细胞凋亡是一种由多基因控制的特殊的细胞死亡类型.神经细胞凋亡与中枢神经系统疾病的发生发展联系紧密.近年来,有大量关于中药有效成分、中药提取物或中药复方对于抑制神经细胞凋亡机制的实验研究.这些实验证实了中药在抗神经细胞凋亡、保护脑组织、改善中枢神经系统功能等方面发挥了重要作用.结合国内外文献,该文综述了神经细胞凋亡的途径及中药针对不同靶点抗神经细胞凋亡的作用机制,以期为中西医结合及中药靶向研究提供新思路.

Objective To explore the active components, potential targets, and mechanism of Huoxue Lishui Prescription in the treatment of acute anterior ischemic optic neuropathy（AION）using network pharmacology.Methods The active components and potential targets of Huoxue Lishui Prescription were searched and screened through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP）,and the unpredicted targets of the active components were supplemented from literature reports.Cytoscape 3.9.0 was used for visualization.The targets of acute AION were identified from GeneCards and Online Mendelian Inheritance in Man（OMMI）databases.The protein-protein interaction（PPI）network of Huoxue Lishui Prescription in the treatment of acute AION was constructed through the STRING database, and the key targets were screened with the help of Cytoscape software.The Gene Oncology（GO）analysis and Kyoto Encyclopedia of Genes and Genomes（KEGG）analysis were conducted via the Database for Annotation, Visualization, and Integrated Discovery（DAVID）.AutoDock Vina 1.1.2 was used to perform molecular docking of key active components and action targets.Results A total of 159 active components of Huoxue Lishui Prescription were screened out, and the key screened targets mainly involved MAPK14,FOS,MYC,ESR1,etc.KEGG enrichment analysis showed that AGE-RAGE,MAPK,PI3K-Akt, TNF,and HIF-1 signaling pathways might serve as important pathways involved in the treatment of acute AION by Huoxue Lishui Prescription.Molecular docking revealed that the main active components of Huoxue Lishui Prescription had a regulatory effect on the core targets including MAPK14,FOS,MYC,and ESR1.Conclusion The active components in Huoxue Lishui Prescription can treat acute AION through multiple targets and multiple pathways.

目的 基于中医传承辅助系统内容分析、数据挖掘技术,研究古籍中眼外伤的病名演变、治疗思路和特点.方法 计算机结合人工检索中华医典、国医典藏、医案古籍知识库、读秀学术搜索等数据库,收集先秦到民国眼外伤相关古籍,并提取作者、成书年代、原文、病名、内服药、外用药等资料,录入中医传承辅助平台并进行数据挖掘.结果 共纳入相关条文75条.其中,内服方95首,外用方13首,2个穴位.(1)病名:古籍中多以病因、症状命名眼外伤,属于"血灌瞳人(仁)""惊振内障""惊振外障""物损真睛"等范畴;(2)内服药:共计用药133味,累计频次699次,用药频次≥8共31味,前3位依次为当归、防风、川芎;以性温307次(43.92％)、味苦364次(31.73％)、归肝经418次(22.77％)药物占比最高;提取31对高关联度药物组合,其中"前胡-当归""前胡-熟地黄""前胡-白芍"排前3位.(3)外治法:主要包括敷眼、点眼、针药并用多种治疗手段.结论 古代以补虚扶正、行气化瘀、祛风止痛为治则的中药辨证论治是眼外伤重要治疗手段之一.

良性颅内压增高症(benign intracranial hypertension ,BIH)临床可见头痛、呕吐、视乳头水肿等症状,除颅内压升高外,脑脊液检查、影像学检查、意识水平大多无异常,故称为"良性"[1].国外文献[2]报道的年发病率约为2.4/10万,肥胖者、青春期或年轻女性多见.高颅压长期存在可继发视神经萎缩,导致视野缺损,视力下降等严重症状,约有25.0％的BIH患者可发生永久性的视力丧失[3].本病在眼科并不少见,但常易与可导致视乳头水肿的疾病(如视神经炎等)混淆,临床易贻误治疗.

