益气活血通络法对非动脉炎性前部缺血性视神经病变视功能保护的研究
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摘要
目的
通过分析益气活血通络法对NAION患者的临床疗效,评价益气活血通络法对NAION患者视力、视野及视神经纤维层的影响。实验观察益气活血通络法在不同时间段rAION大鼠视网膜细胞超微结构、RNFL的变化,本法对rAION的视网膜神经纤维层的保护。探讨益气活血通络法治疗NAION的临床疗效和可能实验作用机制。
方法
1.临床研究
本试验采用随机对照的临床研究,以NAION患者39例49眼为观察对象,随机分为观察组及对照组。观察组：黄芪注射液20 ml、川芎嗪注射液160 mg、醒脑静注射静脉20 ml及地塞米松10mg分别加入0.9%N.S 250 ml中静脉点滴,每日1次,2周为1个疗程。静脉点滴1～2个疗程。地塞米松3～5天后逐渐减量。同时予以益气活血通络汤随证加减,每日1剂。
对照组：地塞米松10mg分别加入0.9%N.S 250 ml中静脉点滴,每日1次,静脉点滴1～2个疗程。地塞米松3～5天后逐渐减量。
观察该综合疗法对NAION患者视力、视野及神经纤维层厚度的影响,通过治疗前后对照,及组间疗效的比较,探讨该综合疗法对NAION的临床疗效及可能的作用机理。
2.实验研究
将符合条件要求的SD大鼠共40只,随机分成4组,分别为空白对照组、模型对照组、观察组、对照组,每组10只SD大鼠。研究采用从大鼠尾静脉注入孟加拉红2.5 mmol／(mL.kg),即刻加置VLOK 90D前置镜对视盘上方2／3面积,用裂隙灯绿光(514～535 nm)进行照射,光斑直径500 um,照射时间20s,来造模。在造模成功后,观察组予以黄芪注射液1.8ml／kg、川芎嗪注射液15mg／kg以及醒脑静注射液1.8ml／kg腹腔注射,每天1次；西药对照组予以地塞米松注射1.8mg／kg腹腔注射,每天1次。通过对rAION大鼠者治疗前后进行OCT检测,以客观评价中药黄芪注射液、川芎嗪注射液及醒脑静注射液对rAION视网膜视神经纤维层改变的影响。通过对rAION治疗前后视网膜光学显微镜及电子显微镜下改变的观察,以客观评价中药黄芪注射液、川芎嗪注射液及醒脑静注射液对rAION眼底视网膜病理及超微结构的改变研究。
结果
1.在本组病例的临床观察中,观察组20例(26眼)患者中,治愈5眼,治愈率19.23%；显效11眼,有效8眼,无效2眼,总有效率92.31%；对照组19例(23眼)患者中,治愈2眼,治愈率8.7%；显效8眼,有效8眼,无效5眼,总有效率78.26%。两组比较,经统计学分析,观察组疗效优于对照组。
2.观察组中患者经过治疗,患者视力普遍得到提高。在经过2周治疗后,观察组与对照组视野缺损对比,两组视野缺损度都有改善,两组比较,t=1.811,P>0.05,统计学分析无明显差异。在经过4周治疗后,观察组与对照组视野缺损对比,观察组好转明显,两组比较,t=2.666,P<0.05,统计学分析差异有统计学意义,说明本疗法对NAION经过4w治疗后,对视野缺损改善明显优于对照组。
3.在本组临床观察的39例患者中,在治疗前及治疗后2周进行OCT检查共计15例,观察组9例12眼,对照组7例10眼。观察组与对照组经过2周治疗,患者神经纤维层水肿都有所减轻,两组比较,t=-3.978,P<0.05,统计学分析差异有统计学意义,对照组与观察组比较,神经纤维层开始萎缩、变薄。
4.实验研究OCT显示：
正常SD大鼠OCT扫描右眼提示鼻侧RNFL厚度79.80±6.94um,视网膜各层结构清晰；模型组造模1d后RNFL厚度为96.70±5.60 um,RNFL水肿增厚,与空白对照组经统计学分析,P<0.05,差异有统计学意义；模型组造模7d后RNFL厚度为88.75±7.03um,RNFL仍水肿增厚,与模型组造模1d经统计学分析,P<0.05,差异有统计学意义；模型组造模后14 d后RNFL厚度为67.17±5.49 um,RNFL萎缩变薄,与模型组造模1d经统计学分析,P<0.05,差异有统计学意义。
