中医辨证治疗视神经萎缩的临床研究
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摘要
目的
观察中医辨证论治治疗视神经萎缩的临床疗效。
方法
对21例(34眼)视神经萎缩患者具体情况分为肝肾不足、气血不足、肝郁气滞、阴虚火旺四种证型,分别予以左归饮加减(补益肝肾)、八珍汤加减(补益气血)、丹栀逍遥散加减(疏肝理气)、知柏地黄汤加减(滋阴清热)进行治疗,在视力、视野、视觉诱发电位、视网膜断层扫描方面进行治疗前后的比较,并进行显效率、有效率的评价。
结果
1、在视力结果分析中,治疗前后差异有非常显著性意义p＜0.01。其中13只眼视力提高2排以上,5只眼视力提高1排。
2、在视野检查中,视敏感度及视野缺损的治疗前后差异无明显变化。
3、在视觉诱发电位结果分析中,P100波潜伏期明显缩短p＜0.02,波幅无显著性差异。
4、在视网膜断层扫描方面结果分析中,视杯面积、C/D比值及盘沿面积前后治差异不显著(p＞0.05);但是,视网膜神经纤维层厚度有明显提高。
5、根据中医证型疗效分析,治疗好转有极显著性差异,总效率达73.53%。
6、病程与治疗疗效的比较中,病程短高于病程较长,病程与疗效率成相对性。数据显示显著性差异有一定统计意义。
结论
中医辨证论治治疗各病因所导致的视神经萎缩的治疗方法具有较好的临床疗效,好转率达73.53%。在治疗前后分析视力及视觉诱发电位的潜时变化上有明显的差异,(p＜0.02)。在视网膜断层扫描方面,虽然病例样本量少,在统计学上无意义,这里却证明视网膜纤维层厚度在治疗前后的比较有明显性的增生,说明该治疗方法具有保护视神经,提高患者视功能的作用,病程长短对治疗疗效有一定的影响。
Objective
Clinical effectiveness of TCM differentiation treatment on various optic atrophy.
Method
21 cases consists of 34 eyes with various etiological classification of optic atrophy are divided according to their TCM symptomatic conditions into four categories based on deficiency of liver-kidney, deficiency of qi and blood, qi and liver stagnation as well as yin-deficiency and fire-excess types. The four categories were treated respectively with modified zuoguiyin (to nourish liver and kidney), modified bazhentang (to tonify qi and blood ), modified danzhixiaoyaosan (to regulate liver qi ) and modified zhibaidihuangtang (to nourish yin to clear pathogenic heat). Comparisons were done on data obtained before and after treatment. Statistical analysis were performed on data from visual acuity test, field analysis test, Visual Evoked Potential (VEP) and Heidelberg Retina Tomography (HRT).
Results
1. There is significant improvement in vision acuity between before and after treatment, p<0.01.
2. Light sensitivity and visual defects remained almost constant.
3. In the Visual Evoked Potential (VEP) analysis, it is found that P100 peak latency period has significantly reduced, p<0.02 after treatment, while amplitude remained unchanged.
4. In Heidelberg Retina Tomography analysis, cup area, cup/disc ratio and rim area are of no significance improvement, p>0.05; however, retina nerve fiber layer thickness has shown a significant increase.
5. Based on TCM treatment analysis, it is found that the overall effectiveness is 73.53%.
6. There is an observed improvement in effectiveness of treatment for patients with shorter period of disease, however, it is statistically insignificant.
Conclusion
With TCM differentiation treatment on various types of optic atrophy, there is an observbed significant improvement in acuity (p<0.01) and a reduction in VEP latency period (p<0.02). Although sample collected was limited to reach a statistical conclusion on parameters done on HRT tests, it is observed that retina nerve fiber thickness increased by 5% as compared to before treatment. It is evident that TCM differentiation treatment has an impact on visual function protection and thus can improve its functionality.
观察中医辨证论治治疗视神经萎缩的临床疗效。
方法
对21例(34眼)视神经萎缩患者具体情况分为肝肾不足、气血不足、肝郁气滞、阴虚火旺四种证型,分别予以左归饮加减(补益肝肾)、八珍汤加减(补益气血)、丹栀逍遥散加减(疏肝理气)、知柏地黄汤加减(滋阴清热)进行治疗,在视力、视野、视觉诱发电位、视网膜断层扫描方面进行治疗前后的比较,并进行显效率、有效率的评价。
结果
1、在视力结果分析中,治疗前后差异有非常显著性意义p＜0.01。其中13只眼视力提高2排以上,5只眼视力提高1排。
2、在视野检查中,视敏感度及视野缺损的治疗前后差异无明显变化。
3、在视觉诱发电位结果分析中,P100波潜伏期明显缩短p＜0.02,波幅无显著性差异。
4、在视网膜断层扫描方面结果分析中,视杯面积、C/D比值及盘沿面积前后治差异不显著(p＞0.05);但是,视网膜神经纤维层厚度有明显提高。
5、根据中医证型疗效分析,治疗好转有极显著性差异,总效率达73.53%。
6、病程与治疗疗效的比较中,病程短高于病程较长,病程与疗效率成相对性。数据显示显著性差异有一定统计意义。
结论
中医辨证论治治疗各病因所导致的视神经萎缩的治疗方法具有较好的临床疗效,好转率达73.53%。在治疗前后分析视力及视觉诱发电位的潜时变化上有明显的差异,(p＜0.02)。在视网膜断层扫描方面,虽然病例样本量少,在统计学上无意义,这里却证明视网膜纤维层厚度在治疗前后的比较有明显性的增生,说明该治疗方法具有保护视神经,提高患者视功能的作用,病程长短对治疗疗效有一定的影响。
Objective
Clinical effectiveness of TCM differentiation treatment on various optic atrophy.
Method
21 cases consists of 34 eyes with various etiological classification of optic atrophy are divided according to their TCM symptomatic conditions into four categories based on deficiency of liver-kidney, deficiency of qi and blood, qi and liver stagnation as well as yin-deficiency and fire-excess types. The four categories were treated respectively with modified zuoguiyin (to nourish liver and kidney), modified bazhentang (to tonify qi and blood ), modified danzhixiaoyaosan (to regulate liver qi ) and modified zhibaidihuangtang (to nourish yin to clear pathogenic heat). Comparisons were done on data obtained before and after treatment. Statistical analysis were performed on data from visual acuity test, field analysis test, Visual Evoked Potential (VEP) and Heidelberg Retina Tomography (HRT).
Results
1. There is significant improvement in vision acuity between before and after treatment, p<0.01.
2. Light sensitivity and visual defects remained almost constant.
3. In the Visual Evoked Potential (VEP) analysis, it is found that P100 peak latency period has significantly reduced, p<0.02 after treatment, while amplitude remained unchanged.
4. In Heidelberg Retina Tomography analysis, cup area, cup/disc ratio and rim area are of no significance improvement, p>0.05; however, retina nerve fiber layer thickness has shown a significant increase.
5. Based on TCM treatment analysis, it is found that the overall effectiveness is 73.53%.
6. There is an observed improvement in effectiveness of treatment for patients with shorter period of disease, however, it is statistically insignificant.
Conclusion
With TCM differentiation treatment on various types of optic atrophy, there is an observbed significant improvement in acuity (p<0.01) and a reduction in VEP latency period (p<0.02). Although sample collected was limited to reach a statistical conclusion on parameters done on HRT tests, it is observed that retina nerve fiber thickness increased by 5% as compared to before treatment. It is evident that TCM differentiation treatment has an impact on visual function protection and thus can improve its functionality.
引文
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