中心性浆液性脉络膜视网膜病变荧光素渗漏与中医辨证关系探讨

Study on the relationship between differentiation of symptoms and signsof traditional Chinese medicine and central serous chorioretinopathy and fluorescin leakage

目的 探讨中心性浆液性脉络膜视网膜病变 (简称中浆 )荧光素渗漏类型与中医证型之间的关系。方法 经眼底荧光血管造影 (FFA)确诊为中浆的 77例 (77眼 )患者进行中医分型。肝气郁结型 37例 ,荧光素渗漏类型 :喷出或墨渍型 2 5眼 ,色素上皮着色、微渗漏型 12眼 ;脾虚湿困型 2 9例 ,荧光素渗漏类型 :喷出或墨渍型 2 3眼 ,色素上皮着色、微渗漏型 6眼 ;肝肾亏损型 11例 ,荧光素渗漏类型 :喷出或墨渍型 1眼 ,色素上皮着色、微渗漏型 10眼。所有患者在FFA检查为喷出或墨渍状渗漏期均用活血利水基本方五苓散加减 ;色素上皮着色、微渗漏期依据中医分型论治 :肝气郁结型予逍遥散加减 ,脾虚湿困型予参苓白术散加减 ,肝肾亏损型予杞菊地黄丸加减。结果 中浆的渗漏类型与中医各证型构成比不同 ,经 χ2 检验 ,有显著性差异 (P <0 .0 5 )。 3种不同证型治愈率有显著性差异 (P <0 .0 5 )。结论 荧光素渗漏的喷出或墨渍型多见于肝气郁结型及脾虚湿困型 ,而色素上皮着色、微渗漏型则多见于肝肾亏损型。临床疗效以肝气郁结型最佳。

Objective To investigate the relationship between differentiation of symptoms and signs of traditional Chinese medicine (TCM)and central serous chorioretinopathy(CSC) and fluorescin leakage.Methods Seventy seven patients who were diagnosed by FFA as CSC were classified according to differentiation of symptoms and signs of TCM,which included 37 cases of depression of liver energy, 29 cases of asthenia of spleen and stagnation of wetness evil,11 cases of asthenia of liver and kidney..In the period of smodestack or inkbot, all the patients were treated by Wulingsan(add or minus),during the RPE leakage the patients could be treated based on differentiation of symptoms and signs of TCM; Xiaoyaosan was used in depression of wetness evil; Qijudihuangwan in asthenia of liver and kidney. Results There were different constituent ratios between the types of leakage of CSC and the types of TCM syndrome,the difference was significant (P< 0.05) , by χ 2 test. Conclusion The types of smodestack or inkbot leakage are most of patients in depression of liver energy or asthenia of spleen and stagnation of wetness evil,the types of diffusion of RPE leakage are most part of patients in asthenia of liver and kidney. The classification according to differentiation of symptoms and signs of TCM is a important evidence in determining the treatment method of CSC.