观察组7d后RNFL厚度为74.75±4.03 um,RNFL厚度接近正常SD大鼠RNFL厚度,无明显水肿,与空白对照组经统计学分析,P>0.05,差异无统计学意义；观察组14d后RNFL厚度为80.17±5.12 um,RNFL厚度接近正常SD大鼠RNFL厚度,与空白对照组经统计学分析,P>0.05,差异无统计学意义；观察组7d与14 d RNFL厚度接近,经统计学分析,P>0.05,差异无统计学意义。
对照组7d后为97.50±9.06 um, RNFL仍水肿增厚,与空白对照组经统计学分析,P<0.05,差异有统计学意义；对照组14 d RNFL厚度为64.0±6.20 um, RNFL厚度萎缩变薄,与空白对照组经统计学分析,P<0.05,差异有统计学意义；对照组7d与14d RNFL厚度经统计学分析,P<0.05,差异有统计学意义。
观察组7d与对照组7 d RNFL厚度,经统计学分析,P<0.05,差异有统计学意义；观察组14d与对照组14 d RNFL厚度,经统计学分析,P<0.05,差异有统计学意义。
5.实验中光镜显示：
正常SD大鼠视神经视网膜光学显微镜像：视网膜形态正常,结构层次清楚,内外节排列整齐规则,分界清晰,视神经纤维排列有序,视网膜色素上皮层,内、外颗粒层清晰,排列有序,神经节细胞密集,血管通畅。
1周后各组rNAON视网膜光镜下的变化：模型组视网膜感光细胞外节结构紊乱、破裂,视神经纤维水肿、坏死,视网膜移位,血管闭塞；观察组视网膜外节水肿消退,排列有序,血管部分再通；对照组视网膜外节水肿、疏松,排列紊乱,空泡化,血管闭塞。
2周后各组rNAON视网膜光镜下的变化：模型组视网膜神经纤维层变薄明显,仍排列不整齐,血管仍闭塞；观察组视网膜外节水肿消退,视网膜各层结构较清晰,外节稍疏松、肿胀,但较完整,具有较高密度的内节,各层表面轻微的肿胀,神经纤维层排列整齐,未见明显的色素上皮改变,血管再通；对照组视细胞外节轻度肿胀、疏松,神经节细胞轻度肿胀,见空泡化,视网膜神经纤维层进一步变薄,血管仍闭塞。
6.实验中SD大鼠电镜显示：观察组1周毛细血管扩张充血,管壁较薄,神经节细胞大部分线粒体不空,偶见线粒体空泡化,细胞核无溶解,胞膜完整,细胞核致密,突触内微丝减少；对照组1周神经节细胞显示：毛细血管扩张充血,线粒体空泡样改变,细胞核溶解,内质网扩张,细胞核膜完整,轴突内微丝减少较明显。而2周后观察组神经细胞电镜显示：神经节细胞细胞核胞膜完整,胞质正常,线粒体变化不明显,线粒体少许空泡样改变,神经节细胞线粒体稍肿胀,核变化不明显,突触明显可见清晰微丝,毛细血管、神经纤维细胞清晰可见；对照组神经细胞电镜显示：神经节细胞细胞核不均匀、浓缩、凋亡,线粒体空泡,突触内微丝减少明显。观察组治疗作用突出表现在对神经细胞的视网膜突触、内节神经细胞线粒体以及毛细血管的保护作用上,其疗效可由视神经细胞突触及传导通路的连接结构敏感的反映出来,与视信号传导通路的修复密切相关。
结论
1临床证实本综合疗法能使急性期NAION的病情得到较快控制,临床疗效显著。
2临床证实对NAION患者的视力、视野及神经纤维层有改善作用,提示益气活血通络综合疗法对NAION有保护视神经功能的作用,在临床中值得推广。
3动物实验形态学证实,本综合疗法的使用,对rAION视网膜神经纤维层有保护作用,对rAION视网膜缺血损伤有明显的保护作用。
4动物实验证实本综合疗法能有效地改善了眼部血液循环与灌注,增加了视神经血液供应,减轻了神经组织水肿,使受损的视神经功能得到恢复。对视网膜突触复合体、内节神经细胞线粒体以及毛细血管有保护作用。
Objective:To investigate the clinical effect and mechanism of in collaterals on patients with nonarteritic anterior ischemic optic neuropathy (NAION) and to investigate the method of Yiqihuoxuetongluo on protective effect for rNAION.
