目的 探究含活血通络方血清调控IncRNA MEG3 对高糖诱导人视网膜血管内皮细胞(human retinal microvascular endothelial cells,hRMECs)增殖及凋亡的影响作用.方法 选取 20 只SD大鼠,采用随机数字表法对 10 只大鼠灌胃活血通络方,10 只灌胃等量生理盐水.灌胃结束 1h后制备相应血清.分别采用 5mmol/L葡萄糖或 30mmol/L的D-甘露醇、葡萄糖溶液对hRMECs细胞进行诱导 24h.按照诱导情况将细胞分为正常对照组(5mmol/L葡萄糖,n=6)、等渗组(30mmol/L D-甘露醇,n=6)、高糖组(30mmol/L 葡萄糖,n=6)、高糖+2.5%含药血清组(n=6)、高糖+7.5%含药血清组(n=6)、高糖+10%含药血清组(n=6),相应血清干预 24h.采用CCK-8 法、酶联免疫吸附法检测细胞增殖情况及丙二醛(malondialdehyde,MDA)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)含量;采用实时荧光定量聚合酶链反应(quantitative real-time fluorescence polymerase chain reaction,qRT-PCR)测定细胞IncRNA-MEG3 mRNA表达,采用流式细胞术测定细胞凋亡情况;采用蛋白免疫印迹法检测 NOX4、VAV2、血管表皮生长因子受体(vascular epidermal growth factor receptor,VEGFR)、磷脂酰肌醇 3-激酶(phosphoinositide 3-kinase,PI3K)、p-PI3K、蛋白激酶B(protein kinase B,AKT)、p-AKT、哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)、p-mTOR蛋白表达情况.结果 与正常对照组比较,高糖组细胞增殖率下降,MDA 含量增加,GSH-Px 含量降低,凋亡增加,IncRNA-MEG3 mRNA表达降低,p-PI3K/PI3K、p-AKT/AKT、p-mTOR/mTOR、NOX4、VAV2、VEGFR蛋白表达均升高,差异均有统计学意义(P<0.05).与高糖组比较,高糖+7.5%含药血清组和高糖+10%含药血清组细胞增殖率增加,MDA含量降低,GSH-Px含量升高,IncRNA-MEG3 表达升高,差异均有统计学意义(P<0.05);高糖+2.5%含药血清组、高糖+7.5%含药血清组、高糖+10%含药血清组的细胞凋亡下降,p-PI3K/PI3K、p-AKT/AKT、p-mTOR/mTOR、NOX4、VAV2、VEGFR蛋白表达降低,差异均有统计学意义(P<0.05).结论 含活血通络方血清可介导IncRNA-MEG3 调控相关蛋白表达来减少高糖诱导hRMECs细胞的凋亡.

