目的:探究针药联合治疗视神经脊髓炎(NMO)所致视神经萎缩的临床疗效.方法:收集2016年3月～2019年12月就诊于本院眼科或者神经眼科门诊的以视神经炎(ON)为主要临床表现的NMO所致视神经萎缩患者21例(24眼),以患者自身治疗前后为对比,纳入后接受针刺和中药治疗8周,分别于治疗前和治疗后4周、8周进行最佳矫正视力和动态视野检测,评价针药联合对患者视功能的影响.结果:24眼治疗4周后有8只眼视力提高≥2行,总有效率91.67％,治疗8周后有12眼视力提高≥2行,总有效率100.00％;治疗4周,患者动态视野平均缺损度(MD)及平均敏感度(MS)较前改善,但与治疗前相比,差异无统计学意义(MD:t=1.579,P=0.121;MS:t=?1.500,P=0.140);治疗8周后患者MD显著下降(t=2.65,P<0.05),MS明显提高(t=?2.58,P<0.05),差异均有统计学意义.结论:针药联合可显著提高以ON为主要表现的NMO所致视神经萎缩患者的视功能,明显提高患者最佳矫正视力和动态视野敏感度,降低患者视野缺损.

Objective:To discuss the influence of QiShenYiQi Gutta Pills(QGP)on expression of vascular endothelial growth factor(VEGF),pigment epithelium derived factor(PEDF)and mRNA expression of VEGF and PEDF in rats with diabetic retinopathy.Methods:The diabetic rat model was established by one-time injection of streptozotozin(STZ,65mg/kg).All SD rats(n=82)were randomly divided into the normal group,model group, control group and QGP group.After 10 months,the expression of VEGF and PEDF was detected by immunohistochemistry method,VEGFmRNA and PEDFmRNA were examined by reverse transcription-polymerase chain reaction(RT-PCR).Results:The expression of VEGF and VEGFmRNA in model group was higher than that in the normal group(P<0.01).The expression of PEDF and PEDFmRNA in model group was lower than the normal group(P<0.01).The expression of VEGF and VEGFmRNA in QGP group was lower than that in the model group(P<0.01).The expression of PEDF and PEDFmRNA in QGP group was higher than the model group(P <0.01).Conclusion:QGP can delay the development of diabetic retinopathy in rats through decreasing the expression of retinal VEGF and VEGFmRNA,and increasing the expression of retinal PEDF and PEDFmRNA.

OBJECTIVE To discuss the influence of Qishen Yiqi Gutta Pills(QGP)on the expression of advanced glycation end products(AGEs)and mRNA expression of receptor of AGEs(RAGE)in rats with diabetic retinopathy.METHODS The diabetic rat model was established by one-time injection of streptozotocin(STZ,65mg/kg).All SD rats(n=70)were randomly divided into the normal group,model group,control group and QGP group.After 10 months,the expression of AGEs was detected by using immunohistochemistry method and RAGE mRNA was examined by using reverse transcription-polymerase chain reaction(RT-PCR).RESULTS The expression of AGEs and RAGEmRNA in model group was higher than that in the normal group(P0.01).The expression of AGEs and RAGEmRNA in QGP group was lower than that in the model group(P0.01).CONCLUSIONS QGP could delay the development of diabetic retinopathy in rats through decreasing the expression of retinal AGEs and RAGEmRNA.

OBJECTIVE To investigate the effect of Qishen Yiqi Pills on expression of glutamate-aspartate transporters(GLAST) and glutamine synthetase(GS) in diabetic rat's retina and observe the protection mechanism of Qishen Yiqi Pills on retinal nerve cells.METHODS Diabetic rats were induced by streptozotocin.Rats in diabetes prevention group were with Qishen Yiqi Pills once each day.LSAB method detected the expression of GLAST and GS in the retina.Image plus Pro6.0 analytical system was used to calculate the IOD value.RESULTS The expression of GLAST and GS in diabetic rat's retina decreased obviously compared with normal group;Compared with diabetes control group,GLAST and GS expression in the treatment group increased.CONCLUSIONS Qishen Yiqi Pills could promote the expression of GLAST and GS and reduce the high concentrations of the role of glutamate excitotoxicity.

