不同中医证型中青年高度近视患者视盘萎缩弧的形态、大小及黄斑区视网膜厚度的比较

Comparison of the Morphology and Size of Peripapillary Atrophy and Macular Retinal Thickness in Young and Middle-aged High Myopia Patients with Various Traditional Chinese Medicine Syndromes

【目的】探讨不同中医证型的中青年高度近视(high myopia,HM)患者眼底视盘萎缩弧(PPA)的形态、大小及黄斑区视网膜厚度(RT)的差异。【方法】纳入中青年HM患者共133例(133眼)进行中医辨证分型,分析比较不同证型间患者的眼轴长度(AL)、等效球镜度数(SE)、最佳矫正视力(BCVA)、PPA面积与形态、黄斑区RT的差异。【结果】(1)中医辨证分型方面,中青年HM患者以气血不足证占比最大,共54例(54眼,40.6%);其次为肝肾两虚证,共49例(49眼,36.8%);心阳不足证最少,共30例(30眼,22.6%)。(2)相较于气血不足证和心阳不足证患者,肝肾两虚证患者的AL更长、近视度数更高、PPA面积更大,且黄斑区内环、外环及平均RT更薄,差异均有统计学意义(P<0.05)。(3)不同证型中青年HM患者的PPA形态分级比较,差异有统计学意义(P<0.01)。其中,肝肾两虚证患者PPA分级多为Ⅱ级或Ⅲ级,气血不足证患者多为Ⅰ级或Ⅱ级,心阳不足证患者以Ⅰ级为主。【结论】中青年HM患者中医证型的分布以气血不足证为主;不同证型间的AL、SE、PPA面积及形态分级、黄斑区内环、外环及平均RT存在一定差异,总体以肝肾两虚证患者眼底萎缩程度最重,可为中医辨证施治提供参考依据。

Objective To investigate the differences in the morphology and size of the peripapillary atrophy(PPA)and macular retinal thickness(RT)in young and middle-aged patients with high myopia(HM)with different traditional Chinese medicine(TCM)syndrome types.Methods A total of 133 cases(133 eyes)of young and middle-aged HM patients were included and then their TCM syndrome types were differentiated.The differences in ocular axial length(AL),spherical equivalent(SE),best corrected visual acuity(BCVA),PPA area and morphology,and macular area RT were analyzed and compared among various TCM syndrome types.Results(1)In terms of TCM syndromes,the largest proportion of young and middle-aged HM patients were differentiated as qi-blood deficiency syndrome,accounting for 40.6%in 54 cases(54 eye),followed by liver and kidney deficiency syndrome,accounting for 36.8%in 49 cases(49 eyes).And heart-yang deficiency syndrome occupied the smallest proportion of 22.6%in 30 cases(30 eyes).(2)Compared with patients with qi-blood deficiency syndrome and heart-yang deficiency syndrome,patients with liver and kidney deficiency syndrome had long AL,great myopic degree,large PPA area,and thin intra-and extra-macular ring RT and mean RT,all with statistically significant differences(P<0.05).(3)There were statistically significant differences in the PPA morphological classification of young and middle-aged HM patients with various syndrome types(P<0.01).Among them,patients with liver and kidney deficiency syndrome were usually classified into gradeⅡor gradeⅢ,patients with qi-blood deficiency syndrome were usually classified into grade I or gradeⅡ,and patients with heart-yang deficiency syndrome were usually classified into grade I.Conclusion The distribution of TCM syndrome types in young and middle-aged HM patients is dominated by qi-blood deficiency syndrome.Some differences exist in AL,SE,PPA area and morphological grading,intra-and extra-macular ring RT and mean RT among different syndrome types,and overall,severer fundus atrophy can be found in HM patients with liver and kidney deficiency syndrome.The findings will provide evidence for TCM syndrome differentiation and treatment of young and middle-aged patients with HM.