润目Ⅰ号熏眼治疗干眼症疗效及对炎症因子水平影响

Curative effect of eye fumigation and steaming therapy with Runmu No.I decoction on dry eye syndrome and its effect on the level of inflammatory factors

目的观察自拟方润目Ⅰ号熏眼治疗干眼症的临床疗效及对炎症因子水平的影响。方法将2019年1月—2020年12月在西安市中医医院就诊的160例干眼症患者随机分为一般治疗组、玻璃酸钠组、生理盐水组和润目Ⅰ号组各40例。一般治疗组患者仅予清洁睑缘、睑板腺按摩1次,观察2周;玻璃酸钠组患者在一般治疗组治疗基础上予玻璃酸钠滴眼液点眼,4次/d,共2周;生理盐水组患者在一般治疗组基础上予生理盐水熏眼,1次/d,共2周;润目Ⅰ号组在一般治疗组基础上予中药润目Ⅰ号20 mL熏眼,1次/d,共2周。2周后,比较4组患者干眼症状评分、角膜荧光染色(FL)、非侵入式泪膜破裂时间(NIKBUT)、非侵入式泪河高度(NIKTMH)、泪液分泌试验(SIT),检测泪液中炎性因子[白细胞介素-1β(IL-1β)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)]水平,比较4组临床疗效及治疗期间不良反应发生情况。结果治疗后,生理盐水组、玻璃酸钠组、润目Ⅰ号组患者临床症状评分均明显低于治疗前,且润目Ⅰ号组治疗后临床症状评分均明显低于其余3组,差异均有统计学意义(P均<0.05);生理盐水组、玻璃酸钠组、润目Ⅰ号组NIKBUT、NIKTMH、SIT均较治疗前明显提高,FL及泪液中IL-1β、IL-8、TNF-α水平均较治疗前明显下降,且润目Ⅰ号组NIKBUT、NIKTMH、SIT均明显高于其余3组,FL及泪液中IL-1β、IL-8、TNF-α水平均明显低于其余3组,差异均有统计学意义(P均<0.05)。润目Ⅰ号组总有效率为92.5%(37/40),明显高于其他3组(P均<0.05)。治疗期间4组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论润目1号熏眼治疗干眼症可明显减轻患者的临床症状,恢复睑板腺及泪膜的功能,提高临床疗效,机制可能与抑制炎性因子分泌、减轻炎症对眼表的损害有关。

Objective It is to observe the clinical efficacy of eye fumigation and steaming therapy with self-made prescription Runmu No.I decoction in the treatment of dry eye syndrome and its effect on the level of inflammatory factors.Methods A total of 160 patients with dry eye syndrome treated in Xi’an Hospital of Traditional Chinese Medicine from January 2019 to December 2020 were randomly divided into general treatment group,sodium hyaluronate group,normal saline group and Runmu No.I group,40 cases in each group.The patients in the general treatment group were only given cleaning eyelid margin and meibomian gland massage once,and observed for 2 weeks;the patients in the sodium hyaluronate group were given sodium hyaluronate eye drops on the basis of the treatment in the general treatment group,4 times/d,totally treated for 2 weeks;the patients in the normal saline group were treated with eye fumigation and steaming with normal saline on the basis of the general treatment,once/d,totally treated for 2 weeks;the patients in the Runmu No.Ⅰgroup were treated with eye fumigation and steaming with Runmu No.Ⅰdecoction 20 mL on the basis of general treatment,once/d,totally treated for 2 weeks.After 2 weeks of treatment,the dry eye symptom scores,corneal fluorescence staining(FL),non-invasive tear break-up time(NIKBUT),non-invasive tear meniscus height(NIKTMH)and Schirmer I test(SIT)were compared among the 4 groups,the levels of inflammatory factors[interleukin-1β(IL-1β),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)]in tears in the 4 groups were detected,and the clinical efficacy and adverse reactions occurred during treatment were compared among the 4 groups.Results After treatment,the clinical symptom scores of the normal saline group,sodium hyaluronate group and Runmu No.I group were significantly lower than those before treatment,and the clinical symptom scores of Runmu No.I group after treatment were significantly lower than those of the other three groups,the differences were all significant(all P<0.05);NIKBUT,NIKTMH and SIT in normal saline group,sodium hyaluronate group and Runmu No.I group were significantly increased compared with those before treatment,FL and the levels of IL-1β,IL-8 and TNF-αin tears were significantly decreased compared with those before treatment,furthermore,NIKBUT,NIKTMH and SIT in Runmu No.I were significantly higher and FL,the levels of IL-1β,IL-8,and TNF-αin tears were significantly lower than those in the other three groups,and the differences were statistically significant(all P<0.05).The total effective rate of Runmu No.I group was 92.5%(37/40),which was significantly higher than that of the other three groups(all P<0.05).There was no significant difference in the incidence of adverse reactions among the 3 groups during treatment(P>0.05).Conclusion Eye fumigation and steaming therapy with self-made prescription Runmu No.I decoction can significantly relieve clinical symptoms,recovery the function of meibomian glands and tear film,and improve the clinical efficacy in the treatment of dry eye syndrome.The mechanism may be related to inhibiting the secretion of inflammatory factors and reducing the damage of inflammation to the ocular surface.