| The first part of clinical research Clinical characteristics of patients with nonarteritic anterior ischemic optic neuropathySection 1 Correlation analysis between TCM syndromes and risk factors in patients with non-arteritic anterior ischemic optic neuropathyObjective:To investigate the correlation between traditional chinese medicine(TCM)syndromes and risk factors in patients with nonarteritic anterior ischemic optic neuropathy(NAION)Methods:A retrospective study was used to analyze 167 patients who were diagnosed as NAION in the the Department of Ophthalmology,Dongfang Hospital,Beijing University of Chinese Medicine from January 2009 to December 2019.The baseline data of the patients included age,gender,eye class,binocular interval,course of disease,body mass index,etc.According to the review and analysis of relevant risk factors of NAION,the past medical history collected includes:hyperlipidemia,hypertension,diabetes,coronary heart disease,peripheral arteriosclerosis,cerebral infarction and other medical history.All cases underwent BCVA,MD,MS,syndrome differentiation,etc.Result:There was no significant difference in BCVA,MD,MS,between qi deficiency and blood stasis syndrome,qi stagnation and blood stasis syndrome,liver and kidney yin deficiency syndrome,and qi and blood deficiency syndrome in NAION patients(P>0.05).There was a significant statistical difference in the composition ratio of TCM syndromes between the ages under 50 and over 50(P<0.01).The syndrome types of people aged under 50 are mainly qi stagnation and blood stasis,and those over 50 are mainly qi deficiency and blood stasis.There was a significant statistical difference in the number of patients with hyperlipidemia and hypertension between the ages under 50 and over 50(P<0.01);There was no statistical difference in the number of patients with diabetes,cerebral infarction,coronary heart disease,and peripheral arteriosclerosis between the ages under 50 and over 50(P>0.05).There were statistical differences in the distribution of different syndrome types in the history of NAION patients with or without hyperlipidemia,hypertension,diabetes,cerebral infarction,coronary heart disease,and peripheral arteriosclerosis(P<0.05).NAION patients with different risk factors have a certain correlation with the distribution of TCM syndromesConclusion:According to previous research,this study found that patients with NAION had the syndromes of qi deficiency and blood stasis,qi stagnation and blood stasis,liver and kidney yin deficiency,and qi and blood deficiency.The syndrome types of people aged under 50 are mainly qi stagnation and blood stasis,and those over 50 are mainly qi deficiency and blood stasis.The incidence of single and double eyes and different courses of disease have no effect on the overall composition ratio of TCM syndromes.The number of patients with hyperlipidemia and hypertension in people over 50 years old was significantly higher than that in people under 50 years old.There is no difference in the composition of different risk factors between single and double eyes.The history of hyperlipidemia,hypertension,diabetes,cerebral infarction,coronary heart disease,and peripheral arteriosclerosis have certain correlations with the distribution of different syndrome types.Section 2 The clinical Observation of Functional Magnetic Resonance Imaging in NAIONObjective:To investigate the characteristics of functional magnetic resonan ce imaging in NAIONMethods:From January 2018 to December 2019,20 cases(20 eyes)of NAION patients who were treated in the Department of Ophthalmology,Dongfang Hospital,Beijing University of Chinese Medicine were observed.20 healthy people with matched age and gender were selected as controls.The brain low-frequency amplitude(ALFF)about blood-oxygen-level-dependent functional magnetic resonance imaging(BOLD-fMRI)was obtained through BOLD-fMRI examination.Combining with the best visual acuity,visual field,the characteristics of NAION in functional magnetic resonance imaging were discussed Results:Compared with the control group,the BCVA decreased in the NAION group(P<0.05).Compared with the control group,the NAION group had a decrease in MS level and an increase in MD value(P<0.05).Compared with the control group,the primary visual cortex area of the NAION group decreased in ALFF,and the ALFF in the right insula and frontal gyrus area decreased;however,in the NAION group,ALFF increased in other areas of the cerebral cortex,including pons,lingual gyrus,and subparietal Leaflet,leaflet area near the center.Conclusion:Compared with the healthy control group,the functions of primary visual cortex,right insula and middle frontal gyrus in NAION group decreased significantly,and DMN dysfunction was found,which may be