中西医结合治疗湿性老年性黄斑变性临床研究

Clinical Study in Treating Damp Age-related Macular Degeneration with Traditional Chinese and Western Medicine

目的:探讨加味温胆汤联合玻璃体腔内注射康柏西普治疗湿性老年性黄斑变性(Age-related macular degeneration,ARMD或AMD)的有效性和安全性。方法:回顾性分析湿性AMD患者64例(64眼),根据其治疗方案可分为中西药联合组(33眼)和对照组(31眼)。对照组:给予玻璃体腔内注射康柏西普1次,间隔1个月再注射1次,共3次。中西药联合组:在对照组基础上,加服加味温胆汤1个月。检测所有入选者术前、术后1周、术后1个月、术后3个月的最佳矫正视力、黄斑中心凹神经上皮层厚度以及血管渗漏情况。结果:两组患者术前及术后初期(术后1周～1个月)最佳矫正视力、黄斑中心凹神经上皮厚度的平均值差异无统计学意义(P>0.05);术后3个月,中西药联合组最佳矫正视力视力高于对照组(P<0.05),而黄斑中心凹神经上皮厚度小于对照组(P<0.05)。而两组患者术后1个月及术后3个月血管渗漏情况差异无统计学意义(P>0.05)。治疗3个月后中西药联合组和对照组患者在总有效率(显著+有效数,%)方面存在显著性差异,分别为90.3%和75.8%,χ~2值=5.4,P值=0.017。结论:加味温胆汤联合玻璃体腔内注射康柏西普治疗湿性AMD安全、有效。加味温胆汤可以减轻黄斑水肿、提高预后视力,但并不能减少AMD新生血管渗漏。

Objective:To explore the efficacy and safety of Modified Wendan Decoction combined with intravitreal injection of Conbercept to treat the damp age-related macular degeneration(age-related macular degeneration(ARMD or AMD).Methods:Sixty-four patients(64 eyes)of damp AMD were involved in this study.Thirty-three eyes were included in the combined group and 31 eyes in the control group.The control group was given basic medicine treatment and intravitreal injection of Conbercept.One month after fluorescein administration,another dose of injection would be performed immediately.Then the third injection would be performed after another month.The combined group was treated as well as the control group,but with additional Modified Wendan Decoction for 1 month.The best corrected visual acuity and the thickness of the macular fovea neuroepithelial layer were detected before the first injection,1 week later,1 and 3 months later.The leakage rates of FFA and ICGA were detected before the first injection,1 and 3 months later.Results:There was no significant difference of the best corrected visual acuity or the thickness of the macular fovea neuroepithelial layer between two groups before the first injection,1 week and 1 month later(P>0.05).The best corrected visual acuity of the combined group was better than that of the control group(P<0.05),and the thickness of the macular fovea neuroepithelial layer was less than that of the control group 3 months after the first injection(P<0.05).There was no significant difference of vascular leakage between the two groups 1 and 3 months after the first injection(P>0.05).After treatment for 3 months,there was a significant difference in the total effective rate(significant+effective)between the combined group and the control group,which were 90.3%and 75.8%(χ^2=5.4,P=0.017).Conclusion:Modified Wendan Decoction combined with intravitreal injection of Conbercept is effective and safe to treat the damp AMD.Modified Wendan Decoction can relieve macular edema and improve visual acuity,but it can not reduce the leakage of neovascularization.