Methods:This study included two parts:clinical study and experimental study. In clinical study,39 patients with NAION (49 eyes) were randomly divided into observation group and control group. The patients in observation group were treated by intravenous Huangqi injection (20 ml), ligustrazine injection (160 mg), Xingnaojing injection (20 ml) and dexamethasone (10 mg), which were added into 0.9% normal saline (250 ml). The patients in control group were treated by intravenous dexamethasone (10 mg).The drugs were administrated by intravenous drip, once a day, and a course of treatment was 2 weeks. The patients were treated by 1-2 courses of treatment. The dose of dexamethasone was decreased grdually after 3-5 d. In addition, the patients in observation group were treated byYiqihuoxuetongluo decoction, modified with the symptoms, with a dose per day. The vision, field of vision and retinal nerve fiber layer (RNFL) were observation before and after treatment.
In experiment study,40 Sprague-Dawley rats were randomly divided into 4 groups: normal group, model group, observation group and control group, with 10 rats in each group. After rose bengal (2.5 mmol/mL.kg) was injected by tail vein,2/3 of the area above the optic disk was irradiated with green laser (514-535 nm) with 500μm of the laser diameter for 20 s. After the rAION model was made successfully, Huangqi injection (1.8 ml/kg), ligustrazine injection (15 mg/kg), Xingnaojing injection (1.8 ml/kg) were injected intraperitoneally, once a day. The rats in control group were treated by dexamethasone (1.8 ml/kg) intraperitoneally, once a day. The changes of RNFL and retinal ultra microstructure were observated.
Results:
1. Among 20 patients (26 eyes) in observation group,5 eyes were cured with cure rate of 19.23%,11 eyes had marked effect,8 eyes had effect,2 eyes had no effect. The total effective rate was 92.31%. Among 19 patients (23 eyes) in control group,2 eyes were cured with cure rate of 8.7%,8 eyes had marked effect,8 eyes had effect,5 eyes had no effect. The total effective rate was 78.26%. Compared with the control group, the therapeutic effect in observation group was significantly superior to the control.
2. After 2 weeks treatment, the visual field defect were improved in two groups, but there was no statistical significance in the two groups (P>0.05). Compared with the control, the visual field defect of patients in observation group was improved significanly after 4 weeks treatment (P<0.05).
3.15 patients were examed by OCT before treatment and 2 weeks post-treatment,9 patients in observation group and 7 patients in control group. Compared with the control, the edema of retinal nerve fibre were significantly alleviated (P<0.05). The retinal nerve fibre began to shrink and tenuate in patients of control group.
4. The nasal lateral RNFL in model rats of 1d was significantly thicker than that of normal rats (96.70±5.60μm vs 79.80±6.94μm, P<0.05), so was in model rats of 7d (88.75v7.03μm vs 79.80■6.94μm, P<0.05). After 14d, the RNFL was significantly thinner than that of Id (67.17±5.49μm vs 96.70±5.60μm, P＜0.05). The RNFL of rats after 7 d treantment in observation group was close to normal (74.75＜4.03μm vs 79.80＜6.94μm, P>0.05), so was the RNFL of rats after14 d treatment. In control group, the RNFL of rats after 7 d treatment was significantly thicker than that of normal rats (97.50±9.06μm vs 79.80±6.94μm, P<0.05), after 14 d treatment, the RNFL alleviated compared with that of 7 d treatment and that of normal (P＜0.05).
The RNFL of rats after 7 d treatment in observation group was significantly thiner than that of rats 7 d treatment in control group (P<0.05), and The RNFL of rats after 14 d treatment in observation group was significantly thicker than that of rats 14 d treatment in control group (P＜0.05).
