明目合剂治疗小儿弱视的临床观察
摘要
目的:研究明目合剂治疗小儿弱视的临床疗效并对其病因病机进行了系统的探讨。已故著名中医眼科专家衣元良教授根据多年临床经验,对小儿弱视确立了滋补肝肾、健脾益气、养血明目的治疗原则,研制出视明饮汤剂,并在视明饮汤剂的基础上制成明目合剂。本人在导师指导下对临床服用明目合剂的弱视患者进行了初步临床观察,旨在客观评价本药对弱视的治疗效果,并作初步机理探讨。方法:治疗组46例79眼口服中药明目合剂加配镜加遮盖。1个月为1疗程,一般进行1～6个疗程。对照组:口服思利巴加配镜加遮盖。4周为1疗程,服用1～3个月。分别观察两组治疗前后远视力,并对治疗组进行治疗前后视觉诱发电位(P-VEP)检查。结果:治疗组基本治愈率和有效率分别为65.8%和95%,优于对照组(58.1%,93%),且治疗组P-VEP的P_(100)波振幅提高,潜伏期缩短。与视明饮汤剂相比,疗效无显著性差异。结论:明目合剂疗效可靠,与汤剂具有相同的结果。其治疗机理实质可能是通过提高机体自身的反应性而达治疗目的。
Objective: To observe the clinical effect and primary mechanism of Mingmu Mixture treating Amblyopia in Children. According to the clinical experience of famous ophthalmologist of TCM Yi Yuanliang, we established the therapeutic principle of nourishing the kidney and liver, recuperating the spleen and Qi, replenishing blood, and made Siming Yin. On the base of Siming Yin, Mingmu Mixture was made treating Amblyopia in Children. Methods:Curative group fourty-six patients with seventy-nine eyes of amblyopia were treated by Mingmu Mixture with glasses. Four weeks was a course of treatment, and were made one to six courses. Control group were treated by Siliba with glasses. Four weeks was a course of treatment, and were made one to three courses. The changes of presbyopia and the data of P-VEP of curative group were observed before and after treatment. Results: The primary cure rate and effective rate are 65.8% and 95%. Compared with control group, the data of P-VEP after treatment was also improved significantly. Compared with Siming Yin, the curative effect of Mingmu Mixture had no remarkable difference. Conclusion: Mingmu Mixture, the same as Siming Yin is a group of effective drugs treating Amblyopia in Children. The crux of the therapy of Mingmu Mixture may be credited with the promotion of the body self's responsibility to outer stimuli.
Objective: To observe the clinical effect and primary mechanism of Mingmu Mixture treating Amblyopia in Children. According to the clinical experience of famous ophthalmologist of TCM Yi Yuanliang, we established the therapeutic principle of nourishing the kidney and liver, recuperating the spleen and Qi, replenishing blood, and made Siming Yin. On the base of Siming Yin, Mingmu Mixture was made treating Amblyopia in Children. Methods:Curative group fourty-six patients with seventy-nine eyes of amblyopia were treated by Mingmu Mixture with glasses. Four weeks was a course of treatment, and were made one to six courses. Control group were treated by Siliba with glasses. Four weeks was a course of treatment, and were made one to three courses. The changes of presbyopia and the data of P-VEP of curative group were observed before and after treatment. Results: The primary cure rate and effective rate are 65.8% and 95%. Compared with control group, the data of P-VEP after treatment was also improved significantly. Compared with Siming Yin, the curative effect of Mingmu Mixture had no remarkable difference. Conclusion: Mingmu Mixture, the same as Siming Yin is a group of effective drugs treating Amblyopia in Children. The crux of the therapy of Mingmu Mixture may be credited with the promotion of the body self's responsibility to outer stimuli.
引文
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[22] 张方华.我国弱视与斜视防治10年进展.中华眼科杂志,2000:36(3):208-211.
[23] 郭少山等.视网膜多巴胺与实验性近视相关性研究.中国斜视与小儿眼科杂
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[3] 高亚林.思利巴联合同视机治疗儿童弱视.眼科新进展,2004:24(5):411-412.
