丹栀逍遥散加减对视网膜激光...F、ICAM-1水平的影响_徐丹.pdf

基金项目:国家自然科学基金-青年基金项目(编号:81200711)。作者简介:徐丹,硕士,住院医师,主要从事眼科工作,E-mail:xu-dan17782 ;通讯作者:郭斌,博士,副主任医师,272510706 。丹栀逍遥散加减对视网膜激光损伤的疗效及对血清 VEGF、ICAM-1 水平的影响徐丹1,陈世久2,卞玉凡3,马艳萍1,郭斌1,(1.泰康仙林鼓楼医院眼科,江苏 南京 210046;2.青岛大学研究生院,山东 青岛 266000;3.泰康仙林鼓楼医院中医科,江苏 南京 210046)摘要:目的:探讨丹栀逍遥散加减方对视网膜激光损伤的疗效及对血清中血管内皮生长因子(VEGF)、细胞黏附因子-1(ICAM-1)的影响。方法:选取 2018 年 8 月-2021 年 4 月泰康仙林鼓楼医院眼科收治的 76 例可治性视网膜激光损伤患者,按照随机数字表法分为对照组和研究组,各 38 例。对照组给予常规西药治疗,研究组在对照组基础上加以丹栀逍遥散加减方治疗,观察并比较两组临床疗效、激光区视功能、视网膜功能及对血清 VEGF、ICAM-1 的影响及不良反应发生情况。结果:治疗后,研究组临床有效率为 89.53%高于对照组的 68.43%(P0.05);两组激光区每个视点相对三维视野的平均视阈值差、视力均升高,且研究组激光区每个视点相对三维视野的平均视阈值差、视力均高于对照组(P0.05)。治疗后,两组潜伏期视网膜震荡点位(Ops)2 点位、Ops3 点位、Ops4 点位均降低,研究组 Ops1 点位、Ops2 点位均低于对照组(P0.05);两组振幅各时段点位均降低,且研究组 Ops1 点位、Ops2 点位、Ops4 点位均低于对照组(P0.05)。治疗后,两组血清 VEGF、ICAM-1 水平均降低,且研究组血清 VEGF、ICAM-1 水平均低于对照组(P0.05)。结论:丹栀逍遥散加减方可有效改善激光区相对三维视野的平均视阈值及视网膜功能,提高视力,降低炎性反应发生风险,具有较高的临床价值。关键词:视网膜激光损伤;丹栀逍遥散加减方;血管内皮生长因子;血清细胞黏附因子 中图分类号:R 774.1 文献标志码:A 文章编号:1000-3649(2023)02-0177-04 Efficacy Modified Danzhi Xiaoyao Powder for Retina Laser Injury and Its Influence on Serum VEGF and ICAM-1Levels/XU Dan1,CHEN Shijiu2,BIAN Yufan3,et al./1.Department of Ophthalmology,Taikang Xianlin Gulou Hospital(Nanjing Jiangsu 210046,China);2.Graduate School,Qingdao University(Qingdao Shandong 266000,China);3.Depart-ment of Traditional Chinese Medicine,Taikang Xianlin Gulou Hospital(Nanjing Jiangsu 210046,China)Abstract:Objective:To explore the effect of Modified Danzhi Xiaoyao Powder for retinal laser damage and its influence onvascular endothelial growth factor(VEGF)and cell adhesion factor-1(ICAM-1)in serum.Methods:A selection of 76 patientswith curable retinal laser injury included in the ophthalmology department of the hospital from August 2018 to April 2021 weregrouped according to the random number table method,with 38 cases in each group.The controlled group was treated with con-ventional western medicine,and the study group was treated with Modified Danzhi Xiaoyao Powder on the basis of the controlledgroup,observed and compared the clinical efficacy,laser zone visual function,retinal function,the influence on serum VEGF,ICAM-1 and the occurrence of adverse reactions between the two groups.Results:After treatment,the clinical effective rate ofthe study group(89.53%)was higher than that of the controlled group(68.43%)(P0.05).The average visual thresholddifference and visual acuity of each viewpoint relative to the three-dimensional visual field of the two groups of laser areas were in-creased,and