Clinical Observation Of Supplementing Qi,Nourishing Yin And Promoting Blood Flow Method In The Treatment Of Diabetes Dry Eye And Related Basic Research

ObjectiveDry eye is a kind of high incidence of ocular surface disease in diabetic patients.Western medicine is given priority with artificial tear,but it is difficult to treat fundamentally.Under the guidance of the treatment based on syndrome differentiation,the TCM has certain advantages in treatment.This project mainly observes Supplementing Qi,Nourishing Yin and Promoting Blood Flow Method in the improvement of the clinical symptoms,tear film stability,reduce in chronic inflammatory statement,etc.studying the correlation among the TNF-?,IL-1?,and diabetic dry eye,At the same time.It will provide clinical basis for standardization of TCM treatment and curative effect evaluation,taking full advantages in traditional Chinese medicine treatment of the disease.Methods The clinical trailThis topic was collected China academy of traditional Chinese medicine ophthalmology hospital diabetes eye department in April 2016 to December2016,84 cases(168 eyes)of diabetic patients with dry eye.All the patients met criteria of diagnostic and inclusion.The clinical observation,collection cases were randomly divided into two groups,treatment group,42 cases(84 eyes),control group,42patients(84eyes).Treatment group used Supplementing Qi,Nourishing Yin and Promoting Blood Flow Method combined with meibomian gland massage treatment,the control used artificial tear combined with meibomian gland massage treatment.Subjective symptoms before and after treatment,Schirmer the I test,tear film breakup time,corneal perception classification and fluorescein staining,meibomian gland function,on the two group before and after treatment of symptoms,signed scores.and finally,finished the analysis of the index data and worked out relevant conclusions.The basic researchWe collected diabetic patients with dry eye,diabetic patients,non-diabetic patients with dry eye,and the normal,each group of twenty people.The contents of triglyceride,total cholesterol,IL-1?,and TNF-?,with the OSI(objective scattering index)values were observed at the same time,then analysis,and finally came to the conclusion that whether there were correlations.Results The clinical trailCases with Deficiency of both Qi and Yin and collaterals siltation and stagnant were included 84 patients(168 eyes),among which 38 were male,female 46 cases.Treatment group after treatment ocular symptoms integral(P<0.01),SIT(P<0.01),the cornea fluorescein staining(P<0.01),corneal sensation(P<0.01),meibomian gland function(P<0.01),were lower than control group,BUT(P<0.05)was higher than control group,and the difference was statistically significant.The effective rate was 90.5% in treatment group,66.7% in control group.According to the X2 test,difference was significant(P<0.01).The basic researchVenous blood triglyceride and total cholesterol levels in four groups haveno difference between groups(P>0.05),there was no statistically significant difference.IL-1? in diabetic group(P<0.01),diabetic dry eye group(P<0.01),dry eye group(P<0.05),the difference was statistically significant;TNF-? in dry eye group(P<0.05),diabetic dry eye group(P<0.01),diabetic group(P<0.01),difference was statistically significant.The relationship between the objective scattering index(OSI)with IL-1?and TNF-?: 1,the OSI values and IL-1? in patients with dry eye concentrations were positively correlated,correlation coefficient r=0.771,P<0.01,determination coefficient R2=0.594.the OSI values were related to the concentration of IL-1?,and the OSI values increased with the increase of concentration of IL-1?.2,OSI values positively correlated with the concentration of TNF-? in dry eye patients,correlation coefficient r = 0.762,P <0.01,determination coefficient R2= 0.581.OSI values related to the concentration of TNF-?,and the OSI values increased with the increase of concentration of TNF-?.ConclusionsQi and activating blood method on improving the clinical symptoms,changing meibomian gland dysfunction,protecting corneal integrity and reducing the inflammatory state of comprehensive efficacy,which is superior to the external treatment.But its specific pathways,function link remains to be discussed from the aspects of pharmacokinetics and pharmacology.Triglyceride and cholesterol had no obvious correlation with dry eye.The change IL-1? and TNF-? were positively associated with the degree of instability in tear film,suggests that the inflammatory response play an important role in diabetic dry eye.Therefore,by controlling of the inflammatory response,we can effectively control the development of the course,improve the clinical symptoms.