目的 分析外伤性视神经病变(TON)的病理分期专家问卷,总结其分期时间,为临床针对性治疗提供依据.方法 在文献研究的基础上,编制TON病理分期专家问卷,问卷包含25个问题,通过问卷星向全国247位专家发送调查问卷表.结果 共收回问卷247份,回收问卷及有效问卷所占比率均为100％.涉及三甲级医院高级职称170人(占57.89％);认为外伤后7 d以内需手术介入者158人(占63.97％);认为TON的糖皮质激素冲击治疗的时间窗为48 h以内者155人(占62.75％);习惯将TON进行3种临床分期者160人(占64.78％).结论 结合专家问卷及目前文献研究,建议将TON临床分为急性期、亚急性期、慢性期,本研究为更好地探索TON的临床治疗方案提供思路.

目的 采用数据挖掘技术分析文献数据库中有关外伤性视神经病变(TON)的中医证候及中药组方用药规律.方法 检索中国知网、万方、重庆维普数据库中有关中医汤剂治疗TON的文献,检索时间为建库至2020年10月31日.提取纳入文献的题目、作者、发表时间、中药处方、文献类型、疗程等信息,录入Excel表格中.统计中药的四气、五味、归经、证候分析、用药频次并进行聚类分析,使用IBM SPSS Modeler 18.0对数据进行关联规则分析,总结TON的中医证候及用药规律.结果(1)一般情况:最终纳入文献23篇,包括处方28首,中药62味.四气以寒性药最多(25味,40.32％),五味以甘味药最多(23味,37.10％),归经以肝经最多(26味,41.94％).(2)证候分布特征:共涉及证候6个.频率占比由高到低分别为气滞血瘀证(71.43％);肝肾亏虚证、气血两虚证、气虚血瘀证(各占7.14％);肝郁气滞证、肝郁肾虚证(各占3.57％).(3)中药频次统计:使用频次排在前6位的分别是当归、川芎(各24次,85.71％);红花(19次,67.86％);柴胡(17次,60.71％);桃仁、赤芍(各15次,53.57％).(4)功效归类:共涉及中药种类14种,其中以活血化瘀药、补虚药最多(各14味,22.58％),其次为解表药、清热药(各6味,9.68％);化痰止咳平喘药、理气药(各4味,6.45％).(5)中药关联规则:相关性最高的前5位分别是川芎-当归;川芎-红花;当归-红花;柴胡-川芎;柴胡-当归.(6)中药聚类分析:可得到4类处方,其功效分别是活血化瘀、补气活血、补脾益肾、散瘀止痛.结论 TON中医证候核心为气滞血瘀证,治疗原则以调畅气机、活血化瘀为法,重在理气养血、补益肝肾.

AIM:To evaluate the clinical efficacy of different interventions of traditional Chinese medicine in the treatment of traumatic optic neuropathy by means of mesh Meta-analysis.METHODS:The Computer searched of Chinese databases(CNKI, VIP, WanFang, SinoMed)and English databases(PubMed, Embase, Cochrane Library). Search time was limited from their inception to March 2020. Randomized controlled clinical trials of traditional Chinese medicine for treatment of traumatic optic neuropathy were subjected to Meta-analysis. Cochrane evaluation tool was used to evaluate the quality of the included studies and Stata 14.2 software was used to conduct network Meta-analysis.RESULTS: Twenty-one RCT studies involving 1 297 patients were included and 7 interventions were involved. Among them, Chinese medicine, Chinese medicine+hormone drugs, acupuncture+Chinese medicine+neurotrophic drugs were better than those with neurotrophic drugs alone. Chinese medicine+hormone drugs, acupuncture+Chinese medicine+neurotrophic drugs, acupuncture+Chinese medicine+hormone drugs were better than that of hormone drugs alone(P<0.05), and the intervention measures ranked first in terms of effective treatment rate is acupuncture+Chinese medicine+neurotrophic drugs.CONCLUSION: Chinese medicine has advantages in the treatment of traumatic optic neuropathy. Among them, acupuncture+ Chinese medicine+neurotrophic drugs is most likely to be the best choice.

