从痰瘀互结论治视网膜中央静脉阻塞合并黄斑水肿的临床疗效观察

Clinical observation on the therapeutic effect of treating central retinal vein occlusion with macular edema based on the theory of accumulation of blending of phlegm and blood stasis

[目的]通过临床对照观察中药治疗与抗血管内皮生长因子(VEGF)治疗视网膜中央静脉阻塞(CRVO)合并黄斑水肿(ME)疗效,为该病探寻性价比更高的治疗方案。[方法]将2014年7月至2016年9月的CRVO合并ME患者54例,采用前瞻性对照研究,以1∶1入组比例,分为中药治疗组27例27眼,抗VEGF组27例27眼,疗程28 d,治疗2个疗程,记录治疗前后视力、ME和光学相干断层扫描(OCT)指标,进行统计学分析,评价其临床疗效。[结果]入组病例54例,两组各1例因故退出,两组各26例26眼完成临床观察。视力:西药组、中药组治疗后视力均有提高,与治疗前有统计学差异(P<0.001),但两组间无统计学差异(P=0.85);黄斑水肿:西药组、中药组治疗后黄斑水肿最高点厚度均较治疗前降低,有统计学差异(P<0.001),但两组间无统计学差异(P=0.83);西药组、中药组治疗后黄斑中心1mm区域平均厚度均较治疗前降低,有统计学差异(P<0.001),但两组间无统计学差异(P=0.63)。[结论]抗VEGF与中药经验方治疗CRVO合并ME在提高视力和改善黄斑水肿方面均确实有效,且疗效相似,差异无显著性。

[Objective] To explore treatment protocol with higher performance-cost ratio by a clinical controlled observation on anti-VEGF and traditional Chinese medicine in the treatment of central retinal vein occlusion （CRVO） with macular edema （ME）. [Methods] Fifty-four cases of CRVO with ME from Jal. 2014 to Sep. 2016 were brought into a prospective controlled research, seperated with a 1-1 ad rationem, 27 cases were treated by Chinese medicine, and the other 27 cases were treated by anti-VEGF for 2 courses （56 days）. Then visual acuity and data of optical coherence tomography for ME of the two groups, before and after treatment, were analyzed statistically to evaluate the clinical effect. [Results] The clinical observation had been made on 52 patients （52eyes） in 2 groups with 26 patients （26eyes） of western medicine （anti VEGF） in one group and 26 patients （26eyes） of Chinese medicine in the other group, with one case exit in each group. Visual acuity： visual acuity of patients in both groups was increased after treatment （P〈0.000 1, P〈0.000 1）, but there were no statistical differences between the two groups （P〉0.05）. Macular edema： the maximum of the macular retina thickness and the average of the macular central retina thickness of patients in both groups was reduced after treatment（P〈0.001, P〈0.000 1）, but there were no statistical differences between the two groups （P〉0.05）. [Conclusion] The experienced prescription provides similar efficacy to anti- VEGF in the treatment of central retinal vein occlusion with macular edema.