Objective To assess the expression of GFAP,GLAST,GS and NT-3 in Müller cells and the apoptosis of retinal nerve cells in rats with diabetes mellitus(DM) and to discuss the mechanisms of retinal nerve cell injury in DM rats.Design Experimental study.Paticipants 82 Sprague-Dawley(SD) rats.Methods Diabetic model in rats was induced by streptozotocin method.The rats are randomly divided into 2 groups: model group and normal group.The expression of GFAPmRNA in retina was measured by RT-PCR.LSAB method was used to measured the expression level of GFAP,GLAST,GS,NT-3 in retinal Müller cells.Apoptosis of retinal nerve cells was measured by TUNEL assay and apoptosis cells were counted.Immunological histochemistry assay was used for quantitative analysis.Main Outcome Measures The expression of GFAP,CLAST,GS,and NT-3;the number of apoptotic cells in inner nuclear layer and RGC layer.Results Compared with normal group(1.00±0.02),the positive expression of GFAP in the retina of diabetic rats(5.22±1.34) was increased significantly(P=0.000).The positive apoptotic retinal cells were only expressed in RGCs and inner nuclear layer.The numbers of apoptotic cells in RGCs and inner nuclear layer of diabetic rats(36.00±6.02 and 11.48±2.08) were significantly higher than that of normal group(16.33±2.34 and 5.34±0.52)(all P=0.000).Compared with normal group(0.29±0.08),the expression of GFAPmRNA in the retina of diabetic rats(7.00±0.37) was enhanced significantly(P=0.000).The number of apoptotic RGCs and cells in inner nuclear layer was correlated positively with the positive expression level of GFAP(r=0.88,0.85,P=0.021,0.028),and was negatively correlated with the expression of GLAST,GS and NT-3(r=-0.74~-0.93,-0.71~-0.90;all P<0.05).Conclusion The number of apoptosis of retinal nerve cell is closely related to the active proliferation of glial reactive state in retinal Müller cells and the deficiency of neurotrophic factors.The excitotoxicity of high concentrations of glutamate and the deficiency of neurotrophic factors are important mechanism of retinal nerve cell injury in diabetes.

Objective:To study the therapeutic effect of Yiqi Huoxue therapy on vascular endothelial growth factor(VEGF) in retina of diabetic rats.Methods:The diabetic rat model was set up by a single intraperitoneal injection of streptozotocin(65mg/kg).Fifty rats were randomly divided into normal group,model group and Yiqi Huoxue medicine group,the normal group and model group were given normal saline by intragastric administration,and Yiqi Huoxue medicine group was given extractum of Qisheng Yiqi Dripping Pills(0.2g·kg-1·d-1) by intragastric administration.All rats were killed after 300days.The serum VEGF levels were measured.Immunological histochemistry assay was used to observe the expression of VEGF of eyeball slice for quantitative analysis.SPSS was used for statistical analysis.Results:Ten months later,the levels of VEGF in serum of model group were higher than those in control group,the levels of VEGF in serum of Yiqi Huoxue medicine group were lower than those in model group(P0.05).The model group rats displayed high expression of VEGF.Compared with the model group,the expression of VEGF in Yiqi Huoxue medicine group decreased evidently(P0.01).Conclusion:Yiqi Huoxue medicine can reduce damage of diabetic retinopathy and this effect may be achieved by restraining the expression of VEGF.

Objective To discuss the influence of Qishenyiqi Gutta Pills (QGP)on expression of intercellular adhesion molecule-1 (ICAM-1) in rats with diabetic retinopathy.Methods The diabetic rat model was established by one-time injection of streptozotozin (STZ,65 mg/kg).All SD rats (n=50) were randomly divided into the control group,model group and QGP group.The extractum of QGP (0.2 g/(kg·d)) was administrated intragastrically.After 10 months,the rats were killed and the eyeballs were collected for the observation of retinal vascular digest preparations.The expression of ICAM-1 was detected by using immunohistochemistry method,and ICAM-1-mRNA was examined by using reverse transcription-polymerase chain reaction (RT-PCR).The blood samples were collected from rats for detecting the serum content of ICAM-1.Results The serum content of ICAM-1 was higher in the model group than that in the control group,and was lower in the QGP group than that in the model group,but had no statistical significance (P>0.05).The expressions of retinal capillary ICAM-1 and retinal ICAM-1-mRNA were higher significantly in the model group than those in the control group,and was lower significantly in the QGP group than those in the model group with a significant difference (P<0.01).Conclusion QGP can delay the occurrence and development of diabetic retinopathy in rats through decreasing the expressions of retinal ICAM-1 and ICAM-1-mRNA.