1 临床资料 患儿,马某,女,8岁.2岁时发现视力差,在外院诊断为"双眼青光眼",给予布林佐胺滴眼液、布林佐胺噻吗洛尔滴眼液、拉坦前列素滴眼液等眼药水降眼压治疗.眼压控制不佳,双眼眼压在30～45 mm Hg (1 mm Hg=0.133 kPa)波动,于2019年7月24日来中国中医科学院眼科医院就诊.

Objective:To evaluate the effectiveness and safety of glucocorticoids in the treatment of non-arteritic anterior ischaemic optic neuropathy (NAION).Methods:Glucocorticoids published in the National Library of Medicine PubMed; Netherlands Medical Abstracts Database Embase; Cochrane Library, an evidence-based medical library; China Cnkipedia; China Biomedical Literature Service; Chongqing Vipul Chinese Science and Technology Journal Database, and Wanfang Science and Technology Journal Full Text Database were searched about computer. Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) for the treatments of NAION were subjected to meta-analysis. The search period was from the establishment of each database to March 2020. The literature was screened and data were extracted according to the inclusion and exclusion criteria. The methodological quality of the RCT and NRCT studies was evaluated using the Risk of Bias Assessment Tool and the MINORS evaluation scale, respectively. The data were analyzed using RevMan version 5.3 software which was provided by the Cochrane Collaboration Network.Results:An initial search of 395 papers was conducted, and 10 papers were finally included for this meta-analysis, including 3 RCT studies and 7 NRCT studies. A total of 1057 patients with NAION were included. The 3 RCT studies were analyzed descriptively as the outcome indicators were described in different ways. A meta-analysis of 7 NRCT studies showed that patients in the treatment group showed significantly better visual prognosis (relative risk=1.28, 95% confidence interval 1.09 to 1.51, P=0.003) and retinal nerve fibre layer thickness were obviously improved (mean difference=7.76, 95% confidence interval 1.58 to 13.94, P=0.01) than the control group. Four studies reported the occurrence of adverse reactions in the treatment versus control groups. None of the above studies provided a detailed analysis of the prognosis of patients with adverse reactions. Conclusion:The efficacy and safety of glucocorticoids in the treatment of NAION is unclear and needs to be validated in a larger sample of RCTs.

视网膜内皮细胞间的紧密连接(TJs)是血-视网膜内屏障(iBRB)的重要结构,对神经-视网膜微环境的稳态起到重要作用,内皮细胞TJs改变导致的iBRB功能障碍参与了许多视网膜疾病的生理病理过程,尤其与合并黄斑水肿或视网膜新生血管性疾病密切相关.本文以TJs为重点,从TJs主要分子结构、调节视网膜内皮细胞TJs的常见信号通路方面,综述视网膜内皮细胞TJs相关分子机制,为相关视网膜疾病研究提供理论依据.

目的 对中医药(中药、中成药、针刺)治疗缺血性视神经病变(ION)的相关文献进行现状分析及质量评价.方法 检索4大中文数据库、3大英文数据库近10年关于中医药治疗ION的文献,并对纳入文献进行全面的评价,包括研究对象、干预措施、研究类型等,并采用相应的质量评估工具评价文献质量.结果 纳入的50篇文献中,研究对象以前部缺血性视神经病变为主(46.15％);针刺治疗的文献较少(5.77％);随机对照试验占所有试验类型的65.38％,但可信度较低;所有文章均未采用隐藏序列、盲法、样本量估算;仅1篇文章报告脱落病例,但缺乏原因和意向治疗分析;多数(80.77％)文献未报告安全性评估.结论 中医药治疗ION的相关文献普遍质量不高,应重点关注干预措施为针刺治疗的研究和规范严谨的多中心大样本临床试验.

