| Part Ⅰ:The clinical effect of traditional Chinese medicine on wAMD:a meta analysisObjectiveTo evaluate the clinical efficacy of the traditional Chinese medicine treatment of wAMD systematically.MethodsWe searched Wan Fang Med Onlion database,CNKI database,PubMed and Cochrane Library database,we collected clinical randomized controlled trials on the treatment of wAMD treated with traditional Chinese and western medicine published in the self-built database until December 2020.according to the literature inclusion standard,Note Express 3.2 should be used to screen the literature and select data.We evaluated the methodological quality by using Cochrane bias risk assessment tool.Meta-analysis was performed using RevMan5.4.ResultsA total of 16 literatures were included,including 1,338 patients with wet agerelated macular degeneration(1,444 eyes).The results of meta analysis showed that:the BCVA(ETDRS)was higher of experimental one than control one(MD=8.4,95%CI=6.40-10.40);The thickness of macular fovea was lower of experimental group than control group(MD=8.63,95%=3.84-13.42);The effective rate of experimental group was better than control group(OR=3.86,95%CI=2.57-5.82);The improvement rate of fluorescence leakage in the experimental group was better than that in the control group(OR=5.02,95%CI=1.81-13.86;the complications incidence has no difference between the experimental group and the control one(OR=0.52,95%=0.22-1.23);The recurrence rate of the experimental group was lower than that of the control group(OR=0.4,95%CI=0.2-0.81).ConclusionTraditional Chinese medicine treatment of wet age-related macular degeneration has a certain effect in Improving patients’ best corrected vision and reducing the thickness of macular fovea;Compared with western medicine alone,The traditional Chinese integrated with western medicine treatment has better clinical efficiency and does not increase the safety risk of medication.This study shows that Traditional Chinese medicine is effective and safe as the treatment of wAMD,and integrated western medicine and traditional Chinese could be used in wet age-related macular degeneration clinical treatment.It can provide synergistic effect for wet age-related macular degeneration treatment in western medicine and provide a new clinical idea for the treatment of wet age-related macular degeneration.Part Ⅱ:Retrospective study on the treatment of wAMD by Jiajian ZhujingfangObjectiveTo evaluate the effects of Jiajian Zhujingfang in treatment of ganshenliangxu wet age-related macular degeneration,about the protection of eyesight,the influence of Chinese medicine symptoms,macular area surface circulation and the central retinal thickness.To evaluate the control function of ganshenliangxu wAMD.To provide a traditional Chinese medicine treatment clinical guidance for wAMD,in order to provide synergistic traditional Chinese medicine treatment for first-line treatment of wAMD in Western medicine.To protect the visual function of patients,and ultimately achieve the purpose of reducing the blindness rate of the disease.MethodsA retrospective study was conducted on 54 patients with wAMD in the Professor Kang’s outpatient department,during 3 years and 9 months from January 2018 to October 2021,including 102 eyes(76 eyes of WAMD and 26 eyes of normal eyes),whose syndrome type was ganshenliangxu.Jiajian Zhujingfang was given oral treatment for 3 months.The Chinese medicine syndrome score,best corrected visual acuity,3.00 × 3.00mm area of retinal surface blood flow density and retinal thickness measured by OCTA were collected,before treatment and be treated 3 months after.Statistical analysis was finished by software SPSS 22.0.Results1.1The best corrected visual acuity of wAMD was 0.49±0.38 before treatment,and 0.44±0.41 after treatment,and there was statistically significant in difference(P=0.011),It was higher than before;1.2 The wAMD surface retinal blood flow density of the incentral 3.00 × 3.00mm area of the macular fovea:a.The fovea retinal blood flow density was 17.28±6.47 before treatment,and 21.25±6.72 after treatment,and there was statistically significant in difference(P<0.001),The blood flow density was higher than before.b.The upper retina blood flow density was 41.89±6.76 before treatment,and 46.24±7.81 after treatment,and there was statistically significant in difference(P<0.001),The blood flow density was higher than before.c.The temporal retinal blood flow density was 41.8±5.82 before treatment,and 46.2±5.5 after treatment,and there was statistically significant in difference(P<0.001),The blood flow density was higher than before.d.The inferior retinal blood flow density was 39.93±4.76 before treatment,and 46.89±6.62 after treatment,and there was statistically significant in difference(P<0.001),The blood flow density was higher than before.e.The nasal retinal blood flow density was 40.75±4.42 before treatment,and 45.89±5.28 after treatment,and there was statistically significant in difference(P<0.001),The blood flow density was higher than before.1.3 The wAMD central retinal thickness of the incentral 3.00 × 3.00mm area of the macular fovea:a.The thickness of the central retina was 304.92±117.54um before treatment,and 285.2±121.69um after treatment,and there was statistically significant in difference(P=0.031),It was lower than before.b.The upper retina thickness was 332.66±81.52um before treatment,and 321.92±75.21 um after,and