和营利水方联合抗血管内皮生长因子治疗视网膜静脉阻塞性黄斑水肿患者对其眼血流动力学的影响

Effects of Heying Lishui Decoction Combined with Anti-VEGF Therapy on the Ocular Hemodynamics of Patients with Retinal Vein Occlusion-Macular Edema

目的探讨和营利水方联合抗血管内皮生长因子(Vascular endothelial growth factor,VEGF)治疗对视网膜静脉阻塞性黄斑水肿(Retinal vein occlusion-macular edema,RVO-ME)患者治疗前后眼动脉(Ophthalmic artery,OA)、视网膜中央动脉(Central retinal artery,CRA)、视网膜中央静脉(Centralretinal vein,CRV)的血流动力学及黄斑中心厚度(Central macular thickness,CMT)的影响。方法选取2021年1月—2022年4月期间上海中医药大学附属龙华医院确诊为RVO-ME,且中医证型符合“瘀血阻络,水湿内停”证型的患者103例,均为单眼发病(右眼64例,左眼39例),按随机数字表法分为对照组49例(单纯抗VEGF治疗),治疗组54例(和营利水方联合抗VEGF治疗)。分别于治疗前和治疗1个月后、3个月后3个时间点用彩色多普勒超声诊断仪(Color Doppler now imaging,CDFI)检测两组患者患眼的眼动脉(OA)和视网膜中央动脉(CRA)的收缩期峰值流速(Peak systolic velocity,PSV)、舒张末期流速(End diastolic velocity,EDV)、阻力指数(Resistance index,RI),CRV的最大血流速度(Maximum blood flow velocity,Vmax)。采用OCT检测黄斑中心区视网膜厚度(CMT)。结果对照组OA-PSV治疗前后无明显变化,差异无统计学意义(P>0.05),治疗组在治疗3个月后PSV与治疗前1个月和治疗前相比明显上升,差异有统计学意义(P<0.05);对照组OA-EDV呈逐渐下降,差异有统计学意义(P<0.05),治疗组治疗3个月后OA-EDV较治疗前和治疗1个月后相比明显升高,差异有统计学意义(P<0.05);对照组OA-RI在治疗后明显上升,差异有统计学意义(P<0.05),治疗组治疗后OA-RI未有明显变化。治疗1个月后和治疗3个月后治疗组PSV明显高于对照组,差异有统计学意义(P<0.001);治疗组EDV在治疗1个月后和治疗3个月后与对照组比较有明显升高,差异有统计学意义(P<0.001);治疗组CRA-RI在治疗3个月后明显低于对照组,差异有统计学意义(P<0.001)。治疗3个月后治疗组CRV的最大血流速度明显高于对照组,差异有统计学意义(P<0.001)。对照组CRV的最大血流速度在治疗后有明显升高,差异有统计学意义(P<0.001),但在治疗1个月后和治疗3个月后比较,差异无统计学意义(P>0.05);治疗组CRV的最大血流速度在治疗后呈逐渐上升,差异有统计学意义(P<0.001)。在治疗前和治疗1个月后CMT在两组间无明显差别,差异无统计学意义(P>0.05),治疗3个月后治疗组CMT明显低于对照组,差异有统计学意义(P<0.001)。结论和营利水方联合抗VEGF治疗后可改善RVO患者患眼血流动力学;CDFI技术对RVO-ME患者治疗效果评价中有重要意义。

Objective To explore the effects of Heying Lishui Decoction combined with anti-vascular endothelial growth factor(VEGF)therapy on the hemodynamics of ophthalmic artery(OA),central retinal artery(CRA),and central retinal vein(CRV)and the central macular thickness(CMT)in the patients with retinal vein occlusion-macular edema(RVO-ME)before and after treatment.Methods A total of 103 RVO-ME patients with the syndrome of blood stasis blocking collaterals and water retention treated in the Longhua Hospital,Shanghai University of Traditional Chinese Medicine from January 2021 to April 2022 were assigned with the random number table method into a control group(n=49,anti-VEGF therapy alone)and a treatment group(n=54,anti-VEGF therapy in combination with Heying Lishui Decoction).The disease only involved one eye in each patient,with the right eye involved in 64 patients and the left eye affected in 39 patients.The peak systolic velocity(PSV),end diastolic velocity(EDV),and resistance index(RI)of OA and CRA,as well as the maximum blood flow velocity(Vmax)of CRV,were determined by Color Doppler flow imaging(CDFI)before treatment and after treatment for one and three months.The CMT of macula was measured by macula was measured by coherence tomography(OCT).Results The OA-PSV in the control group showed no significant difference before and after treatment(P>0.05),and the PSV in the treatment group increased after 3 months of treatment compared with that before treatment and after 1 month of treatment(P<0.05).The OA-EDV in the control group decreased gradually after treatment(P<0.05),and the OA-EDV in the treatment group after 3 months of treatment was higher than that before treatment and after 1 month of treatment(P<0.05).The OA-RI in the control group increased significantly after treatment(P<0.05),while that in the treatment group did not change significantly after treatment.The PSV and EDV in the treatment group was higher than those in the control group after treatment for 1 month and 3 months(P<0.001).After 3 months of treatment,the treatment group had lower CRA-RI and higher CRV-Vmax than the control group(P<0.001).The CRV-Vmax in the control group increased after treatment(P<0.001),while it showed no significant difference between treatment for 1 month and 3 months(P>0.05).The CRV-Vmax in the treatment group increased gradually after treatment(P<0.001).The CMT showed no significant differences between the two groups before treatment and after 1 month of treatment(P>0.05),and the CMT in the treatment group was lower than that in the control group after treatment for three months(P<0.001).Conclusion Heying Lishui Decoction combined with anti-VEGF therapy can improve ocular hemodynamics in patients with RVO.CDFI is of great significance in the evaluation of the therapeutic effect in RVO-ME patients.