目的 探讨针刺治疗儿童石骨症合并视神经萎缩的临床疗效.方法 回顾性研究近1年收治的采用单纯针刺治疗的石骨症合并视神经萎缩患儿10例(20只眼),收集眼部一般情况检查,包括视力、外眼、眼底、眼眶CT.并分析骨髓移植后视神经管变化与针刺后视力的关系.结果 (1)一般临床特征:纳入病例中男2例,女8例,年龄2～10岁.眼球震颤4例(8只眼),斜视4例(5只眼).(2)疗效:治疗后视力好转16只眼,有效率80.00％;眼球震颤改善8只眼.(3)骨髓移植后视神经管变化与针刺后视力好转不具有关联性(P＞0.05).结论 针刺具有改善石骨症合并视神经萎缩患儿视力的作用.

Nonarteritic anterior ischemic optic neuropathy(NAION)is caused by ischemia of the short posterior ciliary artery that supplies the lamina area of the optic disc. It usually occurs in over 50-year-old people. It is acute optic neuropathy and featured with acute, monocular, and painless vision loss, which frequently results in severe permanent vision damage and visual field defects. This disease is attracting increased attention of clinical researchers. This paper overviews the current molecular pathology of NAION from these aspects, including pathogenesis, pathological changes, relevant protein molecules and susceptibility genes in previous studies. This paper lays a theoretical foundation for future research on the pathological mechanism and the treatment of NAION.

目的 评价中药联合头体针治疗非动脉炎性前部缺血性视神经病变(NAION)的有效性和安全性.方法 多中心、随机、平行对照研究,将辨证为肾虚血瘀证的NAION患者96例(117只眼)随机分配为单纯针刺组、腺苷钴胺组和针药组3组.腺苷钴胺组29例(35只眼)予腺苷钴胺肌注治疗;单纯针刺组30例(35只眼)仅使用针刺治疗;针药组37例(47只眼)在针刺组基础上联合中药复方治疗,治疗2个月.比较3组治疗前后最佳矫正视力(BCVA)、视野平均缺损度(MD)差值和模式标准差(PSD)差值和不良反应等情况.结果 (1)有效率:针药组为89.36％、针刺组为87.71％、腺苷钴胺组为48.57％,3组间有效率比较有统计学意义(c2=20.888,P=0.000),针药组、针刺组与腺苷钴胺组比较(c2针药=16.539,P针药=0.000;c2针刺=10.944,P针刺=0.001),均有统计学意义;(2)BCVA:3组治疗后较治疗前改善,均具有统计学意义(t针药=5.979,P针药=0.000;t针刺=4.029,P针刺=0.000;t腺苷钴胺=3.728,P腺苷钴胺=0.001),但3组组间比较差异无统计学意义(F=1.166,P=0.315);(3)视野:MD比较,3组治疗后较治疗前升高,差异均有统计学意义(t针药=-5.569,P针药=0.000;t针刺=-3.752,P针刺=0.001;t腺苷钴胺=-3.057,P腺苷钴胺=0.004);PSD比较,3组治疗后均较疗前降低,差异有统计学意义(t针药=3.535,P针药=0.001;t针刺=2.451,P针刺=0.020;t腺苷钴胺=2.127,P腺苷钴胺=0.041).视野MD和PSD差值,3组组间比较,差异均无统计学意义(P>0.05);(4)不良反应:3组各项安全指标比较均无统计学意义(P>0.05).(5)Logistic回归分析:影响NAION疗效因素为治疗方式(OR=0.248,P=0.000,95％CI为0.128～0.483)、初诊BCVA(OR=0.040,P=0.000,95％CI为0.007～0.241).结论 与腺苷钴胺组相比,针药联合及单纯针刺具有改善NAION患者视功能的作用.

