中药联合无环鸟苷治疗单纯疱疹病毒性角膜炎的临床疗效分析

Clinical Efficacy Analysis of Traditional Chinese Medicine Combined with Non-Cyclic Treatment of Herpes Simplex Virus Keratitis

目的:探讨中药益气解毒方及无环鸟苷联合治疗对单纯疱疹病毒性角膜炎(Herpes Simplex Keratitis,HSK)患者的临床疗效。方法:选取2014年6月至2015年3月本院收治的HSK患者67例(98只眼),随机分为对照组33例(47只患眼)及治疗组34例(51只患眼),对照组给予无环鸟苷治疗,治疗组在对照组的基础上联用中药益气解毒方治疗,2组均治疗4周。统计2组临床疗效,记录并比较2组临床症状恢复时间;检测并比较治疗前后2组角膜厚度、角膜知觉、T淋巴细胞及相关细胞因子的变化;治疗后定期随访1年,记录并比较随访期间2组复发情况。结果:治疗后对照组总有效率为72.34%,显著低于治疗组的90.20%(P<0.05);治疗组起效时间、角膜溃疡愈合时间、充血消退时间、刺激症状消失时间均较对照组显著缩短(P<0.01);与治疗前比较,治疗后2组症状评分、体征评分及角膜厚度均降低,且治疗组显著低于对照组(P<0.05或P<0.01),2组角膜知觉均有明显改善,且治疗组角膜知觉敏感比例显著高于对照组(χ~2=3.965,P=0.047);与治疗前比较,治疗后治疗组CD4+比例及CD4^+/CD8^+比值明显升高,且显著高于对照组(P<0.05);治疗组CD8+比例明显降低,且显著低于对照组(P<0.05),而对照组CD4^+、CD8^+比例,CD4^+/CD8^+比值无显著变化(P>0.05)。与治疗前比较,治疗后2组血清白介素18(IL-18)、γ干扰素(IFN-γ)水平均明显升高,且治疗组显著高于对照组(P<0.05或P<0.01)。随访1年内,对照组累计复发率为43.33%,较治疗组的16.28%显著升高(χ~2=6.503,P=0.011)。结论:中药益气解毒方联合无环鸟苷治疗HSK近远期疗效显著提高,患者临床症状恢复时间显著缩短,角膜厚度、角膜知觉恢复良好,机体细胞免疫功能得到显著提高,复发率降低,疗效显著优于无环鸟苷单用。

Objective：To investigate the clinical efficacy of combined treatment of traditional Chinese medicine（TCM）and non cyclic glycosides in the treatment of herpes simplex keratitis（HSK）.Methods：A total of 67 patients with HSK from June 2014-2015 year in March the hospital treated patients（98 eyes）were randomly divided into control group,33 cases（47 eyes）and a treatment group of 34 cases（51 eyes）,the control group was given acyclovir treatment,the treatment group in the control group on the basis of the solution of poison treatment with traditional Chinese medicine Qi,2 groups were treated for 4 weeks.The clinical efficacy of the 2 groups were recorded and compared 2 groups of clinical symptom recovery time;change detection and comparison of 2 groups before and after treatment of corneal thickness,corneal sensitivity,T cells and related cytokines;regular follow-up 1 years after treatment were recorded and compared during follow-up of patients in the 2 groups.Results：After treatment,the total effective rate of control group was 72.34%,significantly lower than the treatment group（90.20% P〈0.05）;the onset time of the treatment group,corneal ulcer healing time,hyperemia subsided time,stimulation symptoms disappeared time significantly shorter than the control group（P〈0.01）;compared with before treatment,after treatment,2 groups of symptoms and signs score score and corneal thickness were decreased,and the treatment group was significantly lower than the control group（P〈0.05 or P〈0.01）,2 groups of corneal sensitivity were significantly improved,and the treatment group was significantly higher than the proportion of corneal sensitive control group（x2=3.965,P=0.047）;compared with before treatment,after treatment,the CD4＋ ratio and CD4＋/CD8＋ ratio were significantly increased,and significantly higher than that of the control group（P〈0.05）;treatment group CD8＋ significantly decreased and was significantly lower than the control group（P〈0.05）,and control group CD4＋,CD8＋ ratio,CD4＋/CD8＋ ratio.Change（P〉0.05）.Compared with before treatment,after treatment,2 groups of serum interleukin 18（IL-18）and interferon gamma（IFN-gamma）levels were significantly increased,and the treatment group was significantly higher than the control group（P〈0.05 or P〈0.01）.In 1 years of follow-up,the cumulative recurrence rate of control group was 43.33%,compared with 16.28% in the treatment group increased significantly（x2=6.503,P=0.011）.Conclusion：Yiqi Jiedu decoction combined with acyclovir in the treatment of HSK curative effect is significantly improved,the recovery time of clinical symptoms significantly shortened,corneal thickness,corneal sensation recovery,cellular immune function improved significantly,reduce the relapse rate,the curative effect was significantly better than acyclovir alone.