5. The retina was observed by light microscope, indicating that the configuration of retinal photosensitive cells outer segments was turbulent and broken, the optic nerve were dropsical and necrotic, the retina was shifted, the blood vessles were occluded in rNAON after 1 week. In rats of observation group, the edema of retinal outer segments was regressive, and they were organized. A portion of occluded vessesls was reperfused. In rats of control group, the retinal outer segments was dropsical, loose, turbulent and vacuolized, the blood vessles were occluded. Two weeks later, RNFL of rats in model group was attenuated, the vessels were occlusive. In rats of observation group, the edema of retinal outer segments was regressive, the retinal structure was clear, the outer segments were loose and swoln, inner segments were dense, the surface of every layer was some swoln, the layer of nerve fibre was well organized, there is no changes in pigment epithelium, the occluded vessesls was reperfused. In rats of control group, the outer segments were mildly loose and swoln, the nerve cells were mildly swollen and vacuolized, the RNFL was thinner, and the vessels were still occluded.
6. The retina of rats in observation group was observed by electron microscope, indicating congestive and dilated capillary, thin vascular wall, few vacuolized mitochondria, no dissolved nucleolus, intact cell membrane, dense nucleoli and decreased microfilaments in the synapses. In rats of control group, it showed congestive capillary, vacuolized mitochondria, dissolved nucleoli, dilated endoplasmic reticulum, intact nucleus membrane and decreased microfilaments in the synapses. After 2 weeks treatment in observation group, it showed intact nuclear membrane, normal cytoplasma, few vacuolized mitochondria, unchanged nucleoli, and clear microfilaments, capillary and nerve fibrocytes in the synapses. In rats of control group, it showed asymmetric, concentrated and apototic nucleoli, vacuolized mitochondria and decreased microfilaments in the synapses.
Conclusion:
1. The method of Yiqihuoxuetongluo in collaterals could control the condition of acute NAION rapidly with marked effect.
2. The method of Yiqihuoxuetongluo in collaterals could improve the vision, visual field and RNFL, suggesting it could protect the function of optic nerve. The therapy is worth popularizing in clinic.
3. The method of Yiqihuoxuetongluo in collaterals could protect the RNFL and the ischemic injury in rAION.
4. The method of Yiqihuoxuetongluo in collaterals could improve the occular circulation, increase the blood supply of optic nerve, alleviate the edema of nerve and restore the function of optic nerve. It also has protective role on retina synapses complex, mitochondria in inner segment nerve cells and capillary.
