曲安奈德球后注射治疗Purtscher病的疗效及对视力和房水炎性因子、一氧化氮、内皮素-1的影响

Efficacy of triamcinolone acetonide injection behind the eyeball in the treatment of Purtscher disease and its effect on vision,inflammatory factors,nitric oxide and endothelin-1 of aqueous fluid

目的探讨曲安奈德球后注射治疗Purtscher病的疗效及对视力和房水炎性因子、一氧化氮(NO)、内皮素-1(ET-1)的影响。方法选取2016年1月至2020年1月兰州市第一人民医院收治的64例Purtscher病患者,按随机数字表法分为两组,每组32例。对照组给予常规治疗,观察组在此基础上联合曲安奈德球后注射。比较两组治疗6周后总有效率,治疗3、6周后最佳矫正视力,眼动脉和视网膜中央动脉血流动力学指标收缩期峰值流速(Vmax)、舒张末期流速(Vmin)、阻力指数(RI),房水炎性因子肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-1β、IL-2、IL-6和房水NO、ET-1水平,比较两组不良反应发生情况。结果观察组治疗6周后总有效率高于对照组[96.9%(31/32)比75.0%(24/32)],差异有统计学意义(χ^(2)=4.655,P<0.05)。观察组治疗3、6周后最佳矫正视力高于对照组(0.44±0.13比0.35±0.12、0.88±0.16比0.62±0.15),差异有统计学意义(P<0.05)。观察组治疗3、6周后眼动脉Vmax、Vmin和视网膜中央动脉Vmax、Vmin高于对照组[治疗3周后:(29.42±0.93)cm/s比(28.65±0.90)cm/s、(8.04±1.08)cm/s比(6.95±1.12)cm/s、(8.42±1.21)cm/s比(8.39±1.19)cm/s、(4.05±0.61)cm/s比(3.58±0.57)cm/s;治疗6周后:(31.72±1.03)cm/s比(29.58±0.95)cm/s、(9.81±1.06)cm/s比(7.78±1.15)cm/s、(12.01±1.23)cm/s比(10.82±1.07)cm/s、(4.65±0.47)cm/s比(4.02±0.36)cm/s];观察组治疗3、6周后眼动脉和视网膜中央动脉RI低于对照组(治疗3周后:0.76±0.06比0.80±0.05、0.70±0.03比0.76±0.04;治疗6周后:0.71±0.05比0.75±0.04、0.68±0.04比0.72±0.03),差异均有统计学意义(P<0.05)。观察组治疗3、6周后房水TNF-α、IL-1β、IL-2、IL-6水平低于对照组[治疗3周后:(2.61±0.38)μg/L比(4.75±0.41)μg/L、(3.45±0.28)μg/L比(6.28±1.05)μg/L、(6.28±0.34)μg/L比(9.45±1.14)μg/L、(9.82±1.66)ng/L比(12.45±2.31)ng/L;治疗6周后:(0.98±0.23)μg/L比(1.44±0.27)μg/L、(1.11±0.36)μg/L比(1.69±0.38)μg/L、(3.68±1.02)μg/L比(5.73±1.15)μg/L、(4.11±1.19)ng/L比(7.38±1.06)ng/L],差异均有统计学意义(P<0.05)。观察组治疗3、6周后房水NO水平高于对照组[(56.49±9.17)μmol/L比(50.22±8.68)μmol/L、(60.18±8.27)μmol/L比(53.24±7.96)μmol/L],ET-1水平低于对照组[(60.77±9.61)ng/L比(65.02±10.85)ng/L、(56.59±7.22)ng/L比(61.18±6.76)ng/L],差异有统计学意义(P<0.05)。观察组治疗后不良反应发生率与对照组比较差异无统计学意义(P>0.05)。结论曲安奈德球后注射治疗Purtscher病,可改善眼部血流动力学,抑制炎性反应,改善血管内皮功能,提高视力,并具有一定的安全性。

