补肾益精汤治疗肾阳虚型干眼症的临床疗效及Th1/Th17因子变化分析

Clinical Efficacy of Bushen Yijing Decoction for the Treatment of Xerophthalmia of Kidney Yang Deficiency Type and the Analysis of Th1/Th17 Cytokines

【目的】分析补肾益精汤治疗肾阳虚型干眼症的临床疗效及对血清Th1/Th17因子的影响。【方法】选取贵州中医药大学第二附属医院2021年1月至2023年1月收治的96例肾阳虚型干眼症患者为研究对象,根据治疗方法的不同将其分为观察组和对照组,每组各48例。对照组给予玻璃酸钠滴眼液滴眼治疗,观察组在对照组的基础上给予补肾益精汤治疗,疗程为21 d。观察2组患者治疗前后泪膜破裂时间(BUT)、角膜荧光素染色(FL)评分、泪液分泌试验(SIT)值、血清Th1/Th17因子水平、眼表疾病指数(OSDI)量表评分和美国国立眼科研究院视功能问卷(NEI-VFQ-25)评分的变化情况,并比较2组患者的临床疗效和不良反应发生率。【结果】(1)疗效方面:治疗21 d后,观察组的总有效率为95.83%(46/48),对照组为70.83%(34/48),组间比较(χ^(2)检验),观察组的临床疗效明显优于对照组(P<0.01)。(2)眼表功能方面:治疗后,2组患者的BUT、SIT值均较治疗前升高(P<0.05),FL值均较治疗前降低(P<0.05),且观察组对BUT、SIT值的升高作用及对FL值的降低作用均明显优于对照组(P<0.01)。(3)血清Th1/Th17因子水平方面:治疗后,2组患者的血清白细胞介素17(IL-17)、肿瘤坏死因子α(TNF-α)、干扰素γ(IFN-γ)水平均较治疗前降低(P<0.05),且观察组对血清IL-17、TNF-α、IFN-γ水平的降低作用均明显优于对照组(P<0.01)。(4)问卷评分方面:治疗后,2组患者的OSDI评分均较治疗前降低(P<0.05),NEI-VFQ-25评分均较治疗前升高(P<0.05),且观察组对OSDI评分的降低作用及对NEI-VFQ-25评分的升高作用均明显优于对照组(P<0.01)。(5)不良反应方面:观察组的不良反应发生率为4.17%(2/48),对照组为8.33%(4/48),组间比较,差异无统计学意义(P>0.05)。【结论】补肾益精汤可有效提高肾阳虚型干眼症的临床疗效,有助于缓解患者的眼部不适症状,改善患者的眼表功能,调节Th1/Th17细胞因子水平,减轻炎症反应,且未增加不良反应,具有较高的安全性。

To investigate the clinical efficacy of Bushen Yijing Decoction for the treatment of xerophthalmia of kidney yang deficiency type and to observe its effect on serum Th1/Th17 cytokines.Methods From January 2021 to January 2023,a total of 96 patients with xerophthalmia of kidney yang deficiency type were selected as the study objects.According to the treatment methods,the patients were divided into observation group and control group,with 48 cases in each group.The control group was treated with Sodium Hyaluronate Eye Drops externally,and the observation group was given oral use of Bushen Yijing Decoction together with Sodium Hyaluronate Eye Drops externally.The course of treatment for the two groups covered 21 days.The changes of tear film break-up time(BUT),corneal fluorescein staining(FL)score,SchirmerⅠtest(SIT)value,serum Th1/Th17 cytokines,Ocular Surface Disease Index(OSDI)questionnaire scores,and 25-Item National Eye Institute Visual Function Questionnaire(NEI-VFQ-25)score in the two groups were observed before and after treatment.Moreover,the clinical efficacy and incidence of adverse reactions were compared between the two groups.Results(1)After 21 days of treatment,the total effective rate of the observation group was 95.83%(46/48),and that of the control group was 70.83%(34/48).The intergroup comparison(tested by chi-square test)showed that the clinical efficacy of the observation group was significantly superior to that of the control group(P<0.01).(2)After treatment,the ocular surface function indicators of BUT and SIT values in the two groups were higher and the FL values were lower than those before treatment(P<0.05).The increase of BUT and SIT values and the decrease of FL values in the observation group were significantly superior to those in the control group(P<0.01).(3)After treatment,the levels of serum cytokines of interleukin 17(IL-17),tumor necrosis factor alpha(TNF-α)and interferon gamma(IFN-γ)in the two groups were lower than those before treatment(P<0.05),and the decrease of serum IL-17,TNF-αand IFN-γlevels in the observation group was significantly superior to that in the control group(P<0.01).(4)After treatment,the questionnaire scores of OSDI in the two groups were lower and the NEI-VFQ-25 scores were higher than those before treatment(P<0.05).The decrease of OSDI scores and the increase of NEI-VFQ-25 scores in the observation group were significantly superior to those in the control group(P<0.01).(5)The incidence of adverse reactions in the observation group was 4.17%(2/48),and that in the control group was 8.33%(4/48).There was no significant difference between the two groups(P>0.05).Conclusion Bushen Yijing Decoction can enhance the clinical efficacy of xerophthalmia of kidney yang deficiency type,and the decoction is effective on alleviating the eye discomforts,improving the ocular surface function of patients,regulating the levels of Th1/Th17 cytokines,and relieving the inflammatory response without inducing severe adverse reactions while with high safety.