温胆汤加减治疗脾胃湿热型睑板腺功能障碍性干眼症疗效探讨

Modified Wendan Decoction in Treating Meibomian Gland Dysfunction Dry Eye of Spleen-stomach Dampness-heat Type

目的:研究温胆汤加减治疗脾胃湿热型睑板腺功能障碍(MGD)性干眼症的临床疗效。方法:将符合中西医诊断标准的MGD患者62例(124眼)随机分为对照组和治疗组,对照组30例(60眼),治疗组32例(64眼)。对照组应用玻璃酸钠滴眼液点眼,妥布霉素地塞米松眼膏(典必殊眼膏)外涂睑缘,湿热敷,睑板腺按摩;治疗组在对照组基础上给予温胆汤加减治疗(清热化湿、祛瘀散结),并随症加减。观察2组治疗前后睑板腺功能、泪膜破裂时间(BUT)、泪液分泌量(SIt)、角结膜荧光素钠染色(FLS)、中医证候积分变化情况。结果:治疗组总有效率85.94%,高于对照组的71.67%,差异有显著性(P<0.05)。2组睑板腺功能、BUT、SIt、FLS、中医证候积分治疗后均较治疗前改善明显(P<0.05),且治疗组治疗后优于对照组(P<0.05)。结论:应用温胆汤为基础的清热化湿、祛瘀散结法,可有效改善脾胃湿热型MGD的睑板腺功能,延长SIt、BUT,促进角膜上皮恢复,并有效改善患者中医证候。

Objective:To study the clinical effect of modified Wendan Decoction on dry eye caused by meibomian gland dysfunction(MGD)of spleen-stomach dampness-cold type.Methods:62 patients(124 eyes)with MGD were randomly divided into control group(30 cases,60 eyes)and treatment group(32 cases,64 eyes).The control group was treated with sodium hyaluronate eye drops,tobramycin and dexamethasone eye ointment(tobramycin and dexamethasone eye ointment),wet hot compress and meibomian gland massage;the treatment group was treated with Wendan Decoction in addition(clearing heat and removing dampness,dispelling and dispersing blood stasis),and the treatment was modified with the symptoms.The meibomian gland function,tear break-up time(BUT),tear secretion(Sit),Fluorescein sodium staining of cornea and conjunctiva(FLS)and TCM syndrome score were observed before and after treatment.Results:The total effective rate of the treatment group was 85.94%,which was significantly higher than 71.67%of the control group(P<0.05).The meibomian gland function,BUT,SIt,FLS and TCM syndrome score of the two groups were significantly improved after treatment(P<0.05),and the treatment group was better than the control group after treatment(P<0.05).Conclusion:Wendan Decoction,which functions as clearing heat and removing dampness,dispelling and dispersing blood stasis,can effectively improve meibomian gland function,prolong SIt and BUT,promote corneal epithelial recovery,and effectively improve TCM syndrome.