there was statistically significant in difference(P=0.034),It was lower than before.c.The temporal retinal thickness was 330.67±90.83um before treatment,and 315.185±81.51 um after,and there was statistically significant in difference(P=0.006)It was lower than before.d.The inferior retinal thickness was 331.61±93.29um before treatment,and 312.36±82.63um after,and there was statistically significant in difference(P=0.009),It was lower than before.e.The nasal retinal thickness was 341.45±92.63um before treatment,and 321.97±82.35um after,and there was statistically significant in difference(P=0.001),It was lower than before.2.1 The best corrected visual acuity of normal eyes was 0.11±0.15 before treatment,and 0.05±0.12 after treatment,and there was statistically significant in difference(P=0.03),It was higher than before;2.2 The normal surface retinal blood flow density of the incentral 3.00 × 3.00mm area of the macular fovea:a.The fovea retinal blood flow density was 19.46±5.71 before treatment,and 18.62±5.36 after treatment,and there was no difference(P=0.26).b.The upper retina blood flow density was 50.62±5.53 before treatment,and 49.88±5.73 after treatment,and there was no difference(P=0.28).c.The temporal retinal blood flow density was 48.04±5.63 before treatment,and 47.35±6.01 after treatment,and there was no difference(P=0.35).d.The inferior retinal blood flow density was 49.31±6.03 before treatment,and 48.69±6.81 after treatment,and there was no difference(P=0.39).e.The nasal retinal blood flow density was 48.35±6.22 before treatment,and 47.35±6.82 after treatment,and there no difference(P=0.65).2.3 The normal central retinal thickness of the incentral 3.00 × 3.00mm area of the macular fovea:a.The thickness of the central retina was 249.23±16.7um before treatment,and 248.62±18.27um after treatment,and there was no difference(P=0.63).b.The upper retina thickness was 315.19±15.56um before treatment,and 313.38±18.19um after treatment,and there was no difference(P=0.06).c.The temporal retinal thickness was 308.38±23.48um before treatment,and 306.81±24.05um after,and there was no difference(P=0.48).d.The inferior retinal thickness was 303.77±33.83um before treatment,and 310.62±16.73um after,and there was no difference(P=0.09).e.The nasal retinal thickness was 317.85±18.73um before treatment,and 315.81±17.77um after,and there was no difference(P=0.56).3.The Traditional Chinese medicine syndrome score was 11.70±3.93 before treatment,and 7.30±3.56 after treatment.and there was statistically significant in difference(P=0.001).The syndrome score after treatment was lower than before treatment,and the Chinese medicine syndrome was significantly improved.ConclusionJiajian Zhujingfang can improve the visual acuity of patients with ganshenliangxu wAMD,slow down the decrease of visual acuity,improve retinal surface blood flow,improve retinal microcirculation,reduce the thickness of central retina and macular area,improve the symptoms of Chinese medicine symptoms,and control the progression of wAMD.The clinical guidance for the wAMD treatment by Traditional Chinese medicine will be provided,make up for the deficiency of reduced retinal blood flow density caused by anti-VEGF therapy,provide synergistic effect for the first-line treatment of wAMD in Western medicine,protect the patients’ visual function,Aim to achieve the purpose of reducing the blindness rate of the disease.Part Ⅲ:Mechanism of Jiajian Zhujingfang in treating wAMD based on network pharmacologyObjectiveThe method of network pharmacolog was be used,to explore the Jiajian Zhujingfang pharmacological mechanism in the treatment of w AMD.MethodsThe potential action targets and active ingredients of Jiajian Zhujingfang and the action targets of wAMD was screened by using TCMSP platform database;At the same time,Multi-protein analysis was performed on the obtained common targets to obtain target protein interaction data by searching STRING(Version 11.0)database.The GO pathway and KEGG pathway were enriched and analyzed by R software 3.6.3 Bioconductor related data packets,and bubble diagrams were drawn.ResultsA total of 108 active ingredients and 295 targets were included in the modified prescription,and 35 therapeutic targets were included in wAMD.Through GO functional analysis,2318 biological processes,141 cell components and 286 molecular functions were identified.207 signaling pathways were analyzed by KEGG signaling pathway.It was found that the key targets of the treatment of w AMD with Jiajian Zhujingfang were IL-10,MAKP1,IL-6,SOD-1,HIF1-A,IL-1β,EGF,CRP,CCL-2,Signaling pathways include TNF pathway,MAPK pathway,1L-17 pathway,HIF-1 pathway,age-rage pathway,etc.Among them,sesamin,naringin,diosgenin,luteolin,matrine,ginsenoside and quercetin play an important pharmacological role.ConclusionThe wAMD is an important cause of irreversible vision loss in the elderly.The treatment of wAMD by Jiajian Zhujingfang is a complex process of "multi-component,multi-target and multi-pathway",involved oxidative stress,inflammatory immunity and other pathways.It mainly involves HIF-1α/VEGF/VEGFR2 pathway,MAPK1/ERK2 pathway,MAPK3/ERK1MAKP pathway,autophagosome and immune-related proteins,inflammation-related proteins,etc.which provides a theoretical basis for further clinical and experimental research on the mechanism of Jiajian Zhujingfang in the treatment of wAMD. |
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