beneficial to the early diagnosis of NAION.Section 3 The serological characteristics of patients with non-arterial inflammatory anterior ischemic optic neuropathyObjective:To investigate the serological features of nonarteritic anterior ischemic optic neuropathy(NAION)from vasomotor factor,blood sugar,blood lipids,homocysteine,blood routine related inflammation indicators.Methods:From January 2018 to December 2019,30 cases of NAION patients who were treated in the Department of Ophthalmology,Dongfang Hospital,Beijing University of Chinese Medicine were observed.30 healthy people with matched age and gender were selected as controls.The contents of Nitric Oxide(NO)and endothelin1(ET-1),prostacyclin(PGI2)and thromboxane A2(TXA2),Low-density lipoprotein(LDL),fasting blood glucose(GLU),homocysteine(Hcy),blood platelet(Hcy),Mean platelet volume(MPV),Neutrophil to lymphocyte ratio(NLR)were observed in NAION patients and matched healthy people.Results:Compared with the control group,the changes of NO and ET-1,PGI2 and TXA2 in NAION patients were not statistically different(P>0.05).Compared with the control group,the Hey content of the NAION patient group was significantly increased,with statistical differences(P<0.05);the contents of LDL and GLU were not statistically different(P>0.05).Compared with the control group,the PLT and MPV values of NAION patients were not statistically different(P>0.05);the NLR value was significantly increased with statistical difference(P<0.05).Conclusion:Compared with normal healthy people,the levels of Hcy and NLR increased in NAION patients.Therefore,the levels of Hcy and NLR may be important indicators for the diagnosis and morbidity of NAION patients.The second part of clinical research The clinical effect of flavored astragalus membranaceus soup on NAION patients and its effect on Hcy and NLRObjective:To observe the clincal effect of flavored astragalus membranaceus soup on NAION patients and analyze the effect of flavored astragalus membranaceus soup on Hcy and NLR in NAION patients.Methods:From January 2018 to December 2019,16 cases of NAION patients who were treated in the Department of Ophthalmology,Dongfang Hospital,Beijing University of Chinese Medicine were observed.15 healthy people with matched age and gender were selected as controls.The included patients were randomly divided into experimental group and control group according to the random number table method.The control group was given basic treatment(basic treatments included vitamins,nutritional neuropharmaceuticals,drugs to improve circulation,etc.);the experimental group was given flavored astragalus membranaceus soup in addition to the basic treatment.The changes of best corrected visual acuity(BCVA),mean deviation(MD),mean sensitivity(MS),NLR,and Hcy in the two groups after intervention were detected after 1 month.Results:Compared with before treatment,there were statistically significant differences in BCVA,MD and MS in the experimental group after treatment(P<0.01).There were statistically significant differences in BCVA,MD and MS in the control group after treatment compared with before treatment(P<0.01).Compared with the control group,there was no statistical difference in the improvement of BCVA before and after treatment in the experimental group(P>0.05).Compared with the control group,the improvement of MD and MS in the experimental group before and after treatment was statistically significant(P<0.01).The effective rate(number of eyes)was 55.56%in the control group and 68.42%in the experimental group.Compared with the control group,there was no statistical difference in the effective rate of the experimental group(P>0.05).There were statistically significant differences in NLR and Hcy in the experimental group after treatment compared with before treatment(P<0.01).Compared with before treatment,there was significant statistical difference in NLR after treatment in the control group(P<0.01),and no statistical difference in Hcy after treatment in the control group(P>0.05).Compared with the control group,the improvement of NLR and Hcy before and after treatment in the experimental group was statistically different(P<0.05).Conclusion:Flavored astragalus membranaceus soup could significantly improve the best corrected visual acuity,average visual field defect,and average sensitivity index in NAION patients.There was a statistically significant difference in visual field improvement,but no statistically significant improvement in visual acuity.Flavored astragalus membranaceus soup could reduce the level of NLR and Hcy in patients with NAION,and the therapeutic effect on patients with NAION may be closely related to the reduction of NLR and Hcy levels. |
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