| Purpose:To analyze the diagnostic value of different AMD TCM syndrome types with mfERG FOK by measuring P1, N1 wave for age-related macular degeneration(AMD) patients and the healthy. Also serum plasma homocysteine (Hcy), superoxide dismutase (SOD), malondialdehyde (MDA) and serum lipid levels were assayed to study the changes and significance with AMD TCM syndrome types. Then to determine if Hcy level is a risk factor in AMD among Chinese population.Objects and Methods:All 66 AMD patients were divided into early dry form and wet form in western medicine, and phlegm syndrome type, phlegm-blood stasis syndrome type and liver-kidney deficiency syndrome type in TCM. The patients and 13 healthy were measured with RETIscan (Version 3.11) by generating from 6 rings and 4 quadrants of mfERG FOK. Then all the data were analyzed in terms of response density and latency to correlate the variation characteristics among the different TCM syndrome types with response density and latency of P1, N1 waves. Only 51 AMD patients'blood samples were collected and 19 healthy samples. The fasting plasma homocysteine levels were measured by euzyme-linked immunosorbent assay. SOD, MDA, and blood fat concentration were also measured. And then correlated different AMD TCM syndrome types and all these indexes, and to find the influence on Hcy from the related factors and the independent factor of AMD. All the data were analyzed by ANOVA, multiple regression, Binary Logistic regression and so on.Results:①The magnitude of variations of FOK in phlegm syndrome group were consistent with dry AMD group basically, similar changes were also found between phlegm-blood stasis syndrome group as well as liver-kidney deficiency syndrome group and the wet AMD group. P1 wave in ring 1～3 and N1 wave in ring 1 of response densities decreased and P1 wave in ring 1, N1 wave in ring 2,3,5 of latencies delayed in phlegm group (P<0.05), response densities of P1 and Nl wave in ring 1-5 of phlegm-blood stasis syndrome group and any ring in liver-kidney deficiency syndrome group decreased, but mainly in ring 1-4. Response densities decreased and latencies delayed of PI, N1 waves increasingly from phlegm syndrome group to phlegm-blood stasis syndrome group to liver-kidney deficiency syndrome group, among which latency of N1 wave delayed in all syndrome groups.②The response densities in ring 1 of the asymptomatic fellow eyes of wet AMD group decreased compared with the control and asymptomatic fellow eyes of dry AMD groups(P<0.05). No differences were observed in other rings among the three groups.③No changes in the response densities and latencies were observed between one eye in dry form with contralateral wet AMD group and dry AMD group(P>0.05).④The Hcy levels in phlegm-blood stasis syndrome group and liver-kidney deficiency syndrome group were higher than those of the control(P<0.05), yet no differences were detected among three case groups(P>0.05).⑤My results demonstrated inverse correlation between Hcy and SOD level.⑥SOD levels in phlegm-blood stasis syndrome group and liver-kidney deficiency syndrome group were higher than controls and phlegm syndrome group(P<0.05), while TC level was higher than controls(P<0.05); MDA, TC and LDL-C levels all groups were elevated to different degrees(P<0.05). No difference of HDL-C level among four groups was found.Conclusions:Response density in ring 1-3 and latency in ring 1 of P1 wave, response density in ring 1 and latency in ring 2,3,5 of N1 wave of phlegm syndrome; response density in ring 1-4 of P1 wave and ring 1-3 of N1 wave of phlegm-blood stasis syndrome; response density in ring 1-4 of P1, N1 wave, latency in ring 1-3 of PI wave and ring 1,2,3,5,6 of N1 wave of liver-kiney deficiency syndrome among AMD eyes. It was also found that the asymptomatic fellow eyes of wet AMD are vulnerable to become dry AMD, while there is no advanced progression in eyes of dry form with contralateral wet AMD in this study. This research suggested that hyperhomocysteine may play roles in phlegm-blood stasis syndrome and liver-kidney deficiency syndrome AMD by various pathogenic mechanisms, but was not a risk factor of AMD in this survey. Increased TG and LDL-C levels may be microscopic indexes of syndrome differentiation and stage increasing in phlegm syndrome group. Increased TC, TG and LDL-C may be some of the useful markers of phlegm-blood stasis syndrome andliver-kidney deficiency syndrome. Increased SOD and decreased MDA may beregarded as pathological basis in AMD. |
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