Objective:To observe the apoptosis of the retinal ganglion cells(RGCs)and the expression level of vascular endothelial growth factor(VEGF)in diabetic rats and discuss ginseng on RGCs apoptosis and VEGF expression and the relationship between them.Methods:Diabetic rats were induced by streptozotocin and randomly divided into diabetes control(DC)group and diabetes prevention(DP)group.Rats in DP group were given with Ginseng once each day.Apoptosis of RGCs was measured by TUNEL assay and apoptosis RGCs were counted.LSAB method detected the expression of VEGF in the retina.Image analysis detected by immunohistochemistry color intensity and quantitative analysis.Results:Compared with normal control(NC)group,diabetes mellitus rats were significantly increased the number of apoptotic RGCs(P<0.01).Compared with DC,DP significantly reduced the number of apoptotic RGCs(P<0.05).Compared with NC,DM rats increased the expression of retinal VEGF.Compared with DP,VEGF expression in the treatment group decreased.Conclusion:Ginseng can inhibit VEGF expression and reduce the apoptosis of RGCs in diabetic rats.The number of apoptotic RGCs was positively correlated with VEGF expression.

Objective:To observe the pathologic changes of the retinal ganglion cells(RGCs)and capillary in rats with diabetes mellitus for seven months.Methods:Diabetic rats were induced by streptozotocin.After seven months we removed the eyes under anesthesia and made retinal slides and digest preparations.The RGCs and capillary were observed by light and electron microscopy.Results:In light microscopy the retinal tissues were indistinct disturbance and capillaries were enlarged.There were some early symptoms of diabetic retinopathy(DR),such as extensive pericyte loss,endothelial cell proliferation,pericyte ghost,acellular capillary and apoptosis of endothelial cell.Retinal nerve fiber layer was edematous,nuclear shrinkage and mitochondrion condensed.In electron microscopy endothelial cell of capillary and mitochondrial was edematous obviously,the basement membranes were thickened.RGCs were vacuolated,chromatin of nucleus aggregated marginally decreased and densification.Some of RGCs were necrosis,nucleus were dissolved,mitochondria was edematous,the rough endoplasmic reticula decreased obviously.Conclusion:In the early stage of DR in rats,accompanying the retinal capillary,the RGCs were damaged.

目的观察复方丹参滴丸治疗早期糖尿病视网膜病变的疗效.方法收集20例Ⅰ～Ⅲ期糖尿病视网膜病变的患者,其中治疗组10例,对照组10例,治疗组口服复方丹参滴丸,15粒/次,3次/日;对照组口服多贝斯,500mg/次,3次/日,用药时间90天.通过眼底检查及荧光素眼底血管造影、视力及视野观察评价疗效;同时检测血尿便常规及心电图、肝肾功能、空腹血糖等安全性指标.结果治疗组和对照组眼底视网膜微血管瘤数较治疗前明显减少(P<0.05),视野灰度值(mean defect,MD)较治疗前明显降低(P<0.05),两组对比差异无显著性(P>0.05).结论复方丹参滴丸能改善早期糖尿病视网膜病变视网膜的缺血缺氧状态,促进视网膜微血管瘤的吸收,改善视野.

糖尿病视网膜病变(Diabetic Retinopathy, DR)是糖尿病最常见的并发症.多年来对其发病机理的研究主要集中在视网膜毛细血管微循环的改变上,对视网膜神经组织的研究较少.20世纪80年代中期已有学者提出DR的主要发病机理可能不仅是视网膜血管本身,而且与血管周围的神经元或神经胶质组织关系更为密切.视网膜的神经元和/或神经胶质可能对长期的高血糖影响特别敏感,微血管损害就成为其代谢紊乱的继发结果[1].近年大量临床电生理学研究表明,糖尿病患者在DR临床发病前,起源于神经网膜内层的振荡电位视网膜电图波振幅下降,潜伏期延长,其异常早于血-视网膜屏障通透性异常.应用持续固定聚焦视网膜电图研究发现,DR病变前期和/或早期,视网膜神经节细胞(retinal ganglion cells ,RGCs)和双极细胞功能已发生异常.实验动物研究也显示,发生DR前,视网膜神经节细胞和苗勒氏(Müller)细胞已出现凋亡[2].有学者推测,糖尿病因耗尽了神经元所依赖的神经营养因子而导致DR的发生[3],神经网膜、神经细胞与DR的关系探讨成为目前DR发病机制的研究热点.本文就与DR神经网膜关系密切RGCs的研究现状作一综述.

