原发性开角型青光眼患者血管内皮、血小板功能改变及与中医证型关系的研究

目的：探讨原发性开角型青光眼的发病机制。方法将85例原发性开角型青光眼患者分为高眼压型组、正常眼压型组,并与24例正常人进行对照,对其血管内皮和血小板功能指标的改变及与中医辨证分型的关系进行了研究。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,内皮素（ET）、血浆血栓素B2（TXB2）、血浆β-血栓球蛋白（β-TG）、vonWillebrand 因子（vWF）、6-酮-前列环素 F1α（6-keto-PGF1α）、T/K 比值均有显著性差异（P<0.05或 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ET-1、TXB2、β-TG、vWF和T/K比值升高,6-keto-PGF1α下降。其中肝郁气滞证和肝肾亏虚证组分别与正常组相比,TXB2、β-TG、vWF、6-keto-PGF1α和T/K比值均有显著性差异（P<0.05或P<0.01）;痰湿泛目证组与正常组相比,T/K比值有显著性差异（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管内皮细胞受损和血小板聚集性增强,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。

Changes in the Function of Vascular Endothelia and Blood Platelets and Its Relationship with TCM Syndromes in Primary Open-Angle Glaucoma Patients

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 data were compared with that of 24 normal persons. These data included the function changes of vascular endotelia and blood platelets and their relationship with TCM syndromes. Results Compared with the normal group, ET-1, TXB2, β-TG, vWF, 6-keto-PGF1α and T/K values in the high IOP group and the normal IOP group had significant difference (P<0.05 or P<0.01). ET-1, TXB2, β-TG, vWF and T/K values were higher and 6-keto-PGF1α was lower in all syndromes of open-angle glaucoma than those in normal group. Compared with the normal group, the TXB2, β-TG, vWF, 6-keto-PGF1α and T/K in sydrome of liver-Qi stagnation group and the deficiency of liver and kidney group were statistically significant (P<0.05 or P<0.01), T/K value had significant difference. Conclusion There are obvious injury of vascular endothelia cell, increased aggregation of the blood platelets, and the stagnation of the blood in the high IOP group and the normal IOP group, while the change of blood stagnation in normal control group is not distinct. 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.