Effect of Siwu Wuzi Decoction on vascular endothelial growth factor, transforming growth factor-β1 and inflammatory factor levels in patients with wet age-related macular degeneration
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摘要:目的
探讨四物五子汤治疗湿性年龄相关性黄斑变性(wAMD)对患者血管内皮生长因子(VEGF)、转化生长因子-β1(TGF-β1)及炎性因子水平的影响。
方法将216例wAMD患者随机分成西医组(n=108)与中西医组(n=108)。西医组接受康柏西普+光动力疗法(PDT)治疗, 中西医组接受康柏西普+PDT+四物五子汤治疗, 2组均治疗3个月。观察2组中医证候积分、最佳矫正视力(BCVA)、眼压、VEGF、TGF-β1、炎性因子水平[白细胞介素(IL)-6、IL-13]、生活质量[低视力者生活质量量表(CLVQOL)]以及临床疗效。
结果治疗后, 2组中医证候积分均降低，且中西医组中医证候积分低于西医组，差异有统计学意义(P < 0.05)。治疗后, 2组BCVA均降低，且中西医组BCVA低于西医组，差异有统计学意义(P < 0.05)。治疗后, 2组眼压均升高，但中西医组眼压低于西医组，差异有统计学意义(P < 0.05)。治疗后, 2组VEGF、TGF-β1水平均降低，且中西医组VEGF、TGF-β1水平低于西医组，差异有统计学意义(P < 0.05)。治疗后, 2组IL-6、IL-13水平均降低，且中西医组IL-6、IL-13水平低于西医组，差异有统计学意义(P < 0.05)。治疗后, 2组CLVQOL评分均升高，且中西医组CLVQOL评分高于西医组，差异有统计学意义(P < 0.05)。中西医组治疗总有效率为97.22%, 高于西医组的85.19%, 差异有统计学意义(P < 0.05)。
结论四物五子汤治疗wAMD的效果较好，可减轻患者症状，恢复视力，降低眼压，调节VEGF、TGF-β1及炎性因子水平，提高生活质量。
Abstract:ObjectiveTo investigate the effect of Siwu Wuzi Decoction in the treatment of wet age-related macular degeneration (wAMD) on the levels of vascular endothelial growth factor (VEGF), transforming growth factor-β1 (TGF-β1), and inflammatory factors in patients.
MethodsA total of 216 patients with wAMD were randomly divided into western medicine group (n=108) and integrated Chinese and western medicine group (n=108). The western medicine group received conbercept plus photodynamic therapy (PDT), while the integrated Chinese and western medicine group received conbercept, PDT, and Siwu Wuzi Decoction. Both groups were treated for 3 months. The traditional Chinese medicine syndrome scores, best-corrected visual acuity (BCVA), intraocular pressure, VEGF, TGF-β1, inflammatory factor levels[interleukin (IL)-6, IL-13], quality of life [Chinese Low Vision Quality of Life Scale (CLVQOL)], and clinical efficacy were observed in both groups.
ResultsAfter treatment, the traditional Chinese medicine syndrome scores decreased in both groups, with the scores in the integrated Chinese and western medicine group being lower than those in the western medicine group (P < 0.05). After treatment, BCVA decreased in both groups, with the BCVA in the integrated Chinese and western medicine group being lower than that in the western medicine group (P < 0.05). After treatment, intraocular pressure increased in both groups, but the intraocular pressure in the integrated Chinese and western medicine group was lower than that in the western medicine group (P < 0.05). After treatment, VEGF and TGF-β1 levels decreased in both groups, with the levels in the integrated Chinese and western medicine group being lower than those in the western medicine group (P < 0.05). After treatment, IL-6 and IL-13 levels decreased in both groups, with the levels in the integrated Chinese and western medicine group being lower than those in the western medicine group (P < 0.05). After treatment, CLVQOL scores increased in both groups, with the scores in the integrated Chinese and western medicine group being higher than those in the western medicine group (P < 0.05). The total effective rate of treatment in the integrated Chinese and western medicine group was 97.22%, which was higher than 85.19% in the western
ConclusionsSiwu Wuzi Decoction has a good therapeutic effect on wAMD, which can alleviate symptoms, restore vision, reduce intraocular pressure, regulate VEGF, TGF-β1, and inflammatory factor levels, and improve quality of life.
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表 1 2组中医证候积分比较(x±s)
分 组别 n 视物昏花 目睛干涩 倦怠乏力 气短懒言 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 西医组 108 2.46±0.45 1.15±0.37* 2.42±0.47 1.16±0.32* 2.20±0.51 1.01±0.35* 2.14±0.34 0.95±0.21* 中西医组 108 2.49±0.43 1.03±0.22*# 2.45±0.44 0.88±0.22*# 2.22±0.48 0.78±0.25*# 2.16±0.31 0.84±0.15*# 与治疗前比较, * P < 0.05; 与西医组比较, #P < 0.05。 
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表 2 2组最佳矫正视力与眼压比较(x±s)
组别 n 最佳矫正视力/logMAR 眼压/mmHg 治疗前 治疗后 治疗前 治疗后 西医组 108 0.86±0.15 0.47±0.09* 15.63±3.05 16.28±2.45* 中西医组 108 0.87±0.14 0.41±0.06*# 15.60±3.07 16.16±2.33*# 1 mmHg=0.133 kPa。与治疗前比较, * P < 0.05; 与西医组比较, #P < 0.05。
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表 3 2组VEGF与TGF-β1水平比较（x±s）
ng/L 组别 n VEGF TGF-β1 治疗前 治疗后 治疗前 治疗后 西医组 108 168.63±12.43 82.16±9.52* 56.55±7.72 38.62±6.68* 中西医组 108 169.71±12.35 74.35±8.60*# 56.81±7.65 30.05±6.19*# VEGF: 血管内皮生长因子; TGF-β1: 转化生长因子-β1。与治疗前比较, * P < 0.05; 与西医组比较, #P < 0.05。
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表 4 2组炎性因子水平比较（x±s）
pg/mL 组别 n IL-6 IL-13 治疗前 治疗后 治疗前 治疗后 西医组 108 45.25±4.83 23.58±4.11* 5.58±1.14 3.35±0.92* 中西医组 108 45.31±4.80 20.52±3.96*# 5.62±1.11 2.67±0.87*# IL-6: 白细胞介素-6; IL-13: 白细胞介素-13。与治疗前比较, * P < 0.05; 与西医组比较, #P < 0.05。
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表 5 2组生活质量比较（x±s）
分 组别 n 低视力者生活质量量表评分 治疗前 治疗后 西医组 108 50.62±7.34 79.41±8.74* 中西医组 108 50.54±7.39 90.35±9.11*# 与治疗前比较, * P < 0.05; 与西医组比较, #P < 0.05。
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