四物五子汤治疗视网膜中央静脉阻塞继发黄斑水肿的临床疗效研究

Clinical Efficacy of Siwu Wuzi Decoction on Macular Edema Secondary to Central Retinal Vein Occlusion

目的:观察四物五子汤治疗视网膜中央静脉阻塞继发黄斑水肿的临床疗效。方法:选择2020年1月至2022年1月于青岛市中医医院治疗的视网膜中央静脉阻塞继发黄斑水肿患者100例,按随机数字表法分为对照组和治疗组。对照组50例患者给予常规西医治疗,治疗组50例患者在对照组基础上加用四物五子汤治疗。于治疗前后检测两组患者单核细胞趋化蛋白-1(MCP-1)、内皮素-1(ET-1)、可溶性细胞间黏附分子-1(sICAM-1)、基质金属蛋白酶2(MMP-2)、血管内皮生长因子(VEGF)、肿瘤坏死因子α(TNF-α)、基质金属蛋白酶抑制剂2(TIMP-2)、白细胞介素8(IL-8)、纤维蛋白原、红细胞沉降率和血浆黏度水平,检测患眼脉络膜毛细血管层血流密度(CFD)、视网膜中心凹无血管区旁宽300μm区的血流密度(FD300)、黄斑中心视网膜厚度(CMT)及最佳矫正视力(BCVA),观察黄斑水肿消退情况,比较临床疗效。结果:治疗后,治疗组患者MCP-1、ET-1、sICAM-1和VEGF含量较对照组明显降低,MMP-2、TNF-α和IL-8含量较对照组明显降低,TIMP-2较对照组明显升高,红细胞沉降率、纤维蛋白原和血浆黏度较对照组明显降低,差异均有统计学意义(P<0.05)。治疗后,治疗组患者CFD、CMT较对照组明显降低,FD300、BCVA较对照组明显升高,黄斑水肿消退效果较对照组明显更好,差异均有统计学意义(P<0.05)。治疗组患者总有效率为98.00%(49/50),较对照组(88.00%,44/50)明显更高,差异有统计学意义(P<0.05)。结论:四物五子汤治疗视网膜中央静脉阻塞继发黄斑水肿患者,可减少血管内皮损伤,降低MMP-2、TNF-α和IL-8水平,抑制机体炎症,改善血液流变学及脉络膜微循环,改善视力,促进黄斑水肿消退,提高临床疗效。

OBJECTIVE:To observe the clinical efficacy of Siwu Wuzi decoction on macular edema secondary to central retinal vein occlusion.METHODS:A total of 100 patients with macular edema secondary to central retinal vein occlusion admitted into the Qingdao Traditional Chinese Medicine Hospital from Jan.2020 to Jan.2022 were extracted to be divided into the control group and the treatment group via the random number table.,with 50 cases in each group Fifty patients in the control group were treated with conventional western medicine,while 50 patients in the treatment group received Siwu Wuzi decoction on the basis of the control group.Levels of monocyte chemoattractant protein-1(MCP-1),endothelin-1(ET-1),soluble intercellular adhesion molecule-1(sICAM-1),matrix metalloproteinase 2(MMP-2),vascular endothelial growth factor(VEGF),tumor necrosis factorα(TNF-α),and tissue inhibitor of matrix metalloproteinase 2(TIMP-2),interleukin-8(IL-8),fibrinogen,erythrocyte sedimentation rate,and plasma viscosity before and after treatment were detected in two groups.The flow density of choroidal capillary layer(CFD),the blood flow density(FD300)of the 300μm wide area next to the foveal avascular area,and the macula central retinal thickness(CMT)and best-corrected visual acuity(BCVA)were observed.And the macular edema regressed in the patients were recorded,the clinical efficacy were compared.RESULTS:After treatment,the contents of MCP-1,ET-1,sICAM-1 and VEGF in the treatment group group were significantly lower than those in the control group,the contents of MMP-2,TNF-αand IL-8 were lower than those in the control group,the TIMP-2 in was higher than that in the control group,the erythrocyte sedimentation rate,fibrinogen and plasma viscosity were significantly lower than those in the control group,with statistically significant differences(P<0.05).After treatment,CFD and CMT in the treatment group were significantly lower than those in the control group,FD300 and BCVA were significantly higher than those in the control group,and the macular edema regression was significantly better than that in the control group,with statistically significant differences(P<0.05).The total effective rate of the treatment group was 98.00%(49/50),significantly higher than 88.00%(44/50)of the control group,the difference was statistically significant(P<0.05).CONCLUSIONS:Siwu Wuzi decoction in the treatment of macular edema secondary to central retinal vein occlusion can reduce vascular endothelial damage,decrease the levels of MMP-2,TNF-αand IL-8,inhibit inflammation,improve hemorheology and choroidal microcirculation and patients’vision,promote the regression of macular edema with significant clinical efficacy.