针刺对青光眼患者视功能影响的临床观察
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摘要
[目的]探讨针刺治疗对眼压稳定的青光眼患者视功能影响。[方法]选取青光眼患者68例,采用前瞻性随机对照研究,将68例青光眼性视神经病变者随机治疗组及对照组。对照组继续接受原来的降眼压基础治疗;治疗组在基础治疗外予以针刺治疗,取穴如下:主穴风池、太阳、睛明、合谷,配穴:球后、四白、承泣、童子髎、丝竹空,百会等,每日1次,每周治疗6 d,4周为1个疗程,连续治疗3个疗程(12周),观察患眼视力、眼压、视野、视觉诱发电位的变化。[结果] 1)治疗后,治疗组视力均数较治疗前提高(P<0.05);2)两组患者治疗前后眼压未见明显改变及差异(P<0.05);3)治疗后,与治疗前比较,治疗组视野平均敏感度(MS)值提高(P<0.05),视野平均缺损值(MD)降低(P<0.05);4)治疗12周后两组的P100波峰均提高,潜伏期时间缩短。[结论]针刺治疗青光眼虽不能明显提高患者视力、降低眼压,但可以改善视野光敏度、降低平均缺损值,值得临床作为青光眼的辅助治疗以保护视神经、改善视功能。
[Objective] To explore the effect of acupuncture on the visual function of glaucoma patients with stable intraocular pressure.[Methods] The 68 patients with glaucoma were selected,and randomly divided into two groups:control group and acupuncture group.The control group continued to receive the original treatment for reducing intraocular pressure. The acupuncture group was also given acupuncture treatment on the premise of basic treatment. And the basic point prescription is as follows:the main point,Taiyang(EXHN5),Fengchi(GB20), Jingming(BL1),Hegu(LI4);with acupuncture point:Qiuhou(EX-HN7),Sibai(ST2),Chengqi(ST1),Tongziliao(TE23),Sizhukong(SJ23),Baihui(DU20),once per day,to treat for 6 days a week,with one month as the course of treatment,Treatment was continued for about 3 months(12 weeks),then to observe the patients' visual acuity,intraocular pressure,vision field and the changes of visual evoked potential. [Results] 1) The visual acuity was improved after acupuncture treatment,and the difference was significant(P<0.05). 2) In intraocular pressure,there was no significant improvement before and after treatment(P>0.05).3) After treatment of acupuncture group vision mean sensitivity(MS) value increase,the mean visual defect value(MD) reduce(P<0.05),the differences were significant compared with before treatment. 4) After 12 weeks of treatment,the P100 wave peak of the two groups was increased,and the diving time was shortened. [Conclusion] Acupuncture therapy in patients with glaucoma cannot improve eyesight or reduce intraocular ressure,but it can improve the average photosensitivity of the vision field,reduce the average defect value,Is worthy of clinical application as an adjuvant treatment of glaucoma to protect the optic nerve and improve the visual function.
[Objective] To explore the effect of acupuncture on the visual function of glaucoma patients with stable intraocular pressure.[Methods] The 68 patients with glaucoma were selected,and randomly divided into two groups:control group and acupuncture group.The control group continued to receive the original treatment for reducing intraocular pressure. The acupuncture group was also given acupuncture treatment on the premise of basic treatment. And the basic point prescription is as follows:the main point,Taiyang(EXHN5),Fengchi(GB20), Jingming(BL1),Hegu(LI4);with acupuncture point:Qiuhou(EX-HN7),Sibai(ST2),Chengqi(ST1),Tongziliao(TE23),Sizhukong(SJ23),Baihui(DU20),once per day,to treat for 6 days a week,with one month as the course of treatment,Treatment was continued for about 3 months(12 weeks),then to observe the patients' visual acuity,intraocular pressure,vision field and the changes of visual evoked potential. [Results] 1) The visual acuity was improved after acupuncture treatment,and the difference was significant(P<0.05). 2) In intraocular pressure,there was no significant improvement before and after treatment(P>0.05).3) After treatment of acupuncture group vision mean sensitivity(MS) value increase,the mean visual defect value(MD) reduce(P<0.05),the differences were significant compared with before treatment. 4) After 12 weeks of treatment,the P100 wave peak of the two groups was increased,and the diving time was shortened. [Conclusion] Acupuncture therapy in patients with glaucoma cannot improve eyesight or reduce intraocular ressure,but it can improve the average photosensitivity of the vision field,reduce the average defect value,Is worthy of clinical application as an adjuvant treatment of glaucoma to protect the optic nerve and improve the visual function.
