵越娟. 健脾化浊法治疗湿性老年性黄斑变性25例临床观察[J]. 浙江中医杂志, 2005, 40(12): 521-522.
[10] 崔红培, 周尚昆, 毛海燕. 益气复明汤治疗湿性脾气虚弱型老年性黄斑变性37例观察[J]. 四川中医, 2006, 24(2): 94-95.
[11] 曾平, 欧阳芳, 李晓霞. 中药为主治疗湿性老年性黄斑变性[J]. 中国中医眼科杂志, 2006, 16(2): 112-113.
[12] 李波, 张波涛, 李传课, 等. 滋阴明目丸治疗湿性老年性黄斑变性的临床观察[J]. 中国中医眼科杂志, 2007, 17(6): 311-314.
[13] 张励, 唐由之, 冯俊. 中药治疗湿性老年性黄斑变性临床观察[J]. 中国中医眼科杂志, 2005, 15(1): 2-4.
[14] 贾洪亮,邓续旺,袁灵梅.加味温胆汤治青光眼睫状体炎综合征临床体会[J].江西中医药,2008,12(39):17.
[15] 陈金红.加味温胆汤治疗椎-基底动脉供血不足46例临床观察[J].中国校医,2006,20(6):669-670.
[16] 汪月红,徐盈.温胆汤合明目地黄汤治疗复发性中心性浆液性脉络膜视网膜病变68例[J].浙江中医杂志, 2011,46(5):353-354.
[17] 姚大莉,王明芳.用内眼辨证治疗老年性黄斑变性[J].四川中医,2002,20(6):7-8.
[18] 朱金华,孙昊鑫,熊迎秋,等.温胆汤对精神分裂症模型鼠血清TNF-α、IL-6及海马组织Glu活性表达的影响[J].中国实验方剂学杂志,2014,20(14):160-164.
[19] 周海虹,陆汎,陈艳玲,等.柴郁温胆汤对大鼠抑郁模型行为学及脑内单胺类神经递质的影响[J].中华中医药杂志,2008,23(10):931-934.
[20] 皮明钧,刘莺,陈力,等.加味温胆汤对亚急性衰老大鼠血GSH-Px及肝、脑MAO、LPF的影响[J].中国中医基础医学杂志,1999,5(2):14-16.
[21] 马伯艳,宋颖星,郑慧娟,等.温胆汤对高脂饮食诱导的糖耐量受损大鼠脂代谢的影响[J].中医杂志,2015,56(10):874-876.
[22] 汪月红,徐盈.温胆汤合明目地黄汤治疗复发性中心性浆液性脉络膜视网膜病变68例[J].浙江中医杂志,2011,46(5):353-354.
[23] 舒智宇.黄连温胆汤联合噻吗洛尔滴眼液治疗青光眼睫状体炎综合征的临床疗效[J].中药药理与临床,2015,31(4):275-277.