文献类型：期刊文献

中文题名：中药联合头体针治疗非动脉炎性前部缺血性视神经病变的临床研究

英文题名：Clinical study one treatment of non-arteritic inflammatory anterior ischemic optic neuropathy with Chinese Medicine combined with acupuncture

作者：杨继若[1];罗向霞[2];尤斌[1];颉瑞萍[3];侯雅慧[4];王军杰[5];魏彬彬[5];龙思羽[5];王影[5]

第一作者：杨继若

机构：[1]兰州市第一人民医院,兰州730050;[2]甘肃省中医院,兰州730050;[3]甘肃中医药大学附属医院,兰州730000;[4]甘肃省第二人民医院,兰州730000;[5]中国中医科学院眼科医院,北京100040

第一机构：兰州市第一人民医院,兰州730050

年份：2020

卷号：30

期号：7

起止页码：477

中文期刊名：中国中医眼科杂志

外文期刊名：China Journal of Chinese Ophthalmology

收录：CSTPCD

基金：兰州市人才创新创业课题(2015-RC-27);国家自然科学基金(81503453);中国中医科学院院内联合创新专项(zz11-041)。

语种：中文

中文关键词：非动脉炎性前部缺血性视神经病变;针刺;中药;多中心随机对照试验

外文关键词：non-arteritic inflammatory anterior ischemic optic neuropathy;acupuncture;Chinese Medicine;multi-center randomized controlled trial

摘要：目的评价中药联合头体针治疗非动脉炎性前部缺血性视神经病变(NAION)的有效性和安全性。方法多中心、随机、平行对照研究,将辨证为肾虚血瘀证的NAION患者96例(117只眼)随机分配为单纯针刺组、腺苷钴胺组和针药组3组。腺苷钴胺组29例(35只眼)予腺苷钴胺肌注治疗;单纯针刺组30例(35只眼)仅使用针刺治疗;针药组37例(47只眼)在针刺组基础上联合中药复方治疗,治疗2个月。比较3组治疗前后最佳矫正视力(BCVA)、视野平均缺损度(MD)差值和模式标准差(PSD)差值和不良反应等情况。结果(1)有效率:针药组为89.36%、针刺组为87.71%、腺苷钴胺组为48.57%,3组间有效率比较有统计学意义(c2=20.888,P=0.000),针药组、针刺组与腺苷钴胺组比较(c2针药=16.539,P针药=0.000;c2针刺=10.944,P针刺=0.001),均有统计学意义;(2)BCVA:3组治疗后较治疗前改善,均具有统计学意义(t针药=5.979,P针药=0.000;t针刺=4.029,P针刺=0.000;t腺苷钴胺=3.728,P腺苷钴胺=0.001),但3组组间比较差异无统计学意义(F=1.166,P=0.315);(3)视野:MD比较,3组治疗后较治疗前升高,差异均有统计学意义(t针药=-5.569,P针药=0.000;t针刺=-3.752,P针刺=0.001;t腺苷钴胺=-3.057,P腺苷钴胺=0.004);PSD比较,3组治疗后均较疗前降低,差异有统计学意义(t针药=3.535,P针药=0.001;t针刺=2.451,P针刺=0.020;t腺苷钴胺=2.127,P腺苷钴胺=0.041)。视野MD和PSD差值,3组组间比较,差异均无统计学意义(P>0.05);(4)不良反应:3组各项安全指标比较均无统计学意义(P>0.05)。(5)Logistic回归分析:影响NAION疗效因素为治疗方式(OR=0.248,P=0.000,95%CI为0.128~0.483)、初诊BCVA(OR=0.040,P=0.000,95%CI为0.007~0.241)。结论与腺苷钴胺组相比,针药联合及单纯针刺具有改善NAION患者视功能的作用。
OBJECTIVE To evaluate the efficacy and safety of Chinese Medicine combined with scalp and body acupuncture in the treatment of non-arterial anterior ischemic optic neuropathy(NAION). METHODS It was a multicenter, randomized, parallel controlled study. NAION patients(96 cases, 117 eyes) with syndrome of kidney deficiency and blood stasis were randomly divided into acupuncture combined with herbal decoction(AHD) group(37 cases, 47 eyes),mono-acupuncture(MA) group(30 cases, 35 eyes), and cobamamide injection(CI) group(29 cases, 35 eyes). Treatment duration was 2 months. The outcome indicators were evaluated before and after treatment, including log MAR visual acuity(VA), mean defect(MD)and pattern standard deviation(PSD) of visual field, and adverse reactions(AE). RESULTS(1) Effective rate: there was statistically significant difference among the effective rate in AHD group(89.36%), MA group(87.71%), and CI group(48.57%)(c2=20.888, P=0.000). And result of RAHD, MA group were significantly better than CI group(c2 AHD=16.539, PAHD=0.000;c2 MA=10.944, PMA=0.001).(2) LogMAR VA: The LogMAR VA of three groups were significantly improved after treatment(tAHD=5.979, PAHD=0.000;tMA=4.029, PMA=0.000;tCI=3.728, PCI=0.001). There was no statistically significant difference among the three groups(F=1.166, P=0.315).(3) Visual field: After treatment, MD of three groups elevated significantly(tAHD=-5.569, PAHD=0.000;tMA=-3.752, PMA=0.001;tCI=-3.057, PCI=0.004). After treatment,PSD of three groups dropped significantly( tAHD=3.535, PAHD=0.001;tMA=2.451, PMA=0.020;tCI=2.127, PCI=0.041). The variation before and after treatment of MD and PSD between the three groups were of no statistical significance(FMD=1.695, PMD=0.188, FPSD=0.297, PPSD=0.744).(4) Adverse Reactions(AE): there was no significant difference of AE among three groups(P>0.05).(5)Logistic regression analysis showed the factors that influencing curative effect were interventions(OR =0.248,P =0.000, 95% CI 0.128 ~0.483) and best corrected visual acuity of initial diagnosis(OR=0.040, P=0.000, 95%CI 0.007~0.241). CONCLUSIONS Compared with cobamamide, both acupunctures combined with herbal decoction and mono-acupuncture could improve the visual function of patients with NAION.