引文
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[6]张杏林,徐鸣曙,张英杰,等.针刺治疗脑缺血再灌注损伤机制研究进展[J].江苏中医药,2017,49(12):85-88.
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[9]汤晓东,冶英,杨光.针刺对眼压控制稳定青光眼患者视野影响的临床研究[J].中国中医眼科杂志,2015,25(6):428-430.
[10]孙晓雯.针刺治疗青光眼性视神经病变的疗效分析[J].中医临床研究,2015,7(21):84-85.
[11]王蕊.针刺对青光眼眼压控制及患者眼功能的影响[J]国际眼科杂志,2017,5(5):958-960.
[12]刘江,孙河,董霏雪,等.针刺对青光眼视神经损害视觉诱发电位的影响[J].针灸临床杂志,2014,30(6):39-41.
[13]王舒,周颖,李军,等.风池穴提插手法对椎基底动脉供血不足患者血流动力学的影响[J].针灸临床杂志,1997,14(11):26-28.
[14]于慧,韩晶,谭奇纹.针刺睛明穴对颈性眩晕患者椎-基底动脉血流动力学影响的初步观察[J].针灸临床杂志,2011,27(10):1-3.
[15]吴咚咚,李岩,张智龙.针刺配合益智饮对血管性痴呆大鼠海马组织Bcl-2和Bax蛋白表达的影响[J].中医药学报,2017,45(1):31-36.
[16]梁超.电针对脑缺血再灌注大鼠脑皮质局部血流量和血管新生的影响研究[D].武汉:湖北中医药大学,2014.
[17]罗勇,董为伟.电针下调大鼠局灶性脑缺血/再灌注时大脑皮质促凋亡基因bax蛋白表达[J].针刺研究,1999,24(4):274-277.
[18]李梅,王彦荣,王琦,等.青光眼视神经损害的血流动力学观察[J].中国实用医药,2015,10(24):39-40.
[19]罗勇,董为伟.电针上调大鼠局灶性脑缺血/再灌注时脑组织抗凋亡基因bcl-2蛋白表达[J].中华物理医学与康复杂志,2000,22(1):52.
[20]张志英,余安胜,严振国.电针对脊髓损伤早期bcl-2 mRNA及蛋白表达的影响[J].中国针灸,2003,23(8):37-40.
[21]Oku H,Yamaguchi H,Sugiyama T,et al.Retinal toxicity of nitric oxide released by administration of anitric oxid donor in the albino rabbit[J].Invest Ophthalmol Vis Sci,2014,38(11):2540-2544.
[22]陶陶,徐坚,董佑忠,等.电针及天麻对大鼠脑缺血再灌注后神经细胞凋亡及相关蛋白Bcl-2、Bax表达的影响[J].中国针灸,2004,24(9):55-58.
[23]邹军,张家维,赖新生,等.电针对缺血性中风兴奋性氨基酸、C-fos及细胞凋亡影响[J].陕西中医,2002,23(8):759-761.
[24]李星儿.针刺对宫内窘迫缺氧缺血性脑损伤大鼠新生神经细胞凋亡的影响研究[D].广州:广州中医药大学,2012.
[25]林莉,王玮.视网膜神经节细胞损伤机制及神经保护药物研究进展.[J]医学综述,2013,13(8):318-321.
[26]范春玲.针刺“百会”透“曲鬓”对脑出血模型大鼠脑组织细胞凋亡的作用及机制研究[D].哈尔滨:黑龙江中医药大学,2014.
