祛积通络方联合抗VEGF药物对黄斑微血管损伤修复的疗效观察

目的研究中药祛积通络方联合抗VEGF药物治疗非缺血型视网膜分支静脉阻塞合并黄斑水肿黄斑微血管损伤修复作用的临床疗效。方法收集2018年1月—2019年6月符合纳入标准的非缺血型视网膜分支静脉阻塞合并黄斑水肿患者100例(100眼),随机分为2组,对照组和试验组各50例(50眼)。对照组采用康柏西普眼用注射液治疗,试验组采用祛积通络方联合康柏西普眼用注射液治疗。观察治疗前后2组视力,光学相干断层扫描血管成像技术(OCTA),视网膜浅层毛细血管密度、深层毛细血管密度以及中心凹无血管区变化情况。结果(1)ETDRS视力:2组患者ETDRS视力字母数在治疗后1、3、6个月均比治疗前增加,均有统计学意义(P<0.05)。治疗后1个月,2组间比较无统计学意义(P>0.05),治疗后3个月和6个月,2组比较,t_3个月=3.224,P3个月=0.002;t_6个月=4.567,P6个月=0.000,均有统计学意义。(2)D-SCP:2组患者D-SCP在治疗后1、3和6个月均比治疗前增加,均有统计学意义(P<0.05)。治疗后1、3和6个月,2组比较,t_1个月=2.498,P1个月=0.014;t_3个月=2.063,P3个月=0.042;t_6个月=2.781,P6个月=0.007,均有统计学意义。(3)D-DCP:2组患者D-DCP在治疗后1、3和6个月均比治疗前增加,均有统计学意义(P<0.05)。治疗后1、3和6个月,2组比较,t_1个月=5.934,P1个月=0.000;t_3个月=2.852,P3个月=0.005;t_6个月=9.957,P6个月=0.000,均有统计学意义。(4)FAZ:2组患者FAZ在治疗后3、6个月均比治疗前减少,均有统计学意义(P<0.05)。2组比较,治疗后1个月,无统计学意义(P>0.05);而治疗后3、6个月,t_3个月=2.005,P3个月=0.048;t_6个月=2.673,P6个月=0.009,均有统计学意义。(5)Spearman相关分析:D-SCP和D-DCP与ETDRS视力字母数呈显著正相关(r_SCP=0.695,P=0.010;rDCP=0.863,P=0.001),而SCP-FAZ与ETDRS视力字母数呈负相关(r=-0.583,P=0.040)。结论祛积通络方联合抗VEGF治疗对于视网膜分支静脉阻塞黄斑微血管损伤修复作用优于单纯抗VEGF治疗组,有助于提高视功能。

Clinical effect of Quji Tongluo decoction combined with anti-VEGF agents on repairing macular microvascular injury in macular edema secondary to non-ischemic retinal branch vein occlusion

OBJECTIVE To study the clinical effect of Quji Tongluo decoction combined with anti-VEGF agents in repairing macular microvascular injury of macular edema secondary to non-ischemic branch retinal vein occlusion(BRVO-ME).METHODS It was a prospective randomized controlled trial.A total of 100 cases of non-ischemic BRVO-ME patients admitted to our hospital and met the inclusion criteria from January 2018 to June 2019 were collected and randomly divided into two groups,50 cases(50 eyes)in the control group and 50 cases(50 eyes)in the experimental group.The control group was treated with anti-VEGF agents,and the experimental group was treated with Quji Tongluodecoction and anti-VEGF agents.Before and after treatment,the visual acuity,the capillary density of the superficial capillary plexus(D-SCP),the capillary density of the deep capillary plexus(D-DCP)and the area of fovea avascular zone(FAZ)were observed.RESULTS(1)Comparison of ETDRS visual acuity:Number of visible letters of the two groups at three time points(1,3,6 months)all increased significantly than results before the treatment(P<0.05).After the treatment for one month,there was no statistical significance between the two groups(P>0.05).After the treatment for 3 and 6 months,there was statistical significance between the two groups(t_3mon=3.224,P3 mon=0.002;t_6mon=4.567,P6 mon=0.000).(2)Comparison of the capillary density of the superficial capillary plexus:The D-SCP results of two groups all experienced significant increase at three time points(P<0.05).After the treatment for 1,3 and 6 months,there was statistical significance between the two groups(t_1mon=2.498,P1 mon=0.014;t_3mon=2.063,P3 mon=0.042;t_6mon=2.781,P6 mon=0.007).(3)Comparison of the capillary density of the deep capillary plexus:The D-DCP results of two groups all experienced significant increase at three time points(P<0.05).After the treatment for 1,3 and 6 months,there was statistical significance between the two groups,the combined treatment group was better than the control group(t_1mon=5.934,P1 mon=0.000;t_3mon=2.852,P3 mon=0.005;t_6mon=9.957,P6 mon=0.000).(4)FAZ area comparison:The FAZ results of two groups on 3rd and 6th month after the treatment both decreased significantly than their counterparts before treatment(P<0.05).After the treatment for one month,there was no difference between the two groups(P>0.05);After the treatment for 3 and 6 months,there was statistical significance between the two groups(t_3mon=2.005,P3 mon=0.048;t_6mon=2.673,P6 mon=0.009).(5)Spearman correlation analysis:There was a significant positive correlation between D-SCP and D-DCP and the number of letters in ETDRS(rSCP=0.695,P=0.010;rDCP=0.863,P=0.001),while there was a negative correlation between SCP-FAZ and the number of letters in ETDRS(r=-0.583,P=0.040).CONCLUSIONS Combination of Quji Tongluo decocation and anti-VEGF treatment is better than anti-VEGF treatment alone in repairing macular microvascular injury of non-ischemic BRVO-ME.It can improve visual function.