通过分析益气活血通络法对NAION患者的临床疗效,评价益气活血通络法对NAION患者视力、视野及视神经纤维层的影响。实验观察益气活血通络法在不同时间段rAION大鼠视网膜细胞超微结构、RNFL的变化,本法对rAION的视网膜神经纤维层的保护。探讨益气活血通络法治疗NAION的临床疗效和可能实验作用机制。
方法
1.临床研究
本试验采用随机对照的临床研究,以NAION患者39例49眼为观察对象,随机分为观察组及对照组。观察组：黄芪注射液20 ml、川芎嗪注射液160 mg、醒脑静注射静脉20 ml及地塞米松10mg分别加入0.9%N.S 250 ml中静脉点滴,每日1次,2周为1个疗程。静脉点滴1～2个疗程。地塞米松3～5天后逐渐减量。同时予以益气活血通络汤随证加减,每日1剂。
对照组：地塞米松10mg分别加入0.9%N.S 250 ml中静脉点滴,每日1次,静脉点滴1～2个疗程。地塞米松3～5天后逐渐减量。
观察该综合疗法对NAION患者视力、视野及神经纤维层厚度的影响,通过治疗前后对照,及组间疗效的比较,探讨该综合疗法对NAION的临床疗效及可能的作用机理。
2.实验研究
将符合条件要求的SD大鼠共40只,随机分成4组,分别为空白对照组、模型对照组、观察组、对照组,每组10只SD大鼠。研究采用从大鼠尾静脉注入孟加拉红2.5 mmol／(mL.kg),即刻加置VLOK 90D前置镜对视盘上方2／3面积,用裂隙灯绿光(514～535 nm)进行照射,光斑直径500 um,照射时间20s,来造模。在造模成功后,观察组予以黄芪注射液1.8ml／kg、川芎嗪注射液15mg／kg以及醒脑静注射液1.8ml／kg腹腔注射,每天1次；西药对照组予以地塞米松注射1.8mg／kg腹腔注射,每天1次。通过对rAION大鼠者治疗前后进行OCT检测,以客观评价中药黄芪注射液、川芎嗪注射液及醒脑静注射液对rAION视网膜视神经纤维层改变的影响。通过对rAION治疗前后视网膜光学显微镜及电子显微镜下改变的观察,以客观评价中药黄芪注射液、川芎嗪注射液及醒脑静注射液对rAION眼底视网膜病理及超微结构的改变研究。
结果
1.在本组病例的临床观察中,观察组20例(26眼)患者中,治愈5眼,治愈率19.23%；显效11眼,有效8眼,无效2眼,总有效率92.31%；对照组19例(23眼)患者中,治愈2眼,治愈率8.7%；显效8眼,有效8眼,无效5眼,总有效率78.26%。两组比较,经统计学分析,观察组疗效优于对照组。
2.观察组中患者经过治疗,患者视力普遍得到提高。在经过2周治疗后,观察组与对照组视野缺损对比,两组视野缺损度都有改善,两组比较,t=1.811,P>0.05,统计学分析无明显差异。在经过4周治疗后,观察组与对照组视野缺损对比,观察组好转明显,两组比较,t=2.666,P<0.05,统计学分析差异有统计学意义,说明本疗法对NAION经过4w治疗后,对视野缺损改善明显优于对照组。
3.在本组临床观察的39例患者中,在治疗前及治疗后2周进行OCT检查共计15例,观察组9例12眼,对照组7例10眼。观察组与对照组经过2周治疗,患者神经纤维层水肿都有所减轻,两组比较,t=-3.978,P<0.05,统计学分析差异有统计学意义,对照组与观察组比较,神经纤维层开始萎缩、变薄。
4.实验研究OCT显示：
正常SD大鼠OCT扫描右眼提示鼻侧RNFL厚度79.80±6.94um,视网膜各层结构清晰；模型组造模1d后RNFL厚度为96.70±5.60 um,RNFL水肿增厚,与空白对照组经统计学分析,P<0.05,差异有统计学意义；模型组造模7d后RNFL厚度为88.75±7.03um,RNFL仍水肿增厚,与模型组造模1d经统计学分析,P<0.05,差异有统计学意义；模型组造模后14 d后RNFL厚度为67.17±5.49 um,RNFL萎缩变薄,与模型组造模1d经统计学分析,P<0.05,差异有统计学意义。
观察组7d后RNFL厚度为74.75±4.03 um,RNFL厚度接近正常SD大鼠RNFL厚度,无明显水肿,与空白对照组经统计学分析,P>0.05,差异无统计学意义；观察组14d后RNFL厚度为80.17±5.12 um,RNFL厚度接近正常SD大鼠RNFL厚度,与空白对照组经统计学分析,P>0.05,差异无统计学意义；观察组7d与14 d RNFL厚度接近,经统计学分析,P>0.05,差异无统计学意义。
对照组7d后为97.50±9.06 um, RNFL仍水肿增厚,与空白对照组经统计学分析,P<0.05,差异有统计学意义；对照组14 d RNFL厚度为64.0±6.20 um, RNFL厚度萎缩变薄,与空白对照组经统计学分析,P<0.05,差异有统计学意义；对照组7d与14d RNFL厚度经统计学分析,P<0.05,差异有统计学意义。
观察组7d与对照组7 d RNFL厚度,经统计学分析,P<0.05,差异有统计学意义；观察组14d与对照组14 d RNFL厚度,经统计学分析,P<0.05,差异有统计学意义。
5.实验中光镜显示：
正常SD大鼠视神经视网膜光学显微镜像：视网膜形态正常,结构层次清楚,内外节排列整齐规则,分界清晰,视神经纤维排列有序,视网膜色素上皮层,内、外颗粒层清晰,排列有序,神经节细胞密集,血管通畅。
1周后各组rNAON视网膜光镜下的变化：模型组视网膜感光细胞外节结构紊乱、破裂,视神经纤维水肿、坏死,视网膜移位,血管闭塞；观察组视网膜外节水肿消退,排列有序,血管部分再通；对照组视网膜外节水肿、疏松,排列紊乱,空泡化,血管闭塞。
2周后各组rNAON视网膜光镜下的变化：模型组视网膜神经纤维层变薄明显,仍排列不整齐,血管仍闭塞；观察组视网膜外节水肿消退,视网膜各层结构较清晰,外节稍疏松、肿胀,但较完整,具有较高密度的内节,各层表面轻微的肿胀,神经纤维层排列整齐,未见明显的色素上皮改变,血管再通；对照组视细胞外节轻度肿胀、疏松,神经节细胞轻度肿胀,见空泡化,视网膜神经纤维层进一步变薄,血管仍闭塞。
6.实验中SD大鼠电镜显示：观察组1周毛细血管扩张充血,管壁较薄,神经节细胞大部分线粒体不空,偶见线粒体空泡化,细胞核无溶解,胞膜完整,细胞核致密,突触内微丝减少；对照组1周神经节细胞显示：毛细血管扩张充血,线粒体空泡样改变,细胞核溶解,内质网扩张,细胞核膜完整,轴突内微丝减少较明显。而2周后观察组神经细胞电镜显示：神经节细胞细胞核胞膜完整,胞质正常,线粒体变化不明显,线粒体少许空泡样改变,神经节细胞线粒体稍肿胀,核变化不明显,突触明显可见清晰微丝,毛细血管、神经纤维细胞清晰可见；对照组神经细胞电镜显示：神经节细胞细胞核不均匀、浓缩、凋亡,线粒体空泡,突触内微丝减少明显。观察组治疗作用突出表现在对神经细胞的视网膜突触、内节神经细胞线粒体以及毛细血管的保护作用上,其疗效可由视神经细胞突触及传导通路的连接结构敏感的反映出来,与视信号传导通路的修复密切相关。
