标题：自拟清目汤联合西药治疗双眼干眼症的疗效及其对患者泪膜MMP-9水平的影响

      作者：周鲜琳，孔林，王斌，王道升    (湖北医药学院附属随州医院眼科，湖北 随州 441300)

      卷次： 2018年29卷22期

      【摘要】 目的 探讨自拟清目汤联合西药治疗双眼干眼症的临床疗效及对患者泪膜基质金属蛋白酶-9(MMP-9)水平的影响。方法 选取2016年1月至2017年6月湖北医药学院附属随州医院眼科收治的136例干眼症患者为研究对象，按照随机数表将患者分为对照组和观察组，每组68例。对照组采用玻璃酸钠滴眼液以及维生素AD胶丸治疗，观察组在对照组的基础上以自拟清目汤联合治疗，疗程一个月，比较两组患者的临床疗效及治疗前后的泪膜白介素1β (IL-1β)、肿瘤坏死因子(TNF-α)和MMP-9水平，以及眼部症状指标眼表疾病指数(OSDI)、基础泪液分泌实验 I (Sit)、泪膜破裂时间(BUT)以及角膜荧光染色(FL)。结果 观察组患者的临床治疗总有效率为97.06%，明显高于对照组的85.29%，差异有统计学意义(P<0.05)；治疗前两组患者的OSDI、SIt、BUT、FL等相关指标比较差异均无统计学意义(P>0.05)；治疗后两组患者的SIt、BUT较治疗前升高，且观察组上升明显高于对照组，差异均有统计学意义(P<0.05)；治疗后两组患者的OSDI、FL较治疗前明显下降，且观察组明显低于对照组，差异均有统计学意义(P<0.05)；治疗前两组患者的泪液中 IL-1β、TNF-α及MMP-9水平比较差异均无统计学意义(P>0.05)；治疗后两组患者的泪液中 IL-1β、TNF-α及MMP-9水明显下降，且观察组明显低于对照组，差异均有统计学意义(P<0.05)；观察组患者的药物不良反应率为4.47%，与对照组的1.47%比较差异无统计学意义(P>0.05)。结论 运用自拟清目汤联合西药治疗干眼症患者可明显提高患者的临床疗效，改善眼部症状，且安全可靠。
      【关键词】 干眼症；自拟清目汤；西药；临床疗效
      【中图分类号】 R772 【文献标识码】 A 【文章编号】 1003—6350（2018）22—3156—04

Effect of self-made Qingmu Decoction combined with western medicine on MMP-9 level in tears in treatment ofdry eye syndrome.
ZHOU Xian-lin, KONG Lin, WANG Bin, WANG Dao-sheng. Department of Ophthalmology, theAffiliated Suizhou Hospital of Hubei Medical College, Suizhou 441300, Hubei, CHINA
【Abstract】 Objective To investigate the effect of self-made Qingmu decoction combined with western medi-cine on matrix metalloprotein 9 (MMP-9) level in tears in the treatment of dry eye syndrome. Methods A total of 136dry eye patients treated in Department of Ophthalmology in the Affiliated Suizhou Hospital of Hubei Medical Collegefrom January 2016 to June 2017 were selected and randomly divided into two groups, each with 68 cases. The controlgroup received sodium hyaluronate eye drops and vitamin AD pills, and the observation group received self-made Qing-mu Decoction based on the treatment in the control group. Then the clinical efficacy, levels of interleukin-1β (IL-1β), tu-mor necrosis factor alpha (TNF-α), and MMP-9 in lacrimal film before and after treatment were compared between twogroups. Ophthalmological symptoms including ocular surface disease index (OSDI), schlrmer I test (SIt), tear filmbreak-up time (BUT), and corneal fluorescence staining (FL) were also compared. Results (1) The clinical efficacy ofthe observation group was significantly higher than that of the control group (97.06% vs 85.29%, P<0.05). (2) Beforetreatment, the OSDI, SIt, BUT and FL had no significant difference between the two groups (P>0.05). After treatment,the SIt and BUT were increased, while the OSDI and FL were decreased (P<0.05), with both changes more significant inthe observation group than in the control group (P<0.05). (3) Before treatment, the levels of IL-1β, TNF-α, and MMP-9showed no significant difference between the two groups (P>0.05). After treatment, the levels were all decreased aftertreatment in both groups, and the levels were lower in the observation group than in the control group (P<0.05). (4) Theadverse drug reactions rate in the observation group was not statistically different from that in the control group (4.47%vs 1.47%, P>0.05). Conclusion Qingmu Decoction combined with western medicine can effectively and safely amelio-rate the eye symptoms for dry eye patients.
      【Key words】 Dry eye syndrome; Qingmu Decoction; Western medicine; Clinical efficacy·论 著·doi:10.3969/j.issn.1003-6350.2018.22.015