目的 探究当归多糖对糖尿病视网膜病变(DR)模型大鼠长链非编码RNA母系表达基因3(lncRNA MEG3)表达调控细胞焦亡的影响及其作用机制.方法 选取DR模型构建成功SD大鼠52 只,应用随机数字表法分为对照组、研究 1 组、研究 2 组及抑制组,每组 13 只,分别给予生理盐水,低剂量当归多糖(15 mg/kg)、高剂量当归多糖(30 mg/kg)和高剂量当归多糖(30 mg/kg)+lncRNA MEG3 抑制剂(2.5 mg/kg)干预,每天 1 次.观察各组大鼠视网膜病理学改变,定量逆转录PCR检测lncRNA MEG3、补丁蛋白(PTCH)、平滑受体蛋白(SMO)、GLI家族锌指蛋白 3(GLI3)、蛋白激酶B(PKB)mRNA表达,酶联免疫吸附试验(ELISA)检测丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)水平,Western blot检测PTCH、SMO、GLI3、PKB、半胱氨酸天冬氨酸蛋白酶-1(Caspase-1)、半胱氨酸天冬氨酸蛋白酶-4(Caspase-4)、半胱氨酸天冬氨酸蛋白酶-5(Caspase-5)蛋白表达.结果 对照组大鼠病理学检测显示,视网膜细胞破裂增加,细胞焦亡增多,视网膜神经节细胞结构完整性被破坏,细胞质基质密度降低,细胞核染色质稀疏,细胞质内形成空泡;研究 1组视网膜细胞破裂及细胞焦亡减少,视网膜神经节细胞结构完整性较对照组改善;研究 2组神经节细胞结构完整,视网膜细胞破裂、焦亡进一步减少;抑制组在增加lncRNA MEG3 抑制剂后逆转了当归多糖作用,显示病理表现与对照组相近.研究 1 组、研究 2 组lncRNA MEG3、PTCH mRNA[lncRNA MEG3:(1.59±0.16)、(2.13±0.22)比(1.04±0.11)、(1.02±0.10);PTCH:(1.41±0.15)、(1.82±0.19)比(1.15±0.13)、(1.17±0.13);P<0.05]和PTCH蛋白[(1.45±0.16)、(1.81±0.20)比(1.11±0.11)、(1.09±0.10);P<0.05]相对表达显著高于对照组和抑制组,研究 2 组显著高于研究 1 组(P<0.05);研究 1 组、研究 2 组SMO、GLI3、PKB mRNA[SMO:(2.48±0.25)、(2.10±0.22)比(2.94±0.31)、(3.01±0.33);GLI3:(1.56±0.16)、(1.13±0.11)比(1.95±0.20)、(1.99±0.21);PKB:(1.43±0.14)、(1.05±0.11)比(1.92±0.19)、(1.91±0.19);P<0.05]和蛋白[SMO:(2.55±0.26)、(2.07±0.21)比(2.95±0.30)、(2.93±0.29);GLI3:(1.63±0.17)、(1.14±0.12)比(1.99±0.21)、(2.02±0.23);PKB:(1.52±0.16)、(1.07±0.11)比(2.04±0.21)、(2.01±0.21);P<0.05]相对表达显著低于对照组和抑制组,研究 2 组显著低于研究 1 组(P<0.05).研究 1 组、研究 2 组MDA水平显著低于对照组和抑制组[(18.03±4.09)U/mg、(11.25±3.41)U/mg比(25.76±4.34)U/mg、(25.32±4.31)U/mg;P<0.05],研究 2 组显著低于研究 1 组(P<0.05);研究 1 组、研究 2 组SOD、GSH-Px水平显著高于对照组和抑制组[SOD:(121.48±11.07)U/mg、(149.35±12.14)U/mg比(94.31±10.13)U/mg、(95.12±10.17)U/mg;GSH-Px:(131.48±11.62)U/mg、(159.07±12.25)U/mg比(99.07±10.25)U/mg、(100.24±10.31)U/mg;P<0.05],研究 2组显著高于研究1组(P<0.05).研究 1 组、研究 2 组Caspase-1、Caspase-4、Caspase-5 蛋白表达水平显著低于对照组和抑制组[Caspase-1:(3.01±0.32)、(2.49±0.26)比(3.59±0.38)、(3.51±0.36);Caspase-4:(3.29±0.83)、(2.51±0.71)比(4.13±1.02)、(4.06±1.01);Caspase-5:(2.70±0.59)、(2.24±0.51)比(3.23±0.68)、(2.17±0.66);P<0.05],研究 2 组显著低于研究 1 组(P<0.05).结论 当归多糖能促进DR大鼠lncRNA MEG3 表达,减少其视网膜上皮细胞焦亡,其作用机制可能与调控SMO/PKB通路从而减少Cas-pase-1、Caspase-4、Caspase-5蛋白表达有关.

AIM: To observe the clinical effect of 3% diquafosol sodium eye drops in treatment of meibomian gland dysfunction-related dry eye.METHODS: The study involved 280 patients totally with meibomian gland dysfunction-related dry eye in the ophthalmology department, Hangzhou Hospital of Traditional Chinese Medicine from May 2020 to May 2021. Patients were divided into the treatment group(160 cases with 320 eyes)and the control group(120 cases with 240 eyes)according to the randomized number table method. The control group was treated with YangXueRunMu formula combined with 0.3% sodium hyaluronate eye drops, the treatment group was treated with YangXueRunMu formula combined with 3% diquafosol sodium eye drops. Both groups were administered for 4wk. The following indicators were measured before and after treatment at 2 and 4wk, respectively: the ocular surface disease index(OSDI)score, Schirmer I test( SⅠt), comprehensive analysis of tear meniscus height(TMH), non-invasive tear film break-up time(NITBUT), meibomian gland lipid secretion of smooth degree scoring and meibomian gland loss rate score, the determination of interleukin-6(IL-6)in tears and the level of tumor necrosis factor-alpha(TNF-α). The efficacy of these tests results was evaluated among these indicators.RESULTS: The overall effective rates of the treatment group and the control group were 95.6% and 81.7% respectively(P<0.05). After 2, 4wk of treatment, the ocular surface disease index(OSDI), NITBUT, meibomian gland lipid secretion scoring, meibomian gland loss rate score and the levels of IL-6 and TNF-α in tears of two groups were significantly different than before treatment(P<0.05). and the treatment group was better than the control group; there was no difference between the SⅠt and TMH groups before and after treatment in the two groups(P>0.05).CONCLUSION: The 3% diquafosol sodium eye drops can promote the normal secretion of meibomian gland by prolonging the homeostasis of the tear membrane, and it can also inhibit the release of inflammatory factors in tears in the treatment of blebomian gland dysfunction-related dry eye.