[27]Ju WK,Kim KY,Noh YH,et al.Increased mitochondrial fission and volume density by blocking glutamate excitotoxicity protect glaucomatous optic nerve head astrocytes[J].Glia,2015,63(5):736.
[28]张小卿,刘立,张宇.针刺治疗缺血性脑血管病机制研究[J].辽宁中医药大学学报,2016,18(10):118-121.
[29]Hoffmann DB,Williams SK,Bojcevski J,et a1.Calcium influx and calpain activation mediate preclinical retinal neurodegeneration in autoimmune optic neuritis[J].J Neuropathol Exp Neurol,2013,72(8):745-757.
[30]韩丹丹,李静敏.青光眼视神经保护的相关分析及研究进展[J].眼科学报,2016,31(1):26-34.
[31]Alyahya K,Chen CT,Brendan G.et al.Microvessel loss,vascular damage and glutamate redistribution in the retinas of dogs with primary glaucoma[J].Veterinary Ophthalmology,2007,10(s1):70-77.
[32]Husain S,Abdul Y,Singh S,et al.Regulation of nitric oxide production byδ-Opioid receptors during glaucomatous injury[J].PLoS One,2014,9:e110397.
[33]安成爀.针刺对EAE大鼠IL-17、NO影响的实验研究[D].北京:北京中医药大学,2012.
[34]张慧,孙河.针刺对慢性高眼压兔视网膜NO和Glu含量的影响[J].针灸临床杂,2006,23(10):47-49.
[35]Domenici L,Origlia N,Falsini B,et al.Rescue of retinal function by BDNF in a mouse model of glaucoma[J].PLoS One,2014,9:e115579.
[36]孙河,张慧,林柏松.针刺对慢性高眼压兔视网膜Bcl-xl、BDNF表达的影响[J].中国针灸,2010,30(8):661-664.
[2]曾远宏,张小薇.青光眼的临床分析[J].中国当代医药,2010,17(22):227.
[3]段俊国.中医眼科学[M].北京:人民卫士出版社,2012.
[4]Di Capua M,Coppola A,Albisinni R,et al.Cardiovascular risk factors and outcome in patients with retinal vein occlusion[J].JThromb Thrombolysis,2010,30(1):16-22.
[5]刘志丹,杨森,朱蓓菁.针刺治疗青光眼研究进展[J].中医学报,2015,30(1):149-151.
[6]张杏林,徐鸣曙,张英杰,等.针刺治疗脑缺血再灌注损伤机制研究进展[J].江苏中医药,2017,49(12):85-88.
[7]王余萍,袁源智.青光眼视神经损害机制[J].中国临床医学,2016,23(5):667-671.
[8]郝美玲,路明,杨柳,等.针刺治疗青光眼性视神经病变的临床疗效分析[J].中国中医眼科杂志,2014,24(5):322-326.
[9]汤晓东,冶英,杨光.针刺对眼压控制稳定青光眼患者视野影响的临床研究[J].中国中医眼科杂志,2015,25(6):428-430.
[10]孙晓雯.针刺治疗青光眼性视神经病变的疗效分析[J].中医临床研究,2015,7(21):84-85.
[11]王蕊.针刺对青光眼眼压控制及患者眼功能的影响[J]国际眼科杂志,2017,5(5):958-960.
[12]刘江,孙河,董霏雪,等.针刺对青光眼视神经损害视觉诱发电位的影响[J].针灸临床杂志,2014,30(6):39-41.
[13]王舒,周颖,李军,等.风池穴提插手法对椎基底动脉供血不足患者血流动力学的影响[J].针灸临床杂志,1997,14(11):26-28.
[14]于慧,韩晶,谭奇纹.针刺睛明穴对颈性眩晕患者椎-基底动脉血流动力学影响的初步观察[J].针灸临床杂志,2011,27(10):1-3.
[15]吴咚咚,李岩,张智龙.针刺配合益智饮对血管性痴呆大鼠海马组织Bcl-2和Bax蛋白表达的影响[J].中医药学报,2017,45(1):31-36.
