邹菊生教授柔肝健脾法合并针刺治疗年龄相关性黄斑变性的疗效分析

Analysis on therapeutic effect of Professor Zou Jusheng's emolliating liver and fortifying spleen method combined with acupuncture treating age-related macular degeneration

目的观察柔肝健脾法合并针刺治疗年龄相关性黄斑变性(ARMD)的临床疗效。方法 2012年8月至2014年1月收集门诊符合纳入标准的干性ARMD(肝肾阴虚型)和湿性黄斑变性(脾虚湿困型)共80例,随机分为中药合并针刺治疗组(治疗组)和中成药加维生素E对照组(对照组)。治疗组在针刺治疗的同时,对干性ARMD者,予柔肝健脾、补益肝肾中药,对湿性ARMD者,予柔肝健脾、温阳利水中药。对照组干性、湿性患者均予口服复方血塞通胶囊和维生素E胶囊。2组的总疗程均为3个月,比较2组患者在治疗1个月及3个月时的视力和中医证侯积分的变化差异。结果治疗组共42例(47只眼),对照组共38例(40只眼)。2组患者性别、年龄、ARMD分型差异无统计学意义(P>0.05)。视力疗效:治疗后1个月,治疗组显效16只眼,有效23只眼,无效8只眼,总有效率82.98%,对照组显效3只眼,有效11只眼,无效26只眼,总有效率35.00%(有效率比较c2=20.89,P=0.001);治疗后3个月,治疗组显效17只眼,有效25只眼,无效5只眼,总有效率89.36%,对照组显效6只眼,有效13只眼,无效21只眼,总有效率47.50%(有效率比较c2=18.07,P=0.001)。中医证候疗效:治疗后1个月,治疗组显效12例,有效24例,无效6例,对照组显效6例,有效10例,无效22例(Z=-3.472,P=0.001);治疗后3个月,治疗组显效16例,有效22例,无效4例,对照组显效8例,有效11例,无效19例(Z=-3.319,P=0.001)。即治疗组在治疗1个月、3个月时的视力及中医证候改善情况均好于对照组。结论柔肝健脾法配合针刺治疗可以明显改善ARMD患者的视力及中医症状,对ARMD有一定的治疗效果。

OBJECTIVE To observe the clinical efficacy of combined acupuncture and emolliating the liver and fortifying the spleen method for the treatment of age-related macular degeneration. METHODS From August 2012 to January 2014, 80 cases which have fulfilled the clinical inclusion criteria of age-related macular degenera-tion （liver kidney yin deficiency type） and wet macular degeneration （splenasthenic Hygrosis type ） were collected and randomly divided into traditional Chinese medicine decoction combined with acupuncture therapy group and patterned traditional Chinese medication plus vitamin E group. Patients in the treatment group were given both oral decoction with efficacy of emolliating the liver and fortifying the spleen and orbit acupuncture treatment, patients in the control group were treated with oral compound Xuesaitong capsules and vitamin E capsules, total intervention course 3 months.Visual acuity, visual field, TCM clinical findings were evaluated before and after the intervention in both groups. RESULTS There were 42 enrolled cases in the decoction combined with acupuncture treatment group;There were 38 cases in the control group. No significant difference on general information such as gender, age distri-bution, ARMD types between the two groups were found（P〈0.05）. visual effect：After 1 month of treatment group vi-sion：excellent 16 eyes ,valid 23 eyes, invalid 8 eyes. Total effective rate 82.98%;the control group vision：excellent 3 eyes, valid 11 eyes, invalid 26 eyes. Total effective rate 35.00%, （comparison of the total efficiency c2=20.89,P=0.001）;After 3 month of treatment group vision：excellent 17 eyes ,valid 25 eyes, invalid 5 eyes. Total effective rate 89.36%;the control group vision：excellent 6 eyes ,valid 13 eyes, invalid 21 eyes. Total effective rate 47.50%, （com-parison of the total efficiency c2=18.07,P=0.001）. The effective of syndrome：After1 month of treatment group：ex-cellent 12 cases, valid 24 cases, invalid 6 cases, the control group：excellent 6 cases, valid 10 cases, invalid 22 cases （Z=-3.472,P=0.001）;After 3 month of treatment group：excellent 16 cases ,valid 22 cases, invalid 4 cases, the con-trol group：excellent 8 cases ,valid 11 cases, invalid 19 cases（Z=-3.319,P=0.001）. Treatment group in the treatment of 1 and 3 months of vision and improvement of syndromes are better than the control group. CONCLUSIONS E-molliating the liver and fortifying the spleen method combined acupuncture therapy could significantly improve vi-sion and TCM symptoms of patients with macular degeneration, and this approach for the macular degeneration had certain effect .