结论
1临床证实本综合疗法能使急性期NAION的病情得到较快控制,临床疗效显著。
2临床证实对NAION患者的视力、视野及神经纤维层有改善作用,提示益气活血通络综合疗法对NAION有保护视神经功能的作用,在临床中值得推广。
3动物实验形态学证实,本综合疗法的使用,对rAION视网膜神经纤维层有保护作用,对rAION视网膜缺血损伤有明显的保护作用。
4动物实验证实本综合疗法能有效地改善了眼部血液循环与灌注,增加了视神经血液供应,减轻了神经组织水肿,使受损的视神经功能得到恢复。对视网膜突触复合体、内节神经细胞线粒体以及毛细血管有保护作用。
Objective:To investigate the clinical effect and mechanism of in collaterals on patients with nonarteritic anterior ischemic optic neuropathy (NAION) and to investigate the method of Yiqihuoxuetongluo on protective effect for rNAION.
Methods:This study included two parts:clinical study and experimental study. In clinical study,39 patients with NAION (49 eyes) were randomly divided into observation group and control group. The patients in observation group were treated by intravenous Huangqi injection (20 ml), ligustrazine injection (160 mg), Xingnaojing injection (20 ml) and dexamethasone (10 mg), which were added into 0.9% normal saline (250 ml). The patients in control group were treated by intravenous dexamethasone (10 mg).The drugs were administrated by intravenous drip, once a day, and a course of treatment was 2 weeks. The patients were treated by 1-2 courses of treatment. The dose of dexamethasone was decreased grdually after 3-5 d. In addition, the patients in observation group were treated byYiqihuoxuetongluo decoction, modified with the symptoms, with a dose per day. The vision, field of vision and retinal nerve fiber layer (RNFL) were observation before and after treatment.
In experiment study,40 Sprague-Dawley rats were randomly divided into 4 groups: normal group, model group, observation group and control group, with 10 rats in each group. After rose bengal (2.5 mmol/mL.kg) was injected by tail vein,2/3 of the area above the optic disk was irradiated with green laser (514-535 nm) with 500μm of the laser diameter for 20 s. After the rAION model was made successfully, Huangqi injection (1.8 ml/kg), ligustrazine injection (15 mg/kg), Xingnaojing injection (1.8 ml/kg) were injected intraperitoneally, once a day. The rats in control group were treated by dexamethasone (1.8 ml/kg) intraperitoneally, once a day. The changes of RNFL and retinal ultra microstructure were observated.
Results:
1. Among 20 patients (26 eyes) in observation group,5 eyes were cured with cure rate of 19.23%,11 eyes had marked effect,8 eyes had effect,2 eyes had no effect. The total effective rate was 92.31%. Among 19 patients (23 eyes) in control group,2 eyes were cured with cure rate of 8.7%,8 eyes had marked effect,8 eyes had effect,5 eyes had no effect. The total effective rate was 78.26%. Compared with the control group, the therapeutic effect in observation group was significantly superior to the control.
