前房穿刺联合通窍明目法治疗超过12小时视网膜动脉阻塞气滞血瘀型患者51例临床观察

Clinical Observation on Anterior Chamber Puncture Combined with Orifices-unblocking and Visionimproving Method for the Treatment of Retinal Artery Occlusion for More than 12 Hours with Qi Stagnation and Blood Stasis Syndrome: An analysis of 51 Cases

目的 探讨前房穿刺联合通窍明目法治疗超过12 h视网膜动脉阻塞气滞血瘀证的临床疗效及安全性。方法 纳入病程超过12 h的视网膜动脉阻塞气滞血瘀证的患者52例(51眼),其中视网膜中央动脉阻塞36眼,视网膜分支动脉阻塞16眼,急行前房穿刺术,后予通窍明目法治疗,包括口服通窍活血明目方、针刺、静脉滴注丹参多酚酸盐注射液联合血栓通注射液、肌肉注射注射用腺苷钴胺,共治疗21天。观察治疗前、穿刺后、治疗7天、治疗21天的最佳矫正视力;比较治疗前与前房穿刺后眼压的变化,并评价临床疗效及安全性,分析年龄、性别、疾病类型、病程与治疗效果的相关性。结果 52眼中显效23眼(44.2%),好转22眼(42.3%),无效7眼(13.5%),总有效率为86.5%。患者治疗前、穿刺后、治疗7天、治疗21天最佳矫正视力分别为1.80 (0.55,2.43)、1.65 (0.30,2.18)、1.10 (0.20,2.00)、0.85 (0.20,1.70)。治疗7天、21天最佳矫正视力较治疗前提高,治疗7天、21天最佳矫正视力较穿刺后提高,治疗21天较治疗7天最佳矫正视力提高(P<0.01)。治疗前与穿刺后最佳矫正视力差值、眼压差值与治疗有效性间无相关性(P>0.05)。患者的性别、年龄、疾病分类、病程与治疗有效性间无相关性(P>0.05)。治疗过程中患者均未出现不良反应。结论 前房穿刺联合通窍明目法治疗超过12 h视网膜动脉阻塞气滞血瘀证能够提高患者的最佳矫正视力,具有较好的临床疗效及安全性,且不受性别、年龄、疾病类型及病程的影响。

Objective To construct a tongue manifestation-based diabetic foot risk prediction model using LASSO regression and Bayesian network analysis.Methods The clinical data of patients with type 2 diabetes(T2D)and diabetic foot admitted to the Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 2019 to October 2020 were collected,and 27 variables including age,gender,body mass index(BMI),smoking,education level,light red tongue,pale tongue,red crimson tongue,light purple tongue,dusky red tongue,red tongue tip,enlarged tongue,red tongue edge,thin tongue,spotted tongue,teeth-marked tongue,cracked tongue,thin coating,white coating,yellow coating,scanty coating,peeled coating,glossy coating,thick coating,greasy coating,fasting blood glucose(FBG)and 2-hour postprandial blood glucose(2hPBG)were analyzed.Logistic univariate analysis was used to calculate the unadjusted OR values(cOR values)of tongue manifestation-related variables.The influencing factors significantly related to the occurrence of diabetic foot were screened out by LASSO regression,and then the interaction between variables was further analyzed and reasoned by Bayesian network analysis.Finally,the predictive effectiveness of the model was evaluated.Results A total of 293 diabetic foot patients(diabetic foot group)and 4430 T2D patients(T2D group)were included.There were significant differences in age,BMI,gender,smoking,and education level between the two groups(P<0.05),with no significant differences in FBG and 2hPBG levels(P>0.05).The risk of diabetic foot was increased in patients with light purple tongue(cOR=1.956)and thin tongue(cOR=4.315)through Logistic univariate analysis.Six variables that were most significantly associated with the occurrence of diabetic foot were screened out through LASSO regression,including thin tongue,smoking,dusky red tongue,greasy coating,thick coating,and white coating.Bayesian network analysis further found that thin tongue,dusky red tongue,greasy coating,thick coating,and white coating were directly associated with the occurrence of diabetic foot,while smoking was indirectly linked.The prediction model showed that the max probability of developing diabetic foot was 7.77%in patients with thick coating,and that was 6.43%when there was greasy coating.The probability of thick coating and greasy coating were higher in patients who smoked than those who not,while the probability of dusky red tongue was higher in non-smoking patients.The model efficacy evaluation showed accuracy of 0.93 and 0.97 of f1 value,indicating a good prediction effectiveness.Conclusion The tongue manifestation-based diabetic foot risk prediction model constructed with LASSO regression and Bayesian network analysis shows that the probability of diabetic foot in T2D patients with thick coating and greasy coating is 7.77%and6.43%,respectively,and the probability may further increase if the patients smoke.