激素联合改善微循环对乙胺丁醇所致视神经损伤的疗效观察

Observation on the Efficacy of Hormone Combined with Microcirculation Improvement in the Treatment of Optic Nerve Injury Caused by Ethambutol

为了探讨激素联合改善微循环的治疗策略对乙胺丁醇所致视神经损伤的治疗效果,选取该院2015年~2018年收治的因服用乙胺丁醇所致视神经损伤的结核病患者60例,依据随机数字表法分为观察组及对照组,各30例,分别给予曲安奈德联合甲钴胺治疗及复方樟柳碱注射液联合甲钴胺治疗,对比2组患者治疗前后最佳矫正视力(Best corrected visual acuity,BCVA)、中心视野、图形视觉诱发电位(Pattern visual evoked potential,P-VEP)振幅及潜伏期、视网膜情况,并对比治疗后3个月时临床疗效。结果:观察组治疗后BCAV、视野平均光敏度及平均缺损度改善优于对照组(0.70±0.28,25.92±2.86,5.42±1.91 vs 0.53±0.24,20.25±2.74,7.45±2.66;P<0.05);观察组治疗后P-VEP潜伏期及振幅改善程度优于对照组[(104.25±4.91)ms,(6.68±0.36)μV vs(112.62±4.19)ms,(5.23±0.42)μV;P<0.05];观察组治疗后视网膜杯盘比、盘沿面积及视网膜神经纤维层厚度(Retinal nerve fiber layer,RNFL)改善程度优于对照组[0.94±0.23,(0.60±0.20)μm2,(131.37±4.24)μm vs 0.72±0.25,(0.72±0.13)μm2,(110.34±3.60)μm;P<0.05];观察组治疗后临床疗效高于对照组(96.67%vs 70.00%;P<0.05)。曲安奈德球后注射联合甲钴胺肌肉注射可有效改善因服用乙胺丁醇所导致的视神经损害,且治疗优势显著,临床可推广应用。

To explore the therapeutic effect of hormone combined with microcirculation improvement in the treatment of optic nerve injury caused by ethambutol, a total of 60 patients with tuberculosis who were admitted in the authors′ hospital from 2015 to 2018 due to optic nerve injury caused by ethambutol were included in the study and randomized into the observation group and the control group with 30 cases in each group.The patients in the two groups were given triamcinolone acetonide in combined with mecobalamin, and anisodine injection in combined with mecobalamin, respectively.BCVA,CFOV,the amplitude and latency of P-VEP,and the retina condition before and after treatment in the two groups were compared.The clinical efficacy after 3-month treatment in the two groups was compared.The improvement of BCVA,the average light sensitivity, and the average vision defect degree after treatment in the observation group was significantly superior to that in the control group(0.70±0.28,25.92±2.86,5.42±1.91 vs 0.53±0.24,20.25±2.74,7.45±2.66;P<0.05).The improvement degree of the amplitude and latency of P-VEP after treatment in the observation group was significantly superior to that in the control group [(104.25±4.91) ms,(6.68±0.36) μV vs(112.62±4.19) ms,(5.23±0.42) μV;P<0.05].The improvement degree of retinal cup disk ratio, rim area, and RNFL thickness after treatment in the observation group was significantly superior to that in the control group [0.94±0.23,(0.60±0.20) μm~2,(131.37±4.24) μm vs 0.72±0.25,(0.72±0.13) μm~2,(110.34±3.60) μm;P<0.05].The clinical efficacy after treatment in the observation group was significantly higher than that in the control group(96.67% vs 70.00%;P<0.05).Retrobulbar injection of triamcinolone acetonide combined with intramuscular injection of mecobalamin can effectively improve the optic nerve injury caused by ethambutol, with a significant treatment advantage.Therefore, it deserves to be widely recommended in the clinic.