原发性开角型青光眼患者眼底荧光血管造影及血液流变学改变与中医证型关系的研究

Changes in the Function of Fundus Fluorescein Angiography and Hemorheology and Its Relationship with TCM Syndromes in Primary Open-Angle Glaucoma

目的探讨原发性开角型青光眼的发病机理。方法将85例原发性开角型青光眼患者分为高眼压型组、正常眼压型青光眼组,并与24例正常人进行对照,对其眼底荧光血管造影和血液流变学指标的改变及与中医辨证分型的关系进行研究。结果原发性开角型青光眼高眼压型患者和正常眼压型青光眼患者与正常组相比,高(VH)、中(VM)、低(VI)切变率下全血表观粘度值、红细胞压积升高,差异均有显著统计学意义(P<0.01)。原发性开角型青光眼中医辨证分型各组与正常组比较,均表现为红细胞压积升高(P<0.01)。其中肝郁气滞证和肝肾亏虚证组分别与正常组相比,高(VH)、中(VM)、低(VI)切变率下全血表观粘度值、红细胞压积升高;痰湿泛目证组与正常组相比,红细胞压积比值差异有统计学意义(P<0.05)。原发性开角型青光眼高眼压型患者和正常眼压型青光眼患者与正常组相比,眼底荧光血管造影中臂-脉络膜充盈时间(A-CT)、臂-视网膜动脉充盈时间(A-AT)、视网膜动-静脉充盈时间(A-VT)延长差异均有统计学意义(P<0.01)。原发性开角型青光眼中医辨证分型各组与正常组比较,均表现为A-CT、A-AT、A-VT延长。其中肝郁气滞证、肝肾亏虚证组与痰湿泛目证组与正常组相比差异有统计学意义(P<0.05)。结论原发性开角型青光眼高眼压型患者和正常眼压型青光眼患者均存在明显的血液呈现高凝状态的血瘀病理改变,而正常对照组的血瘀改变不明显。在中医证型中,这种血瘀病理以肝郁气滞证最明显,肝肾亏虚证次之,痰湿泛目证最轻,呈现肝郁气滞证>肝肾亏虚证>痰湿泛目证的趋势。

Objective To investigate the pathogenesis of primary open-angle glaucoma. Methods The 85 patients with open-angle glaucoma were divided into 2 groups, including the high IOP group and the normal IOP group, and their datawere compared with that of 24 normal persons. The changes of fundus fluorescein angiography and hemorheology and their relationship with TCM syndromes were studied. Results Compared with the normal group, the blood viscosity and hematocrit values at VH, VM, VI shear rate in the high IOP group and the normal IOP group were highly significantly different(P<0.01).The hematocrit values were higher in all TCM syndromes of primary open-angle glaucoma than those in normal group(P<0.01).Compared with the normal group, the blood viscosity and hematocrit values were higher in the liver-Qi stagnation and the deficiency of liver and kidney groups; the hematocrit values were significantly different(P <0.05). Compared with the normal group, A-CT, A-AT, A-VT in the high IOP group and the normal IOP group were highly significantly different(P <0.01); the A-CT, A-AT, A-VT values were longer in all TCM syndromes of primary open-angle glaucoma than those in normal group; the A-CT, A-AT, A-VT values were significantly different for groups of liver qi stagnation and deficiency of liver and kidney(P<0.05). Conclusion The patients in primary open-angle glaucoma and normal tension glaucoma groups show obvious changes of aggregation of the hemorheology, and the stagnation of the blood in the patients of normal group is not obvious. For all the syndromes, the most obvious pathologic status of blood stasis occurs in the syndrome of liver-Qi stagnation, the second syndrome is the deficiency of liver and kidney, and the mildest is the group of eye phlegm flooding,the trend of the syndromes is liver-Qi stagnation> deficiency of liver and kidney> eye phlegm flooding.