The Study Of The Relationship Between The Diurnal Variation Of 24h-NCT And TCM Syndrome Types In Patients With Glaucoma To Be Diagnosed

ObjectiveThe relationship between the characteristics of intraocular pressure fluctuation and the TCM syndromes of suspected glaucoma patients was observed through 24h-NCT monitoring.The significance of 24h-NCT monitoring for early diagnosis of glaucoma or high intraocular pressure was evaluated,and the peak of high intraocular pressure was found in time of day to guide the treatment.Methods(1)The general condition,clinical symptoms of traditional Chinese medicine and signs of tongue pulse were recorded for the patients who met the criteria of case selection.After that,I completed a-ultrasound measurement of corneal thickness,visual field examination,OCT examination for glaucoma,UBM examination and 24h-NCT monitoring.The intraocular pressure was measured once every 2 hours for 24h,and three values were measured each time.The average value was taken and recorded.(2)Analyze its 24h-NCT diurnal variation characteristics,conduct TCM syndrome differentiation for all enrolled patients,and analyze the relationship between the 24h-NCT diurnal variation characteristics and TCM syndrome types.(3)The proportion of all the selected patients with suspected glaucoma who had peak intraocular pressure during non-outpatient period(including night),and the rate of diagnosis of glaucoma or high intraocular pressure in the selected patients were calculated and analyzed,and the time characteristics of peak intraocular pressure in these patients were further analyzed.ResultsA prospective study was conducted to include 84 patients(168 eyes)with suspected glaucoma who met the criteria for case selection and were admitted to Guangdong Province Traditional Chinese Medical Hospital from December 1,2018 to January 31,2020.The largest number of patients were POAG patients(35 cases,41.7%),followed by CPACG patients(27 cases,32.1%),10 patients with OHT(11.9%),and 12 patients excluding glaucoma(14.3%).Among the POAG,CPACG and OHT patients included in the study,46%had high peak iop in outpatient time and 54%had high peak iop in non-outpatient time(including night).The proportion of peak intraocular pressure(iop)in non-outpatient time(including night)was slightly higher than that in outpatient time.A total of 72 cases of POAG,CPACG and OHT were confirmed in suspected glaucoma meeting the criteria for case selection.Among them,the peak intraocular pressure was found in 36 cases during the day,and the maximum number of cases with yang-deficiency syndrome was 14 cases(38.9%).There were 10 cases of liver and kidney Yin deficiency syndrome,accounting for 27.8%.Liver depression and qi stagnation syndrome accounted for 19.4%in 7 cases.Phlegm dampness syndrome accounted for 13.9%in 5 cases.There were 36 cases with intraocular pressure peak at night,among which 16 cases(44.4%)had liver stagnation syndrome.There were 8 cases of Yang deficiency syndrome,accounting for 22.2%.There were 6 cases with phlegm and dampness syndrome,accounting for 16.7%.There were 6 cases of liver and kidney Yin deficiency syndrome,accounting for 16.7%.Among the POAG,CPACG and OHT patients included in the study,the peak time of NCT in the sputum-dampness syndrome type within 24 hours was from 15:00 to 17:00 at most.The peak time of NCT in the syndrome of liver stagnation and qi stagnation within 24 hours was from 17:00 to 19:00 at most.The peak period of NCT in yang-deficiency syndrome type was from 11:00 to 13:00 at most within 24 hours.The peak time of NCT in the liver and kidney Yin deficiency syndrome type was from 17:00 to 19:00 at most within 24 hours.The study included the largest number of POAG patients with liver stagnation syndrome(14 cases,accounting for 40.0%),followed by Yang deficiency syndrome(9 cases,accounting for 25.7%),liver and kidney Yin deficiency syndrome and phlegm and dampness syndrome(6 cases,accounting for 17.1%).The study included the largest number of CPACG patients with Yang deficiency syndrome(11 cases,accounting for 40.7%),followed by liver and kidney Yin deficiency syndrome(9 cases,accounting for 33.3%),phlegm and dampness syndrome(5 cases,accounting for 18.5%),and liver stagnation syndrome(2 cases,accounting for 7.4%).The study included the largest number of OHT patients with liver stagnation and qi stagnation(7 cases,accounting for 70.0%),followed by Yang deficiency(2 cases,accounting for 20.0%),and liver and kidney Yin deficiency(1 case,accounting for 10.0%).The age distribution of POAG,CPACG and OHT patients included in the study ranged from 60 to 69 years at the highest,followed by 50 to 59 years,and 70 to 80 years at the lowest.The age distribution is the most in 60-69 years,followed by 50-59 years,and the least in 70-80 years.Conclusion(1)The vast majority of suspected glaucoma patients were diagnosed with insidious symptoms of POAG,CPACG or OHT,so the significance of 24h-NCT in the diagnosis of POAG,CPACG and OHT should be emphasized.(2)24h-NCT monitoring can detect hidden glaucoma patients and patients with high iop with peak iop in non-outpatient time(including night),which is beneficial to reduce missed diagnosis and early diagnosis of POAG,CPACG and OHT.(3)Most of the patients with intraocular pressure peaks of POAG,CPACG and OHT in the daytime had Yang deficiency syndrome,and the least was phlegm-dampness syndrome.Patients with peak intraocular pressure of POAG,CPACG and OHT at night were mostly characterized by liver stagnation and qi stagnation,and at least were characterized by liver and kidney Yin deficiency and phlegm dampness.(4)Most of the patients with POAG and OHT were of liver stagnation syndrome.Among CPACG patients,the syndrome of Yang deficiency was the most.