1 临床资料 患者,男,49岁.因"双眼视物不见2 d"于2018年1月25日至中国中医科学院眼科医院神经眼科就诊.既往"胃溃疡"病史.饮酒20余年,每日2两;吸烟20余年,每日20支.患者于2018年1月21日(18:00-21:30)清除单位沼气池.1月22日下夜班后自觉胸闷不适,自行休息,16时,家属发现患者双手皮肤青紫,面色晦暗,唤醒后发现,其精神较差,予"感冒清热冲剂"口服;22 时,家属发现患者呼之不应,面部发凉,触鼻似无呼吸,呼叫 120 救护车.救护车到达之前,患者已自行苏醒,监测血压120/80 mm Hg(1 mm Hg=0.133 kPa),未见其他阳性体征,遂观.1月23日晨起,患者出现胸闷、咳嗽,于外院就诊,诊断:上呼吸道感染,慢性肾功能不全,高钾血症,高尿酸血症.予消炎药物治疗(具体药名不详),患者自觉咳嗽、胸闷症状稍有好转.1月24日晨起患者发现双眼视物不清,伴眼球转动痛,外院就诊时,双眼视力0.03(矫正不提高),诊断:双眼视神经炎.予以药物治疗(具体药名不详).1月25日晨起患者自觉视力继续下降,自觉双眼光感.于中国中医科学院眼科医院神经眼科就诊,入院治疗.

OBJECTIVE:To observe the effect of acupuncture of intraorbital and extraorbital acupoints on apoptosis and expression of Bax, Bcl-2 and Caspase-3 proteins of retinal ganglion tissue in rabbits with nonarteritis anterior ischemic optic neuropathy (NAION), so as to reveal its mechanism underlying improvement of NAION. METHODS:Female New Zealand rabbits were randomly divided into four groups: model, intraocular needling (ION), extraocular needling (EON), ION＋EON groups (n＝5 per group), and the 5 healthy eyes of those rabbits in the model group were selected to be used as the control group. The NAION model of the right eye was established by photodynamic stroke method. For ION group, acupoints "Jingming" (BL1), "Chengqi" (ST1) and "Qiuhou" (EX-HN7) were needled, and for EON group, "Cuanzhu" (BL2), "Yuyao" (EX-HN4) and "Qiaoming" (EX) were needled with filiform needles, followed by retaining the needles for 30 min. For ION＋EON group, the 6 acupoints were needled simutaneously. The treatment was conducted once daily for 3 days. The apoptosis of retinal ganglion tissue was detected by using TUNEL fluorescence labeling, and the expression of Bax, Bcl-2 and active Caspase-3 in the retinal ganglion were detected by immunohistochemistry. RESULTS:Following modeling and compared with the control group, the number of the apoptotic cells, and the expression levels of Bax and Caspase-3 proteins, as well as the ratio of Bax/Bcl-2 were significantly increased in the model group (P<0.01), while the expression of Bcl-2 was significantly decreased (P<0.01). After intervention, the number of the apoptotic cells in the ION, EON and ION＋EON groups, and the ratio of Bax/Bcl-2 in EON and ION＋EON groups, and the expression of Caspase-3 proteins in the ION and ION＋EON groups were significantly down-regulated (P<0.01, P<0.05), and the expression levels of Bcl-2 in both EON and ION＋EON groups were significantly up-regulated in comparison with the model group (P<0.01). No significant changes were found in the expression levels of Bax in the 3 needling groups relevant to the model group (P>0.05). CONCLUSION:Acupuncture of intraorbital and extraorbital acupoints can reduce apoptosis of retinal ganglion in NAION rabbits via inhibiting the activation of Caspase-3 protein and ratio of Bax/Bcl-2, and up-regulating the expression of Bcl-2 protein.

