| 1.Objective:To observe the efficacy of hormone combined with Xiaoyao San on Acute Optic Neuritis(AON)with liver depression and qi stagnation and analyze the clinical efficacy and characteristics of myelin oligodendrocyte glycoprotein antibody positive optic neuritis(MOG-ON).2.Methods:(1)Curative effect study: According to the inclusion and abasement criteria of liver depression and qi stagnation type AON,65 inpatients in the ophthalmology department of the Affiliated Hospital of Changchun University of Chinese Medicine from November 2021 to November 2022 were selected,they were divided into two groups by random grouping:treatment group and control group.The data of all cases were selected from one eye,and the clinical data of the right eye were collected as statistics for binocular patients.The treatment group(33 cases and 33 eyes)was treated with a combination of Chinese herbal medicine Xiaoyao San and hormones,while the control group(32 cases and 32 eyes)received Western medicine treatment based on hormone.The visual acuity,visual field,fundus,TCM symptom score and the changes of retinal nerve fiber layer after 3 months were observed in the two groups of AON patients before and after treatment to compare whether there were differences in the efficacy between the two groups.(2)Clinical observation: Clinical data of 26 patients(38 eyes)with MOG-ON from November 2021 to February 2023 in ophthalmology Department affiliated to Changchun University of Chinese Medicine were collected,including general information,ophthalmic examination,disease progression,immunological test results,serum MOG antibody titer,treatment response,prognosis and etc.SPSS20.0 was used for data entry and statistical analysis to get the final conclusion.3.Results:(1)Curative effect study: 1)In this study,the number of male and female patients: 1:1.03,the average age was 44.17±13.52 years old,and the median age was 45 years old.The clinical data of the two groups before treatment were comparable.2)Curative effect analysis:After treatment,the visual acuity of most patients was significantly improved,and the congestive edema of optic disc and visual field were significantly improved(P < 0.05).No significant difference was found in improved visual acuity,visual field and nerve fiber layer thickness between the two groups(P > 0.05).The scores of TCM symptoms in the treatment group were significantly lower after treatment than before treatment(P < 0.05).There was no significant difference in TCM syndrome score of control group before and after treatment(P >0.05),and in the late stage of hormone therapy,patients in this group showed obvious symptoms of insomnia,constipation,irritability,dry mouth and so on.The total effective rate of the treatment group was 84.8% and the total effective rate of the control group was 81.3%.The efficacy was significant,but there was no significant difference between the two groups(P > 0.05).Before treatment,some patients will show varying degrees of optic disc edema,and the nerve fiber layer around the optic disc thickens.After treatment,the edema is reduced,but the nerve fiber layer will gradually become thinner,which is more obvious three months after the onset.3)Analysis of influencing factors of curative effect: The curative effect of treatment duration > 7 days was lower than that of treatment duration < 7 days(P < 0.05).The visual acuity varies at the time of visit and the efficacy varies.The more severe the visual impairment at first diagnosis,the lower the effective rate(P < 0.05).(2)Clinical observation: This study showed that female patients were more common,the age of onset was 41.19±18.01 years old,and the median age was 36.50 years old.Binocular disease was involved in 46.2%.The number of attacks is 1-5 times,course of disease: 3d to 5years.38.5% with painful eye rotation,best corrected visual acuity ≤0.1 before treatment accounted for 36.8%,and best corrected visual acuity ≥0.1 after 2 weeks of treatment reached94.7%.Serum MOG antibody titers ranged from 1:10 to 1:1000+,and showed no significant correlation with disease activity or clinical course.In the acute stage,19 eyes(50%)had edema of optic disc,and MRI of optic nerve mainly involved the orbital segment(65.4%),some of which were accompanied by enhancement of orbital tissue.OCT shows that the peridisk retinal nerve fiber layer thickness thickens due to optic disc swelling during acute attacks,and the p RFNL is atrophied and thinner to varying degrees as the disease progresses.MOG-ON patients with syndrome is liver depression and qi stagnation type,followed by qi and blood stasis,after treatment with hormone shock most patients will be fire Yin deficiency syndrome.4.Conclusion:(1)Curative effect study: Xiaoyao San plus and minus combined hormone based Western medicine treatment and simple hormone based Western medicine treatment AON,there was no significant difference in the improvement of visual acuity,visual field and fundus between the two groups.The clinical use of hormone combined with Xiaoyao San for soothing liver and regulating qi can reduce the side effects of hormone and improve the systemic symptoms of patients.The duration of the disease and the degree of visual impairment were the possible factors influencing the curative effect.(2)Clinical observation: The prognosis of MOG-ON vision is relatively good,but it is easy to relapse.Optic nerve MRI often involves the medial orbital segment,which can be accompanied by the enhancement of orbital tissue,and the nerve fiber layer will appear atrophy and thinning to varying degrees with the progression of the disease.Acute phase hormone shock therapy is helpful to control and stabilize the condition.According to the dialectical classification of traditional Chinese medicine,the syndrome of MOG-ON patients is liver depression and qi stagnation.Late treatment of Yin deficiency fire is more common. |
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