180例有玻璃膜疣的人群中医体质类型研究

Study on constitution types of TCM in 180 cases with drusen

目的评价有玻璃膜疣(Drusen)的正常人群和年龄相关性黄斑变性(AMD)患者的中医体质类型,探讨与Drusen相关的AMD的中医体质特点。方法对2017年5月23日至2019年2月1日间就诊于中国中医科学院眼科医院符合纳入标准的有Drusen的正常人群和AMD患者共180人(有Drusen正常36人,AMD患者144人),登记一般资料、行彩色眼底照相、光学相干断层扫描仪(OCT)、视力测试等检查,后分组为:正常人小Drusen组(A组)、AMD中Drusen组(B组)、AMD大Drusen组(C组)、AMD地图状萎缩组(D组)、AMD脉络膜新生血管(CNV)组(E组);填写《中医体质量表》测试中医体质类型,分析中医体质类型与Drusen程度相关性。结果(1)有Drusen干性AMD患者中医体质类型:以阴虚质最为显著(108位患者中,出现52例),其余体质分型分布相差不大。(2)不同体质类型发展到地图状萎缩:阴虚质和气虚质发展到地图状萎缩有相关性(χ^2=0.363,P=0.025,χ^2=0.352,P=0.035)。(3)不同体质类型发展到CNV:痰湿质、湿热质、血瘀质及气郁质与发展到CNV有相关性(χ^2=0.458,P=0.003,χ^2=0.481,P=0.039,χ^2=0.478,P=0.001,χ^2=0.455,P=0.004)。阴虚质在各组间分布差异有统计学意义(χ^2=9.656,P=0.047),D组阴虚质者占比最高(61%);痰湿质、血瘀质、湿热质在各组间分布差异有统计学意义(χ^2=10.298,P1=0.036,χ^2=18.000,P=0.001,χ^2=12.462,P=0.014)。E组占比最高的分别是痰湿质(36%)、血瘀质(39%)、湿热质(33%);平和质在各组间分布差异有统计学意义(χ^2=23.210,P=0.001)。(4)不同性别Drusen人群中医体质类型:气郁质中性别差异有统计学意义(χ^2=4.198,P=0.049),女性患者气郁人数占比较高(23%);平和质中性别差异有统计学意义(χ^2=4.000,P=0.046),男性患者平和质人数占比较高(15%)。(5)视功能:不同组别间视力差异无统计学意义(P>0.05),针对不同程度有Drusen的AMD患者间Amsler表测试结果差异无统计学意义(P>0.05)。结论(1)Drusen的发生与阴虚质、气虚质、阳虚质关系密切,其中阴虚质为主。(2)阴虚质和气虚质患者病情发展到地图状萎缩的概率更大;痰湿质、湿热质、血瘀质及气郁质的患者发展到CNV的概率更大。年龄增高,Drusen增大,AMD进展,为AMD患者早期预防及治疗提供临床参考证据。

OBJECTIVE To evaluate the constitution type of Chinese medicine in age-related macular degeneration(AMD)patients with drusen and probe into the characteristics of TCM constitution in early stage AMD.METHODS A total of 180 normal people with Drusen and AMD patients who met the inclusion criteria at the Eye Hospital of China Academy of Chinese Medical Sciences from May 23,2017 to February 1,2019(36 normal people with Drusen and 144 patients with AMD),register general information,perform color fundus photography,optical coherence tomography(OCT),vision test and other inspections,and then divided into normal Drusen group(A group),AMD middle Drusen group(B group),AMD large Drusen group(C group),AMD geographic atrophy group(D group),AMD choroidal neovascularization(CNV)group(D group);fill in the"Constitutional Classification Table"to test the constitutions in Chinese medicine,and analyze the correlation between the constitutions in Chinese Medicine and Drusen's degree.RESULTS(1)Drusen patients with constitutions in Chinese Medicine’s characteristics of yin deficiency is the most significant(52 out of 108 patients),the other types of body type distribution were not much different.(2)Different physique types develop to geographic atrophy:yin deficiency and qi deficiency are related to the development of Drusen to geographic atrophy(χ^2=0.363,P=0.025,χ^2=0.352,P=0.035).(3)Different physique types develop to CNV:humidity,damp heat,blood stasis and qi stagnation were related to the development of CNV(χ^2=0.458,P=0.003,χ^2=0.481,P=0.039,χ^2=0.478,P=0.001,χ^2=0.455,P=0.004)。The distribution of yin deficiency was statistically significant among the groups(χ^2=9.656,P=0.047),and the proportion of yin deficiency in the geographic atrophy AMD group was 61%.The distribution of phlegm-dampness,blood stasis and damp heat in each group was statistically significant(χ^2=10.298,P=0.036,χ^2=18.000,P=0.001,χ^2=12.462,P3=0.014),and the three in the AMD CNV group accounted for the highest proportion:phlegm-dampness(36%),blood stasis(39%),damp-heat(33%).There was significant difference in the distribution of balanced constitution between groups(χ^2=23.210,P=0.001).(4)Distribution of Physique Types of different sex Drusen population:the gender difference in qi stagnation was statistically significant(χ^2=4.198,P=0.049),and the number of qi stagnation in female patients was 23%;the gender difference in peace and quality was statistically significant(χ^2=4.000,P=0.046),the proportion of male patients with high quality was 15%.(5)Visual function:the difference of visual acuity between groups was not statistically significant(P>0.05).The results of Amsler test for different degrees of Drusen patients were tested byχ^2 test.The Amsler test in different groups did not show statistics significance(P>0.05).CONCLUSIONS The occurrence of drusen is closely related to the yin deficiency,qi deficiency and yang deficiency constitution.The possibility of developing geographic atrophy in yin deficiency and qi deficiency constitution patients is higher;patients with phlegm-dampness,damp-heat,blood stasis and qi-stagnation constitution have a higher tendency of developing CNV.As the age increases,the drusen morbidity increases and AMD progresses.These findings might provide clinical evidence for early prevention and treatment of AMD.