Objective To investigate the efficacy of triamcinolone acetonide injection behind the eyeball in the treatment of Purtscher disease and its effects on vision,inflammatory factors,nitric oxide(NO)and endothelin-1(ET-1)of aqueous fluid.Methods A total of 64 patients with Purtscher disease admitted to First People′s Hospital of Lanzhou City from January 2016 to January 2020 were selected and divided into two groups by random number table,with 32 cases in each group.The control group was given conventional treatment,and the observation group was injected with triamcinolone acetonide behind the eyeball on this basis.The total effective rate after 6 weeks of treatment,the best corrected visual acuity and hemodynamic indicators peak flow velocity(V_(max)),end-diastolic flow velocity(V_(min)),resistance index(RI)of ophthalmic artery and central retinal artery during systole,aqueous humor inflammatory factors tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,IL-2,IL-6,NO,ET-1,and adverse reactions after 3 and 6 weeks of treatment were compared between the two groups.Results After 6 weeks of treatment,the total effective rate in the observation group was higher than that in the control group:96.9%(31/32)vs.75.0%(24/32),and the difference was statistically significant(χ^(2)=4.655,P<0.05).After 3,6 weeks of treatment,the best corrected visual acuity in the observation group was higher than that in the control group:0.44±0.13 vs.0.35±0.12,0.88±0.16 vs.0.62±0.15,and the difference was statistically significant(P<0.05).After 3,6 weeks of treatment,the Vmax and Vmin of the ophthalmic artery and central retinal artery in the observation group were higher than those in the control group:after 3 weeks of treatment:(29.42±0.93)cm/s vs.(28.65±0.90)cm/s,(8.04±1.08)cm/s vs.(6.95±1.12)cm/s,(8.42±1.21)cm/s vs.(8.39±1.19)cm/s,(4.05±0.61)cm/s vs.(3.58±0.57)cm/s;after 6 weeks of treatment:(31.72±1.03)cm/s vs.(29.58±0.95)cm/s,(9.81±1.06)cm/s vs.(7.78±1.15)cm/s,(12.01±1.23)cm/s vs.(10.82±1.07)cm/s,(4.65±0.47)cm/s vs.(4.02±0.36)cm/s;the RI of the ophthalmic artery and central retinal artery in the observation group were lower than those in the control group:after 3 weeks of treatment:0.76±0.06 vs.0.80±0.05,0.70±0.03 vs.0.76±0.04;after 6 weeks of treatment:0.71±0.05 vs.0.75±0.04,0.68±0.04 vs.0.72±0.03,and the differences were statistically significant(P<0.05).After 3 and 6 weeks of treatment,the levels of TNF-α,IL-1β,IL-2,IL-6 of aqueous fluid in the observation group werelower than those in the control group:after 3 weeks of treatment:(2.61±0.38)μg/L vs.(4.75±0.41)μg/L,(3.45±0.28)μg/L vs.(6.28±1.05)μg/L,(6.28±0.34)μg/L vs.(9.45±1.14)μg/L,(9.82±1.66)ng/L vs.(12.45±2.31)ng/L;after 6 weeks of treatment:(0.98±0.23)μg/L vs.(1.44±0.27)μg/L,(1.11±0.36)μg/L vs.(1.69±0.38)μg/L,(3.68±1.02)μg/L vs.(5.73±1.15)μg/L,(4.11±1.19)ng/L vs.(7.38±1.06)ng/L,and the differences were statistically significant(P<0.05).After 3,6 weeks of treatment,the levels of NO in the observation group washigher than that in the control group:(56.49±9.17)μmol/L vs.(50.22±8.68)μmol/L,(60.18±8.27)μmol/L vs.(53.24±7.96)μmol/L;the levels of ET-1 waslower than that in the control group:(60.77±9.61)ng/L vs.(65.02±10.85)ng/L,(56.59±7.22)ng/L vs.(61.18±6.76)ng/L,and the differences were statistically significant(P<0.05).The incidence of adverse reactions in the two groups had no statistical significance(P>0.05).Conclusions The injection of triamcinolone acetonide behind the eyeball to treat Purtscher disease can improve ocular hemodynamics,inhibit inflammation,improve vascular endothelial function and improve visual acuity.It has significant curative effect and certain safety.