丁苯酞治疗早期前部缺血性视神经病变的疗效观察

Efficacy of dl-3-n-butylphthalide on early anterior ischemic optic neuropathy

目的观察芹菜籽提取物左旋芹菜甲素人工合成物丁苯酞对早期非动脉炎性前部缺血性视神经病变的治疗效果。方法将病程不超过2 w的非动脉炎性前部缺血性视神经病变患者51例分为2组:治疗组24例,予丁苯酞注射液静滴10 d后,改口服丁苯酞胶囊20 d;对照组27例,予丹参注射液静滴10 d后,改口服丹参片20 d。在治疗开始前及开始后3 d、10 d、20 d及30 d时对患者行中心视力(最佳矫正视力)、30°静态视野、视盘部视网膜光学相干断层扫描(OCT)及视觉诱发电位(VEP)检查。结果治疗开始第3 d,2组间各项指标对比无差异;治疗10 d后,实验组视野平均光敏感度(MS)、OCT检查视盘周围视网膜神经纤维厚度(RNFL)及VEP检查P_(100)波振幅及潜时改善方面较对照组存在统计学差异(P<0.05);治疗20 d后,实验组各项指标较对照组均存在统计学差异(P<0.05),其中视盘RNFL及视野MS值对比也有统计学差异(P<0.01);治疗30 d后,实验组中心视力和视野平均缺损(MD)值改善方面较对照组有统计学差异(P<0.05),视野MS值改善2组间也有统计学差异(P<0.01),而VEP和视盘RNFL未见有统计学差异(P>0.05)。结论丁苯酞可有效治疗早期前部缺血性视神经病变,尤其对患者视野MS改善方面具有明显疗效,可能与其能迅速改善缺血区微循环、减轻视神经水肿状态及对神经细胞营养作用有关。

OBJECTIVE To assess the efficacy of dl-3-n-butylphthalide on patients with early anterior ischemic optic neuropathy(AION).METHODS Fifty-one eyes with non-arteritis anterior ischemic optic neuropathy whose course of disease were less than2weeks were assigned into dl-3-n-butylphthalide group(24cases)and control group(27cases)randomly.The patients in dl-3-n-butylphtllalide group were treated by dl-3-n-butyIphthalide intravenous injection for10days and capsule by oral for the following20days while patients in control group were treated by Danshen injection and tablets in same protocol.Central vision examination,30°static perimetry,optical coherence tomography(OCT)and visual evoked response(VEP)of patients were recorded when the treatment started and3,10,20and30days after the intervention in both groups.RESULTS There was no difference in all parameters between two groups on the3rd day after the treatment(P>0.05).The mean sensitivity(MS)of perimetry,retinal thickness around the optic disc,amplitude and latency of P100in the experimental group were different from those in the control group on the10th day after the treatment(P<0.05).On the20th day,all the indexes in the experimental group were different from those in the control group(P<0.05),therein,retinal thickness around the optic disc and MS of perimetry in the experimental group were significantly different from those before treatment(P<0.01).On the30th day,there were differences in central vision and mean defect(MD)of perimetry(P<0.05),and significantly different in MS of perimetry(P<0.01)between the two groups.There was no difference in VEP and retinal nerve fiber layer around the optic disc at the end of the course(P>0.05).CONCLUSIONS Dl-3-n-butylphthalide was effective in treatment of early anterior ischemic optic neuropathy,especially in improving MS of visual field damage condition.Its efficacy might relate to the rapid improvement of microcirculation in ischemic area,the reduction of optic nerve edema and restored nutritional function of neurons.