补肾活血中药对原发性青光眼术后视神经保护作用的临床研究∗

摘要

Objective To observe the neuroprotective effects of kidney-tonifying and blood-activating me-dicinals on optical nerve in glaucomatous eyes after filtering surgery with intraocular pressure( IOP) under control. Methods A prospective study was conducted to enroll 36 cases of primary glaucoma after filte-ring surgery with IOP under control. The subjects were randomly divided into control group and treatment group. The control group received monitoring and IOP control management only while the treatment group was added oral intake of kidney-tonifying and blood-activating medicinals for three treatment courses ( each course lasts two months with a total of six months) . Visual acuity, IOP, visual field, optic nerve scanning, and VEP were evaluated before and after treatment. Results The visual acuity and IOP of two group showed no significant changes before and after treatment. After treatment,mean sensitivity ( MS) , mean defect ( MD) , loss variance ( LV) , average retinal nerve fiber layer thickness ( RNFL) , and pat-tern visual evoked potential ( LP100 , AP100 ) were significantly improved in the treatment group ( P <0. 05 ) . There was no significant change in C/D and RA in the treatment group after treatment ( P >0. 05 ) . There were no significant changes in all parameters in the control group after treatment ( P >0. 05). Compared with the control group, MS , MD, LV, average RNFL’s thickness, LP100, and AP100 of two groups were statistically significant after treatment ( P<0. 05 ) . Conclusion Kidney-tonifying and blood-activating medicinals could improve vision, VEP and RNFL thickness in primary glaucomatous eyes after filtering surgery thereby protecting the optic nerve and visual function in glaucomatous patients.%目的：观察补肾活血中药对原发性青光眼术后眼压已控制患者视神经的保护作用。方法采用前瞻性研究方法收集已行抗青光眼手术且眼压已控制的原发性青光眼患者36例,随机分为对照组与治疗组,对照组仅予卡替洛尔滴眼液控制眼压,治疗组在对照组基础上给予口服补肾活血中药3个疗程,每个疗程2个月,共6个月。观察用药前后视力、眼压、视野、视神经视网膜扫描、视觉电生理( VEP)等指标的变化。结果治疗组和对照组用药前后视力、眼压无明显变化。与用药前比较,治疗组用药后视野平均光敏感度( MS)、平均缺损( MD)、丢失方差( LV)、平均视网膜神经纤维(RNFL)厚度、图形视觉诱发电位(LP100,AP100)差异均有统计学意义(P<0.05)；杯盘比(C/D)、盘沿面积(RA)与用药前比较差异无统计学意义(P>0.05)。对照组用药前后各指标无显著性差异。与对照组用药后比较,治疗组用药后MS、MD、LV、平均RNFL厚度、LP100、AP100有显著性差异(P<0.05),MS无显著性差异(P>0．05)。结论补肾活血中药可改善原发性青光眼术后眼压已控制患者的视野、图形视觉诱发电位及视网膜神经纤维层厚度等指标,从而保护青光眼患者视神经和视功能。