中医学认为,糖尿病视网膜病变(DR)属于"消渴内障"或"视瞻昏渺"等范畴.消渴病引发眼病的记载最早见于金元时期,糖尿病性黄斑水肿(DME)的病因病机虽然众说纷纭,但总体认为以气阴两虚为本,血瘀水停为标,多为本虚标实、虚实夹杂."血不利则为水"理论被广泛应用于临床各科治疗水肿,活血利水法也应用于眼科多年,但活血利水法治疗DME的理论依据及治疗方法鲜有人论述,本文就基于"血不利则为水"理论,对其治疗糖尿病性黄斑水肿的运用进行深入探讨.

目的:探讨活血通络方调控磷酸肌醇3激酶/蛋白激酶B(PI3K/Akt)信号通路改善大鼠糖尿病视网膜病变的作用机制.方法:选取清洁级健康雄性SD大鼠72只,采用随机数字表法分为对照组、模型组及药物组,每组24只.建模成功后,药物组大鼠给予活血通络方10mL/(kg·d)灌胃,对照组与模型组大鼠给予等剂量0.9％氯化钠注射液灌胃.3组均连续灌胃3个月.比较3组血糖、血脂、氧化应激指标、炎症因子水平及伊文思蓝渗透量;比较3组大鼠视网膜组织紧密连接蛋白-1(ZO-1)、闭合蛋白(Occludin)、血管内皮钙黏蛋白(VE-Cadherin)、磷酸化磷酸肌醇3激酶(p-PI3K)、磷酸化蛋白激酶B(p-Akt)表达水平;观察大鼠视网膜组织病理学改变.结果:与对照组比较,模型组空腹血糖(FBG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、活性氧簇(ROS)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平均升高(P＜0.05),高密度脂蛋白(HDL)、超氧化物歧化酶(SOD)水平均降低(P＜0.05),伊文思蓝渗透量增加(P＜0.05);与模型组比较,药物组 FBG、HbA1c、TC、TG、LDL、ROS、MDA、IL-6、IL-1β、TNF-α 水平均降低(P＜0.05),HDL、SOD、GSH-Px水平均升高(P＜0.05),伊文思蓝渗透量减少(P＜0.05).与对照组比较,模型组大鼠视网膜组织ZO-1、Occludin、VE-Cadherin表达水平均降低(P＜0.05),p-PI3K、p-Akt表达水平均升高(P＜0.05);与模型组比较,药物组大鼠视网膜组织ZO-1、Occludin、VE-Cadherin表达水平均升高(P＜0.05),p-PI3K、p-Akt表达水平均降低(P＜0.05).模型组大鼠视网膜组织细胞排列紊乱、疏松,色素上皮细胞增生,毛细血管明显扩张充血,外层出现新生血管;药物组大鼠视网膜组织较模型组细胞排列整齐、密度增加,视网膜病理学改变明显减轻.结论:活血通络方可能通过抑制PI3K/Akt信号通路减轻炎症反应、改善氧化应激,从而改善大鼠糖尿病视网膜病变.

目的:构建医院病种协作网络,加强人才培养,提高眼科治疗整体水平,提升专科服务能力.方法:综合2017～2019年某市级中医院眼科疾病的构成情况,统计3年的总手术量,回顾性分析排名前4位的病种及手术类型,并判断增减趋势.结果:排前4位的病种为白内障(26.14％)、糖尿病视网膜病变(18.34％)、视神经疾病(17.58％)、翼状胬肉(13.21％);排名前4的手术类型为白内障手术(23.68％)、视网膜激光光凝术(27.26％)、胬肉手术(16.98％)、玻璃体腔注药术(15.49％).此外还有眼外伤、泪道阻塞、玻璃体切割术、青光眼手术等.结论:医院眼科各类型手术量和接诊量均有所提高,就诊及实施手术比例较高的有白内障及糖尿病视网膜病变.

