曲安奈德联合葛根素治疗非动脉炎性前部缺血性视神经病变

Triamcinolone acetonide combined with puerarin for nonarteritic anterior ischemic optic neuropathy

目的观察曲安奈德联合葛根素治疗非动脉炎性前部缺血性视神经病变(nonarteritic anterior ischemic optic neuropa-thy,NAION)的临床疗效。方法收集我院近年来确诊的NAION患者84例(84眼),随机分为2组,各42例,对照组静脉滴注葛根素400mg,每日1次;治疗组在对照组的治疗基础上,加用曲安奈德注射液20mg患眼球后注射,1周后重复注射1次;疗程均为2周。观察治疗前后患者视力、视野、图形视觉诱发电位、闪光视网膜电图、盘周视网膜神经纤维层厚度变化情况。结果治疗组治疗前后视力分别为0.24±0.12、0.57±0.27,差异有显著统计学意义(t=7.921,P<0.01);对照组治疗前后视力分别为0.25±0.15、0.46±0.62,差异有统计学意义(t=2.185,P<0.05);治疗组治疗后视力高于对照组,差异有统计学意义(t=2.893,P<0.05)。治疗后2组患者平均视野缺损值降低和平均光敏感度提高,与治疗前比较,差异均有统计学意义(均为P<0.05);治疗组患者平均视野缺损值及光敏感度好转程度较对照组高,差异均有统计学意义(t=2.423、2.704,均为P<0.05)。2组患者治疗后图形视觉诱发电位的P100波潜伏期缩短、振幅提高,治疗前后比较差异均有统计学意义(均为P<0.05);治疗组患者P100波潜伏期及振幅的改善程度较对照组好,差异均有统计学意义(t=2.433、2.228,均为P<0.05)。治疗组患者视网膜振荡电位(OPs)总和振幅提高,与对照组比较,差异有统计学意义(t=2.515,P<0.05)。治疗组盘周4个象限视网膜神经纤维层厚度减轻幅度均高于对照组,差异均有统计学意义(均为P<0.05)。结论曲安奈德联合葛根素治疗NAION疗效优于单纯葛根素,能安全有效地促进视功能恢复。

Objective To observe the clinical effects of triamcinolone acetonide combined with puerarin for nonarteritic anterior ischemic optic neuropathy（AION）.Methods Eighty-four patients（84 eyes） with AION in our hospital were collected and randomly divided into two groups.The patients（42 cases） in control group were intravenous injected puerarin about 400 mg once every day,the patients（42 cases） in treatment group were added with triamcinolone acetonide about 20 mg by retrobulbar injection based on the treatment of control group,repeated after 7 days.The visual acuity,visual field,picture visual evoked potential,flare electroretinogram and retinal nerve fiber layer thickness around optic disc before and after treatment were observed.Results The visual acuity before and after treatment in treatment group were 0.24±0.12 and 0.57±0.27,there was significant difference（t=7.921,P〈0.01）;Which in control group were 0.25±0.15 and 0.46±0.62,there was statistical difference（t=2.185,P〈0.05）;The visual acuity after treatment in treatment group was higher than that in control group,there was statistical difference（t=2.893,P〈0.05）.After treatment,the mean defect of visual field in two groups were reduce,and mean sensitivity were improved,there were statistical differences before and after treatment（both P〈0.05）,and statistical differences between two groups（t=2.423,2.704,both P〈0.05）.The latency of P100 wave after treatment in two groups were shortened,and the amplitude were increased,there were statistical differences before and after treatment（both P〈0.05）,and statistical differences between two groups（t=2.433,2.228,both P〈0.05）.The total amplitude of retinal oscillatory potentials in treatment group was increased,compared with that in control group,there was statistical difference（t=2.515,P〈0.05）.The decreased degree of retinal nerve fiber layer thickness around optic disc after treatment in treatment group was higher than that in control group,there were statistical differences（both P〈0.05）.Conclusion The clinical effects of triamcinolone acetonide combined with puerarin for NAION are better than single puerarin,combined treatment can safely and effective promote the recovery of visual function.