[16]梁超.电针对脑缺血再灌注大鼠脑皮质局部血流量和血管新生的影响研究[D].武汉:湖北中医药大学,2014.
[17]罗勇,董为伟.电针下调大鼠局灶性脑缺血/再灌注时大脑皮质促凋亡基因bax蛋白表达[J].针刺研究,1999,24(4):274-277.
[18]李梅,王彦荣,王琦,等.青光眼视神经损害的血流动力学观察[J].中国实用医药,2015,10(24):39-40.
[19]罗勇,董为伟.电针上调大鼠局灶性脑缺血/再灌注时脑组织抗凋亡基因bcl-2蛋白表达[J].中华物理医学与康复杂志,2000,22(1):52.
[20]张志英,余安胜,严振国.电针对脊髓损伤早期bcl-2 mRNA及蛋白表达的影响[J].中国针灸,2003,23(8):37-40.
[21]Oku H,Yamaguchi H,Sugiyama T,et al.Retinal toxicity of nitric oxide released by administration of anitric oxid donor in the albino rabbit[J].Invest Ophthalmol Vis Sci,2014,38(11):2540-2544.
[22]陶陶,徐坚,董佑忠,等.电针及天麻对大鼠脑缺血再灌注后神经细胞凋亡及相关蛋白Bcl-2、Bax表达的影响[J].中国针灸,2004,24(9):55-58.
[23]邹军,张家维,赖新生,等.电针对缺血性中风兴奋性氨基酸、C-fos及细胞凋亡影响[J].陕西中医,2002,23(8):759-761.
[24]李星儿.针刺对宫内窘迫缺氧缺血性脑损伤大鼠新生神经细胞凋亡的影响研究[D].广州:广州中医药大学,2012.
[25]林莉,王玮.视网膜神经节细胞损伤机制及神经保护药物研究进展.[J]医学综述,2013,13(8):318-321.
[26]范春玲.针刺“百会”透“曲鬓”对脑出血模型大鼠脑组织细胞凋亡的作用及机制研究[D].哈尔滨:黑龙江中医药大学,2014.
[27]Ju WK,Kim KY,Noh YH,et al.Increased mitochondrial fission and volume density by blocking glutamate excitotoxicity protect glaucomatous optic nerve head astrocytes[J].Glia,2015,63(5):736.
[28]张小卿,刘立,张宇.针刺治疗缺血性脑血管病机制研究[J].辽宁中医药大学学报,2016,18(10):118-121.
[29]Hoffmann DB,Williams SK,Bojcevski J,et a1.Calcium influx and calpain activation mediate preclinical retinal neurodegeneration in autoimmune optic neuritis[J].J Neuropathol Exp Neurol,2013,72(8):745-757.
[30]韩丹丹,李静敏.青光眼视神经保护的相关分析及研究进展[J].眼科学报,2016,31(1):26-34.
[31]Alyahya K,Chen CT,Brendan G.et al.Microvessel loss,vascular damage and glutamate redistribution in the retinas of dogs with primary glaucoma[J].Veterinary Ophthalmology,2007,10(s1):70-77.
[32]Husain S,Abdul Y,Singh S,et al.Regulation of nitric oxide production byδ-Opioid receptors during glaucomatous injury[J].PLoS One,2014,9:e110397.
[33]安成爀.针刺对EAE大鼠IL-17、NO影响的实验研究[D].北京:北京中医药大学,2012.
[34]张慧,孙河.针刺对慢性高眼压兔视网膜NO和Glu含量的影响[J].针灸临床杂,2006,23(10):47-49.
[35]Domenici L,Origlia N,Falsini B,et al.Rescue of retinal function by BDNF in a mouse model of glaucoma[J].PLoS One,2014,9:e115579.
[36]孙河,张慧,林柏松.针刺对慢性高眼压兔视网膜Bcl-xl、BDNF表达的影响[J].中国针灸,2010,30(8):661-664.