灵杞黄斑颗粒治疗视网膜静脉阻塞继发黄斑水肿的疗效观察

摘要

目的 探讨灵杞黄斑颗粒与联合抗血管内皮生长因子(VEGF)药物玻璃体腔内注射治疗视网膜静脉阻塞(RVO)继发黄斑水肿(ME)的临床疗效.方法 RVO继发ME患者90例(90只眼),随机分为3组.中药治疗组30例(30只眼),予口服灵杞黄斑颗粒;西医治疗组30例(30只眼),予玻璃体腔注射雷珠单抗;中西医治疗组30例(30只眼),予口服灵杞黄斑颗粒联合雷珠单抗玻璃体腔注射.治疗观察6个月,治疗前后进行视力、眼底照相、光学相干断层扫描(OCT)、闪光视网膜电图(F-ERG)及荧光素眼底血管造影(FFA)检查,评价疗效.结果 治疗6个月后,中药治疗组30只眼,显效5只眼,有效12只眼,无效13只眼,总有效率56.7%;西医治疗组30只眼,显效9只眼,有效9只眼,无效12只眼,总有效率60.0%;中西医治疗组30只眼,显效15只眼,有效9 只眼,无效6 只眼,总有效率80.0%.中西医治疗组疗效好于其他两组(与中药治疗组比较,P=0.023,与西医治疗组比较, P=0.177),中药治疗组与西医治疗组的疗效接近(P=1.000).中西医治疗组在视力改善、眼底出血吸收及降低中央视网膜厚度(CRT)方面明显好于其他两组(P＜0.05);中医治疗组的眼底出血吸收情况好于西医对照组(P＜0.05),在改善视力、减少CRT方面与西医治疗组大致相当(P>0.05).各组治疗后ERG视锥细胞反应b波振幅均较治疗前明显增加(P＜0.05),但组间差异无统计学意义(P>0.05).结论 灵杞黄斑颗粒治疗RVO继发的ME有一定的临床疗效,联合抗VEGF药物治疗可更好的达到标本兼治、多靶点治疗的效果.%OBJECTIVE To study the therapeutic effects of Lingqi Huangban granule combined with intravitreal injection of vascular endothelial growth factor (VEGF) for macular ede-ma (ME) secondary to retinal vein occlusion (RVO). METHODS Ninety eyes of ninety RVO pa-tients with ME were randomized into 3 groups. Traditional Chinese medicine (TCM) group (30 eyes of 30 patients) was orally given Lingqi Huangban granule. Western medicine (WM) group (30 eyes of 30 patients) was treated with intravitreal injection of ranibizumab (IVR) alone. TCM plus WM therapy group (30 eyes of 30 patients) was treated with IVR combined with Lingqi Huangban gran-ule. After treatment for 6 months, changes of best corrected visual acuity (BCVA) were recorded. Fun-dus photograph, optical coherence tomography (OCT), flash elec-troretinogram (F-ERG) and fluores-cein fundus angiography (FFA) were done to evaluate the clinical effects. RESULTS After treatment for 6 months, the total effec-tive rate of TCM group was 56.7%, with 5 eyes in 30 eyes being markedly effective, 12 eyes in 30 eyes being effective and 13 eyes in 30 eyes being invalid. The total effective rate of WM group was 60.0%, with 9 eyes in 30 eyes being markedly effective, 9 eyes in 30 eyes being effective and 12 eyes in 30 eyes being invalid. The total effective rate of TCM plus WM group was 80.0%, with 15 eyes in 30 eyes being markedly effective, 9 eyes in 30 eyes being effective and 6 eyes in 30 eyes being invalid. The combined TCM and WM therapy achieved a better therapeutic efficacy in treat-ing ME secondary to RVO (P=0.023, compared to TCM group; P=0.177, compared to WM group), while the therapeutic effects of TCM group and WM group showed no significant difference (P=1.000). The combined TCM and WM therapy could significantly improve visual acuity, help absorb fundus hemorrhage and decrease central retinal thickness (CRT) when compared to the other two groups (P＜0.05). In addition, although TCM group and WM group showed no remarkable difference in improving visual acuity and decreasing CRT (P>0.05), TCM group showed better result in ab-sorbing fundus hemorrhage when compared WM group (P＜0.05). The amplitudes of b wave were all increased in three group after treatment (P＜0.05). However, no significant differences were found between groups(P>0.05). CONCLUSIONS Lingqi Huangban granule was proved to be ef-fective in treating ME secondary to RVO. Combination of Lingqi Huangban granule and IVR ap-pears to be a better multi-target therapy for this type of patient targeting both symptoms and root causes.