杞菊地黄汤治疗肝肾阴虚型干眼症患者疗效及对泪液分泌的影响
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摘要
目的:探讨干眼症肝肾阴虚型应用杞菊地黄汤治疗的临床疗效及对患者泪液分泌的影响。方法:选取华中科技大学同济医学院附属武汉中心医院于2015年1月—2017年1月收治的100例(200眼)肝肾阴虚型干眼症患者,采用随机数字表法均分为两组,每组50例。所有患者均给予相同的基础处理方案,对照组在此基础上予以玻璃酸钠滴眼液治疗,观察组在对照组基础上给予杞菊地黄汤治疗。记录比较两组临床综合疗效;治疗前后角膜荧光素染色(fluorescent test,FL)评分及泪液分泌试验(Schirmer I test,SIT),泪膜破裂时间(tear breakup time,BUT),泪液肿瘤坏死因子-α(tumor necrosis factor,TNF-α),白细胞介素-6(interleukin-6,IL-6)水平;视功能相关生存质量量表-25(25-item national eye institute visual functioning questionnaire,NEI-VFQ-25)综合评分。结果:3个疗程后,观察组总有效率为88.0%,较对照组(68.0%)明显上升(P<0.05);与治疗前相比,两组治疗3个疗程后FL评分均显著下降(P<0.01),NEI-VFQ-25综合评分及SIT,BUT均显著升高(P<0.01);且观察组以上指标的改善效果优于对照组(P<0.01);两组治疗3个疗程后泪液TNF-α,IL-6水平较治疗前均显著降低(P<0.01);且观察组泪液中各项炎性指标改善情况更为显著(P<0.01)。结论:肝肾阴虚型干眼症应用杞菊地黄汤治疗更能有效减轻角膜损伤,增加泪液分泌,缓解眼部炎症,提高生活质量,综合疗效更为显著。
Objective: To explore the clinical efficacy of Qiju Dihuang Tang on patients with xeroma due to Yin deficiency of liver and kidney and its effect on tear secretion. Method: A total of 100 cases( 200 eyes) with xeroma due to Yin deficiency of liver and kidney treated at Tongji Medical College,Huangzhong University of Science and Technology,the Central Hospital of Wuhan from January 2015 to January 2017 were selected as research objectives and divided into two groups randomly. All of the cases were provided with the same basic therapy. In addition,sodium hyaluronate eye drops were also provided to control group,while observation group was also given sodium hyaluronate eye drops and Qiju Dihuang Tang. The two groups' clinical efficacy,corneal fluorescein staining( FL),schirmer I test( SIT),breakup time of tear film( BUT),tumor necrosis factor-α( TNF-α),interleukin-6( IL-6) before and after treatment,as well as the score of national eye institute visual function questionaire-25( NEI-VFQ-25) were recorded and compared. Result: After 3 courses of treatment,observation group's overall effective rate was 88. 0%,which was significant higher than 68. 0% of control group( P < 0. 05). The two groups' FL scores after 3 course treatment were significant lower than those before treatment( P < 0. 01),but NEI-VFQ-2 score,SIT,BUT increased( P < 0. 01). All of the mentioned indexes in observation group was increased more significantly( P < 0. 01). The two groups' tear TNF-α,IL-6 after 3 courses of treatment were significant lower than those before treatment( P < 0. 01). And inflammatory indexes in the tear increased more significantly in observation group( P < 0. 01). Conclusion: Qiju Dihuang Tang helps cases with xeroma due to Yin deficiency of liver and kidney to reduce corneal injury,increase tear secretion,relieve eye inflammation,and improve the quality of life,with a significant clinical efficacy.