OBJECTIVE To analyze the rate of the ocular fundus diseases related with the heart and vascular diseases and investigate the value for diagnosis of the ocular fundus by age and angiography METHODS Fundus fluorescein angiography (FFA) and /or indocyanine green angiography (ICGA) were performed for comparative analyses of the location and features in ocular fundus diseases RESULTS Among all the 1283 cases,there were 700 cases (54 5%) on retinal vascular diseases which average ages was 58 7,macular diseases were 330 cases (25 7%) which average age was 54 1 years old,inflammation ocular fundus were 103 cases (8%) which average age was 44 02 years old CONCLUSION The rate of the ocular fundus diseases would be higher while the age was increased The more heart and vascular diseases,the more related ocular fundus diseases Ocular fundus angiography may be helpful to early diagnosis for eye diseases

Objective:To explore the relationship between the classification of diabetic macular edema(DME)and stages of the diabetic retinopathy(DR)and visual loss.Methods:The clinical data of fundus fluorescein angiography(FFA)and other related information of 425 patients (850 eyes)with DR were analyzed retrospectively.DR were classified according to national standard of the diagnosis and classification of DR,and DME were classified according to the standard made by the Early Treatment Diabetic Retinopathy Study Research Group of the United States.The occurrence of DME in DR in each stage and the relationships between DME and vision were analyzed.Results:In 425 patients,387 eyes had DME(45.5%),including 67 eyes(17.3%)with focal DME,176 eyes(45.5%)with diffuse DME,115 eyes(29.7%)with cystoid edema and 29 eyes(7.5%)with ischemic maculopathy.The occurrence of DME was 1.03% in I-stage DR,11.11% in Ⅱ-stage DR,36.64% in Ⅲ-stage DR,45.47% in Ⅳ-stage DR and 5.7% in V-stage DR.The visual loss of DME: 13.69% in0.1,28.68% in 0.1～0.3,33.85% in 0.4～0.6,16% in 0.7～0.9 and 7.7% in≥1.0. Conclusion:DME is the main cause of visual impairment of DR.Along with the development of retinopathy,the incidence of DME increases,and the severity of DME aggravateds,but the development of DME and its classification do not have definite correspondence or unification with the classification of DR,hence the typing of DME in another individual classification in DR,of course,is necessary.

综述了近年对细胞因子、粘附因子、血液流变学、自由基、糖基化终产物、糖化血红蛋白等在糖尿病视网膜病变的发生、发展中所起作用的研究进展.

糖尿病视网膜病变(Diabetic Retinopathy, DR)是糖尿病最常见的并发症之一.多年来对其发病机理的研究主要集中在视网膜毛细血管微循环的改变上,而对视网膜神经组织的研究较少.事实上,视网膜是由血管和神经元组成的复杂结构,主要由神经网膜组成,神经细胞构成了神经网膜的主要成分,血管组织仅占很少部分.80年代中期已有学者提出DR的主要发病机理可能不在视网膜血管本身,而是在血管周围的神经元或神经胶质组织.大量临床研究表明,糖尿病患者在DR临床发病前,起源于神经网膜内层的振荡电位异常早于血-视网膜屏障通透性异常.实验研究也显示,发生DR前,视网膜神经节细胞(retinal ganglion cells ,RGCs)和Müller细胞已出现凋亡[1].推测:糖尿病因耗尽了神经元所依赖的神经营养因子而导致DR[2] .寻找外源性的神经营养物质来促进RGCs损伤后的修复,控制DR的发生、发展是目前对DR的研究热点.本文就RGCs损伤的机制及中西医治疗的现状作一介绍.

目的:观察红参胶囊对中老年高血压性视网膜病变和血压的影响.方法:患者口服红参胶囊,停服降压药和其他相关治疗.定时测量患者血压,观察眼底变化.结果:用药6周后患者血压有下降;视网膜小动脉痉挛缓解,渗出吸收,视盘水肿逐渐消退.结论:红参胶囊对中老年高血压性视网膜病变有防治作用,对血压有调节作用.