the average visual threshold difference and visual acuity of each visual point relative to the three-dimensional visualfield of the study group were higher than those of the controlled group(P0.05).After treatment,the two groups of incubationperiod retinal oscillation points(Ops)2 points,Ops3,Ops4 points were reduced,the Ops1 and Ops2 points in the study groupwere lower than those in the controlled group(P0.05).The amplitudes of the two groups decreased in each time period,and the Ops1,Ops2,and Ops4 points of the studygroup were lower than those of the controlled group(P0.05).After treatment,the serum VEGF and ICAM-1 levels of the two groups decreased,and the serum VEGF and ICAM-1 levels of the study group were lower than those of the controlled group(P0.05).Conclusion:Modified Danzhi XiaoyaoPowder can effectively improve the average visual threshold of the laser area relative to the three-dimensional visual field and reti-nal function,improve vision,and reduce the risk of inflammatory reactions.It has high clinical value.7712023 年第 41 卷第 2 期Vol.41,No.2,2023四 川 中 医Journal of Sichuan of Traditional Chinese Medicine Keywords:Retinal laser injury;Modified Danzhi Xiaoyao Powder;VEGF;ICAM-1激光治疗是目前防治血管性视网膜病变最为有效的方法,其利用光凝固作用,可减少视网膜总代谢需氧量,进而预防新生血管形成、促进眼底出血吸收1。但激光治疗本质属于创伤性技术,在发挥治疗作用的同时光散射及热扩散可直接使光凝斑之间的非治疗区域视网膜结构发生异常,破坏视网膜屏障,造成脉络膜缺血、炎症等医源性损伤,故如何改善视网膜激光损伤是临床亟待解决的问题2-3。随着医疗水平不断提升,中医汤剂疗法因其具有吸收快、作用好、治疗范围广、药味加减灵活等优势逐渐受到人们关注,有研究证实4,其被广泛应用于心脑血管、眼科、口腔等疾病的治疗。激光损伤在中医学上类属“热毒蕴结伤阴”范畴,即热毒伤阴,外邪入肝,血运阻滞,加之血管内出血,造成气血亏虚,停滞成瘀,治疗应清热活血、疏肝解瘀5-6。丹栀逍遥散加减方是中医祛瘀活血之基础方,方含柴胡、白芍、当归、白术等药,诸药合用,共同发挥活血祛瘀之功效7。目前该方在视网膜激光损伤中的应用报道较少,为进一步明确其效果,本研究以76 例可治性视网膜激光损伤患者为例,探讨丹栀逍遥散加减方的临床应用效果,现报道如下。1资料与方法1.1一般资料选取 2018 年 8 月-2021 年 4 月泰康仙林鼓楼医院眼科收治的 76 例可治性视网膜激光损伤患者,按照随机数字表法分为对照组和研究组,各 38 例。对照组男性 19 例,女性 19 例,年龄 3261 岁,平均年龄(45.1210.20)岁;病程 16 年,平均病程(3.161.02)年。研究组男性 18 例,女性 20 例,年龄 3058 岁,平均年龄(44.9610.17)岁;病程 1 5 年,平均病程(3.141.01)年,两组患者临床资料比较无显著差异(P0.05)。本次研究获取泰康仙林鼓楼医院伦理委员会审查批准。1.2纳入与排除标准纳入标准:(1)激光治疗后,经光学相干断层扫描血管造影(OCTA)检查,眼底后极部存在视网膜缺血现象,可观察到毛细血管无灌注区;(2)经 Tso III 级光轻度凝斑反应确认可以接受治疗者;(3)30视野范围内可见屈光间质透明,后极部视网膜无渗出、出血、活动性病变;(4)可正常沟通交流且有较好依从性者;(5)年龄18 岁;(6)患者及家属对研究流程均知情同意。排除标准:(1)激光治疗后屈光间质出现浑浊或眼底发生活动性病变者;(2)治疗期间再次激光治疗或出现发热者;(3)伴有高血压、心绞痛、肿瘤等可能影响治疗效果疾病者;(4)中途退出研究者。1.3方法激光治疗后 24 h 后开始用药,对照组给予常规西药治疗,复合维生素 B 片(江苏鹏鹞药业有限公司,国药准字:H32023635)、维生素 D 滴剂(青 岛 双 鲸 药 业 股 份 有 限 公 司,国 药 准 字:H20113033)、维生素 E 软胶囊(浙江医药股份有限公司,国药准字:H33022103),每次 50 mg,每日 3次。研究组在对照组基础上辅以丹栀逍遥散加减方治疗,组方如下:柴胡 10g,白芍 10g,当归 10g,茯苓 10g,白术 10g,甘草 5g,牡丹皮 6g,栀子 6g,煨生姜 3g,薄荷 3g。随证加减:若肝火尤盛