[4] 全国儿童弱视斜视防治组.弱视的定义,分类及疗效评价标准[J].中国斜视与小儿眼科杂志,1996,4(3):97
[5] Keyser SM. The induction ofgeneexpression inmammalian cells by radiation[J]. Semin Cancer Biol 1993; 4(2): 119-128.
[6] Imamura K. A neuroscientific approach to amblyopia[J]. Jap Rev Clin Ophthalmol 1997; 91(7): 1049-1053.
[7] 赵春宁,胡聪.斜视性弱视猫视皮质17区c-fos mRNA在治疗前后的表达.眼科新进展,2003:23(1):20-23.
[8] 阴正勤.弱视发病机制研究进展.中国斜视与小儿眼科杂志,2004:12(1):45-48.
[9] Lein ES, Shatz CJ. Rapid regulation of brain-derived neurotrophic factor mRNA within eye-specific circuits during ocular dominance column formation. J Neuroscience, 2000, 20: 1470.
[10] Hata Y, Ohshima M, Icisaka S, et al. Brain-derived neurotrophic factor expands ocular dominance columns in visual cortex in nomocularly deprived and nondeprived kittens but does not in adult cats. J Neuroscience, 2000, 20: 1457.
[11] Mallei L, Berardi N, Dommenici L, et al. Nerve growth factor (NGF) prevents the shift in ocular dominance distribution of visual cortical neurons in monocularly deprived rats. J Neuroscience, 1992, 12: 4651.
[12] Dormnenici L, Fontanesi G, Cattaneo A, et al. Nerve growth factor (NGF) uptake and transport following injection in the developing rat visual cortex. Vision Neuroscience, 1994, 11: 1093.
[13] Lodovichi C, Beradi N, Pizzorusso T, et al. Effects of neu rotrophins on cortical plasticity: same or different J Neuro science. 2000. 20: 2155.
[14] Gu Q, Liu Y, Cynader MS. Nerve growth factor-induced ocular dominance plasticity in adult cat visual cortex. Proc Natl Acad Sci USA, 1994, 91: 8408.
[15] Cabelli RJ, Hohn A, Shatz CJ. Inhibition of ocular dominance column formation by infusion of NT-4/5 or BDNF. Science, 1995, 267: 1662.
[16] Galuske RAW, Rim DS, Castren E, et al. Differential effects of neurotrophins on ocular dominance plasticity in developing and adult cat visual cortex. Eur J Neuroscience, 2000, 12: 3315.
[17] Silver MA, Fagiiolini DC, Gillespie CL, et al. Infusion of nerve growth factor(NGF) into kitten visual cortex increases immunoreactivity for NGF, NGF receptors, and choline acetyltransferase in basal forebrain without affection ocular dominance plasticity or column development: Neuroscience, 2001, 108: 569.
[18] Yin ZQ, Crewther GS, Crewther PD. Distribution and localization of NMDA receptor subunit 1 in the visual cortex of strabismic and anisometropic amblyopic cat. Neuroreport, 1996, 7: 2997.
[19] Yin ZQ, Crewther SG, Pirie B, et al. NMDA-R1 immunoreactivity in the developing visual cortex of strabismic kittens. Invest Ophthalmol Vis. Sci. (Suppl), 1999, 40: 1608.
[20] Philpot BD, Sekhar AK, Shouval HZ, et al. Visuat experience and deprivation bidirectionally modify the composition and function of NMDA receptors in visual cortex. Neuron, 2001, 29: 157.
[21] Cao ZP, Lickey ME, Liu LJ, et al. Postnatal developmentof NR1, NR2A and NR2B immunoreactivity in the visual cortex of the rat. Brain Res. 2000. 859: 26.
[22] 张方华.我国弱视与斜视防治10年进展.中华眼科杂志,2000:36(3):208-211.
[23] 郭少山等.视网膜多巴胺与实验性近视相关性研究.中国斜视与小儿眼科杂