Objective: To explore the clinical efficacy of Qiju Dihuang Tang on patients with xeroma due to Yin deficiency of liver and kidney and its effect on tear secretion. Method: A total of 100 cases( 200 eyes) with xeroma due to Yin deficiency of liver and kidney treated at Tongji Medical College,Huangzhong University of Science and Technology,the Central Hospital of Wuhan from January 2015 to January 2017 were selected as research objectives and divided into two groups randomly. All of the cases were provided with the same basic therapy. In addition,sodium hyaluronate eye drops were also provided to control group,while observation group was also given sodium hyaluronate eye drops and Qiju Dihuang Tang. The two groups' clinical efficacy,corneal fluorescein staining( FL),schirmer I test( SIT),breakup time of tear film( BUT),tumor necrosis factor-α( TNF-α),interleukin-6( IL-6) before and after treatment,as well as the score of national eye institute visual function questionaire-25( NEI-VFQ-25) were recorded and compared. Result: After 3 courses of treatment,observation group's overall effective rate was 88. 0%,which was significant higher than 68. 0% of control group( P < 0. 05). The two groups' FL scores after 3 course treatment were significant lower than those before treatment( P < 0. 01),but NEI-VFQ-2 score,SIT,BUT increased( P < 0. 01). All of the mentioned indexes in observation group was increased more significantly( P < 0. 01). The two groups' tear TNF-α,IL-6 after 3 courses of treatment were significant lower than those before treatment( P < 0. 01). And inflammatory indexes in the tear increased more significantly in observation group( P < 0. 01). Conclusion: Qiju Dihuang Tang helps cases with xeroma due to Yin deficiency of liver and kidney to reduce corneal injury,increase tear secretion,relieve eye inflammation,and improve the quality of life,with a significant clinical efficacy.
引文
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[18]郭雨雅,孙晓琦,方晶,等.加味泽泻汤对NAFLD大鼠肝脏炎症信号通路相关蛋白表达的影响[J].中国实验方剂学杂志,2017,23(5):90-94.
[2]WAN K H,CHEN L J,Young A L.Depression and anxiety in dry eye disease:a systematic review and Metaanalysis[J].Eye,2016,30(12):1558-1567.
[3]Asiedu K,Kyei S,Ayobi B,et al.Survey of eye practitioners'preference of diagnostic tests and treatment modalities for dry eye in China[J].Cont Lens Anterior Eye,2016,39(6):411-415.
[4]赵仲平,郭翠玲,邵鸿展,等.杞菊地黄汤治疗干眼症疗效观察[J].陕西中医,2015,36(7):870-872.
[5]中华医学会眼科学分会角膜病学组.干眼临床诊疗专家共识(2013年)[J].中华眼科杂志,2013,49(1):73-75.
[6]李传课.中医眼科学[M].北京:人民卫生出版社,2011:432-439.
[7]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:75.
[8]Rentz A M,Kowalski J W,Walt J G,et al.Development of a preference-based index from the National Eye Institute Visual Function Questionnaire-25[J].JAMA Ophthalmol,2014,133(3):310-318.
[9]马华贞,孙廷励.干眼症发病机制及其治疗、护理手段的研究进展[J].中国医药导报,2014,11(19):159-162.
[10]朱登峰.玻璃酸钠滴眼液与中药内服、熏蒸治疗老年性干眼症疗效比较[J].现代中西医结合杂志,2016,25(30):3352-3354.
[11]王双勇,田英,程燕,等.不同浓度玻璃酸钠对新西兰兔干眼眼表变化的影响[J].国际眼科杂志,2015,15(10):1705-1708.
[12]陈阳.中西医结合治疗干眼症疗效观察[J].四川中医,2014,32(11):92-94.
[13]郑伟.杞菊地黄丸治疗干眼症临床研究[J].中医学报,2014,29(7):1053-1054.
[14]刘宏伟,彭淑玲,周毅,等.杞菊滴眼液治疗实验性干眼症泪液减少和角膜上皮病变[J].中国中医眼科杂志,2011,21(1):12-15.
[15]李勇,李锐,刘钊臣.过敏性结膜炎泪膜改变与干眼症的相关性浅析[J].国际眼科杂志,2014,14(7):1272-1274.
[16]LI M,ZHANG L.IL-6 and TNF-αexpression in the ocular surface of aqueous tear deficiency dry eye-type rat[J].Int J Ophthalmol,2010,10(7):1281-1283.
[17]田硕,苗明三.菊花的研究及应用现状[J].中医学报,2014,29(3):378-380.
[18]郭雨雅,孙晓琦,方晶,等.加味泽泻汤对NAFLD大鼠肝脏炎症信号通路相关蛋白表达的影响[J].中国实验方剂学杂志,2017,23(5):90-94.