2. After 2 weeks treatment, the visual field defect were improved in two groups, but there was no statistical significance in the two groups (P>0.05). Compared with the control, the visual field defect of patients in observation group was improved significanly after 4 weeks treatment (P<0.05).
3.15 patients were examed by OCT before treatment and 2 weeks post-treatment,9 patients in observation group and 7 patients in control group. Compared with the control, the edema of retinal nerve fibre were significantly alleviated (P<0.05). The retinal nerve fibre began to shrink and tenuate in patients of control group.
4. The nasal lateral RNFL in model rats of 1d was significantly thicker than that of normal rats (96.70±5.60μm vs 79.80±6.94μm, P<0.05), so was in model rats of 7d (88.75v7.03μm vs 79.80■6.94μm, P<0.05). After 14d, the RNFL was significantly thinner than that of Id (67.17±5.49μm vs 96.70±5.60μm, P＜0.05). The RNFL of rats after 7 d treantment in observation group was close to normal (74.75＜4.03μm vs 79.80＜6.94μm, P>0.05), so was the RNFL of rats after14 d treatment. In control group, the RNFL of rats after 7 d treatment was significantly thicker than that of normal rats (97.50±9.06μm vs 79.80±6.94μm, P<0.05), after 14 d treatment, the RNFL alleviated compared with that of 7 d treatment and that of normal (P＜0.05).
The RNFL of rats after 7 d treatment in observation group was significantly thiner than that of rats 7 d treatment in control group (P<0.05), and The RNFL of rats after 14 d treatment in observation group was significantly thicker than that of rats 14 d treatment in control group (P＜0.05).
5. The retina was observed by light microscope, indicating that the configuration of retinal photosensitive cells outer segments was turbulent and broken, the optic nerve were dropsical and necrotic, the retina was shifted, the blood vessles were occluded in rNAON after 1 week. In rats of observation group, the edema of retinal outer segments was regressive, and they were organized. A portion of occluded vessesls was reperfused. In rats of control group, the retinal outer segments was dropsical, loose, turbulent and vacuolized, the blood vessles were occluded. Two weeks later, RNFL of rats in model group was attenuated, the vessels were occlusive. In rats of observation group, the edema of retinal outer segments was regressive, the retinal structure was clear, the outer segments were loose and swoln, inner segments were dense, the surface of every layer was some swoln, the layer of nerve fibre was well organized, there is no changes in pigment epithelium, the occluded vessesls was reperfused. In rats of control group, the outer segments were mildly loose and swoln, the nerve cells were mildly swollen and vacuolized, the RNFL was thinner, and the vessels were still occluded.
6. The retina of rats in observation group was observed by electron microscope, indicating congestive and dilated capillary, thin vascular wall, few vacuolized mitochondria, no dissolved nucleolus, intact cell membrane, dense nucleoli and decreased microfilaments in the synapses. In rats of control group, it showed congestive capillary, vacuolized mitochondria, dissolved nucleoli, dilated endoplasmic reticulum, intact nucleus membrane and decreased microfilaments in the synapses. After 2 weeks treatment in observation group, it showed intact nuclear membrane, normal cytoplasma, few vacuolized mitochondria, unchanged nucleoli, and clear microfilaments, capillary and nerve fibrocytes in the synapses. In rats of control group, it showed asymmetric, concentrated and apototic nucleoli, vacuolized mitochondria and decreased microfilaments in the synapses.
Conclusion:
1. The method of Yiqihuoxuetongluo in collaterals could control the condition of acute NAION rapidly with marked effect.
2. The method of Yiqihuoxuetongluo in collaterals could improve the vision, visual field and RNFL, suggesting it could protect the function of optic nerve. The therapy is worth popularizing in clinic.
3. The method of Yiqihuoxuetongluo in collaterals could protect the RNFL and the ischemic injury in rAION.
4. The method of Yiqihuoxuetongluo in collaterals could improve the occular circulation, increase the blood supply of optic nerve, alleviate the edema of nerve and restore the function of optic nerve. It also has protective role on retina synapses complex, mitochondria in inner segment nerve cells and capillary.
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