目的:观察活血通络方联合针刺治疗糖尿病视网膜病变(DR)的临床疗效.方法:将82例DR患者按随机数字表法分为对照组与研究组各41例,对照组在常规疗法的基础上加上活血通络方治疗,研究组在对照组基础上加上针刺治疗,共治疗2个月.比较2组临床疗效及治疗前后视力水平、平均敏感度、黄斑厚度、微血管瘤、出血点数目及超氧化物歧化酶(SOD)、丙二醛(MDA)水平.结果:治疗后,研究组总有效率87.80％,明显高于对照组68.29％ (P＜ 0.05).与同组治疗前比较,治疗后2组视力水平、平均敏感度及SOD水平均升高(P＜0.05);与对照组治疗后比较,研究组治疗后视力水平、平均敏感度及SOD水平均较高(P＜0.05).与同组治疗前比较,治疗后2组黄斑厚度及MDA水平均降低(P＜0.05);与对照组治疗后比较,研究组治疗后黄斑厚度及MDA水平均较低(P＜0.05).与同组治疗前比较,治疗后2组微血管瘤及出血点数目减少(P＜0.05);与对照组治疗后比较,研究组治疗后微血管瘤及出血点数目较少(P＜0.05).结论:应用针刺联合活血通络方治疗DR患者,能够提高临床疗效,提高患者的视力水平,改善其眼底病变,提高抗氧化能力,预后良好.

AIM: To investigate the effects of fluorometholone combined with sodium hyaluronate eye drops in the treatment of xerophthalmia and the influence on inflammatory factors in tears. METHODS: A prospective randomized controlled study was conducted in 116 patients(232 eyes)with xerophthalmia who were treated between February 2017 and December 2019. They were randomly divided into observation group and control group, 58 cases(116 eyes)in each group. The control group was treated with sodium hyaluronate eye drops, while the observation group was treated with 0.1% fluorometholone eye drops based on the treatment for the control group. Ocular Surface Disease Index(OSDI)scoring was carried out before treatment and after 2wk and 4wk of treatment. The tear film break-up time(BUT), Schirmer I test(SⅠt)and corneal fluorescent staining(FL)scores were measured. The tear meniscus height(TMH)and noninvasive keratograph tear breakup time(NIKBUT)were determined by eye surface comprehensive analyzer. Conjunctival impression cytology was performed to determine epithelial cell grading score and goblet cell density. Levels of interleukin 1β(IL-1β), interleukin -6(IL-6)and transforming growth factor β1(TGF-β1)in tears were determined. Meanwhile, efficacy and safety were evaluated.RESULTS: The overall response rates of the observation group and the control group were 94.8% and 82.8%(P<0.05). The observation group had higher SⅠt, BUT and NIKBUT, lower FL scores and OSDI scores than the control group at 4wk(P<0.05). The goblet cell density was higher in the observation group than in the control group at 4wk(P<0.05). IL-6 and IL-1β in the observation group were significantly lower than those in the control group at 2wk and 4wk, and TGF-β1 was significantly higher than that in the control group at 4wk(P<0.05). The incidences of adverse reactions in the two groups were 3.4% and 1.7%(P>0.05).CONCLUSION: Fluorometholone combined with sodium hyaluronate can significantly improve clinical symptoms as well as tear film stability in patients with xerophthalmia, which may be related to regulating effect on ocular surface inflammatory factors.

本研究回顾性分析我院轻中度近视青少年患者临床资料,以评估该联合疗法的应用价值,兹报道如下. 1 资料与方法 1.1 一般资料:选取2017年4月～2020年8月我院120例(240眼)轻中度近视青少年患者,经二元logistics回归建立倾向性得分模型,获得55对基线资料无统计学差异(P>0.05)的患者,对照组6例失访,最终观察组入组55例(110眼),对照组入组49例(98眼).观察组男29例,女26例;年龄8～16(12.52 ± 2.49)岁;病程9～35(16.97±5.21)月;轻度近视84眼,中度近视26眼.对照组男28例,女21例;年龄8～15(12.06±2.35)岁;病程9～33(15.87 ± 5.08)月;轻度近视76眼,中度近视22眼.

正常眼内压的范围为 10～21mmHg (1mmHg=0.133kPa),眼内压低于正常范围的下限即称之为低眼压,当眼压低于5.0mmHg则会引起眼组织前、后段皱褶,视功能下降甚至眼组织萎缩改变,称之为病理性低眼压[1].低眼压为多种眼病的共同表现,临床常见于眼外伤,长期低眼压可导致视功能部分或完全丧失或眼球萎缩[2].本文通过回顾性分析患者中医证候疗效积分、非接触眼压值、前段相干光学断层扫描(optical coherent tomography,OCT),观察益气升阳法治疗外伤性低眼压脾虚证患者的临床疗效,现报道如下.