目的 探讨不同病因视神经损害致无光感病例临床治疗效果,为该类患者治疗时机提供参考依据.方法 回顾分析我院近5年来视神经损害无光感病例的发病时间与治疗效果相关性,不同病因对视力恢复情况影响,以及采用的临床治疗方案和效果.结果 纳入病例共计59例(73只眼).其中外伤26例(31只眼),有视力恢复者共4只眼,总有效率12.90％.视神经炎17例(20只眼),视力恢复共11只眼,总有效率为55.00％.颅脑占位术后13例(19只眼),有视力恢复者1例(1只眼),有效率5.26％.放射性视神经病变3例(3只眼),无视力恢复者.外伤性视神经病变无光感者患病初期行糖皮质激素冲击或视神经管减压术,比无此治疗的患者更容易视力恢复(P＜0.05).视神经炎患者在大剂量糖皮质激素冲击期比无此治疗的患者更容易视力恢复(P＜0.05).结论 无光感视神经损害患者,病因不同视力恢复概率不同;外伤性视神经病变患者视力损害超过1个月以及视神经炎患者视力损害超过2个月后,再恢复出现光感的概率极低.儿童视神经损害后视力恢复与成人可能存在差异.

1临床资料 患者潘某,男,52岁.因左眼上睑下垂1个月余,以“左眼上睑下垂原因待查”于2016年1月20日收住我院.现病史:患者1个月前出现左眼上睑下垂,晨轻暮重,休息后缓解,无复视、言语不利及饮食呛咳,未见肢体乏力及呼吸困难等症状.未予系统诊治,患者自觉症状逐渐加重.2015年10月因慢性丙型肝炎合并慢性肝炎所致氨基转移酶升高,外院予以聚乙二醇干扰素α-2b 100 μg皮下注射,每周一次;利巴韦林片300 mg,口服,每日三次;双环醇片25 mg,口服,每日三次;利可君片20 mg,口服,每日三次;水飞蓟宾胶囊70 mg,口服,每日三次.

[目的]探讨中医非药物疗法在甲状腺相关眼病病人中的应用效果。[方法]对73例甲状腺相关性眼病病人（143只眼）给予2个~4个疗程的刮痧、刺络放血、穴位放血、针刺疗法及辨证施护,观察病人的临床疗效和焦虑评分、自觉不适症状改善情况。[结果]病人治疗2个疗程后总有效率达73.43%,4个疗程总有效率达83.92%,自觉不适症状以及焦虑症状得到明显改善,且治疗4个疗程效果优于2个疗程（P＜0.05）。[结论]应用中医非药物疗法配合辨证施护,可减轻甲状腺相关性眼病病人的临床症状,提高治疗效果。

OBJECTIVE To observe the clinical efficacy of combined TCM therapy in the treatment of primary retinitis pigmentosa (RP). METHODS Patients with primary retinitis pig-mentosa who met the diagnosis and inclusion criteria were treated with traditional Chinese medicine and acupuncture for 3 months. In addition, patients were also treated with puerarin in-jection intravenous infusion for 2 weeks, once half a year, in 3 consecutive years. And follow-up was performed as well. RESULTS A total of 35 cases (70 eyes) were included. During the trial, 3 cases fell off, and the total effective rate of 32 patients (64 eyes) was 55.37％. After treatment, the visual acuity (ETDRS visual acuity score) was improved, and the variation was of statistical differ-ence (P<0.05). The average sensitivity (MS) of the visual field after treatment was improved signifi-cantly (P<0.05). But there was no statistical difference observed in mean defect of visual field after treatment (P>0.05). CONCLUSIONS The cyclical treatment with combined traditional Chinese medicine on primary retinitis pigmentosa yielded a favorable effect in terms of visual acuity and vi-sual field, and the relationship between the treatment plan and the effect of RP worth further ex-ploring.