目的 调查杭州市西湖区2018-2020年青少年近视流行病学特点,分析青少年近视的相关影响因素,并制定相对策略.方法 采用横断面分层整群随机抽样法,选取杭州市西湖区2018-2020年6～18岁在校生4825例,均接受眼科检查及问卷调查,统计青少年近视率,并经单因素、多因素分析影响青少年近视的相关因素.结果 西湖区2018-2020年青少年近视率58.03％(2800/4825),且近视率呈逐年增长趋势(x2趋势=285.672,P=0.000).Logistic多因素结果发现,西湖区青少年近视的危险因素为女生(OR=2.05,P＜0.01)、16～18岁(OR=16.16,P＜0.01)、高中(OR=27.66,P＜0.01)、户外活动时间不足(OR=4.22,P＜0.01)、学习时间过长(OR=4.25,P＜0.01)、学习距离＜0.2 rn (OR=5.97,P＜0.01)、观看电子设备时间≥2 h/d(OR=3.60,P＜0.01)、父母均近视(OR=1.61,P=0.002)、每天睡眠时间不足(OR=4.68,P＜0.01),保护因素为父母总是监督及提醒用眼习惯(OR=0.23,P＜0.01).结论 杭州市西湖区2018-2020年青少年近视率较高,且呈逐年增长趋势,其发生与多因素综合作用相关,需针对风险因素制定针对性预防措施,以降低青少年近视患病风险.

目的:探索责任医师团队模式应用于中医眼科的管理价值.方法:选择医院2018年7月～2020年6月治疗的82例眼睑痉挛患者作为研究对象,随机分为观察组和对照组各41例.对照组采用常规管理方案.观察组在对照组基础上添加责任医师团队模式管理.结果:观察组眼痉挛症状、瞬目次数、干涩、异物感及视物疲劳等临床症状评分低于对照组(P＜0.05).观察组总满意度高于对照组(P＜0.05).结论:在中医眼科临床管理中添加责任医师团队管理模式,可以全方位地帮助患者管理自我行为,在用眼卫生、饮食、运动方面更加自律,有助于改善患者用眼习惯、维护患者机体免疫稳态,团队管理为患者提供全方位的指导,让患者的健康管理过程更加科学完善,更有利于促进患者身体的恢复.

Objective To evaluate the fundus fluorescein angiography(FFA)in diabetic retinopathy early screening and diagnosis. Methods From December 2011 to October 2016 in our hospital Ophthalmology Department 244 Cases(488 eyes)diabetic patients were diagnosed and underwent nonmydriatic digital fundus photography and FFA,for clinical stage of diabetic retinopathy based on the results to guide treatment. Results 354 eyes' digital fundus photography found that retinopathy lesions rate was 72.54%,Ⅰof 116 eyes,Ⅱof 72 eyes,Ⅲ of 78 eyes,Ⅳof 44 eyes,Ⅴof 44 patients.There are 406 retinopathy eyes were diagnosed by fluorescence fundus angiography inspection with the lesion rate was 83.20%,Ⅰof 145 eyes,Ⅱof 82 eyes,Ⅲof 85 eyes,Ⅳof 50 eyes,Ⅴof 44 eyes. Fundus fluorescein angiography higher diagnostic accuracy of two diagnostic methods was statistically significant difference(P<0.05). Conclusion The diagnosis of fundus fluorescein angiography in diabetic retinopathy has a higher detection rate,and can be judged the course of DR earlier and more accurately. It can guide the early treatment of patients and therapeutic evaluation of an important means.

Objective To observe the clinical efficacy of acupuncture in treating meibomian gland dysfunction. Method Forty patients(80 eyes) diagnosed with meibomian gland dysfunction were randomized into an acupuncture group and a Western medication group. The acupuncture group was intervened by acupuncture at the periocular points, while the control group was by dropping of glucocorticoid and artificial tear. The subjective symptoms, palpebral margin score, fluorescein staining, tear film break-up time, and tear secretion were evaluated and determined before and after treatment. Result After treatment, the two groups both had significant changes in improving the optic symptoms, palpebral margin score, fluorescein staining, extending the tear film break-up time, and increasing the tear secretion. The acupuncture group was better in improving the palpebral margin score and increasing the tear secretion, indicating that its therapeutic efficacy should be better than that of the Western medication group. Conclusion Acupuncture has a content therapeutic efficacy in treating meibomian gland dysfunction.