[关键词]
[摘要]
视网膜静脉阻塞(RVO)常伴发黄斑水肿(ME),是导致患者视力损伤的主要病因。从中医理论来看,其病理机制关键为气滞血瘀、水湿内停,与肝郁气滞、脾失健运、肾虚水泛等脏腑功能失调密切相关。尽管抗血管内皮生长因子(VEGF)治疗已成为视网膜静脉阻塞性黄斑水肿(RVO-ME)的一线治疗方案,但部分患者对该疗法呈现低反应或无应答,导致ME反复发生。中医认为此类难治性病例多因久病入络、痰瘀互结,或正气亏虚、邪气留恋所致,需采用活血利水、化痰通络、扶正祛邪等治法进行干预。目前,RVO-ME的发病机制尚未完全明确,现代医学认为可能涉及视网膜微结构损伤、血流异常及全身系统性疾病等多种因素,而中医则强调局部病变与全身气血阴阳失衡的整体关联。文章系统回顾了现有关于RVO-ME的中西医研究成果,分析其可能的高危因素,并为此类患者制定融合中西医优势的个体化治疗方案提供理论依据。
[Key word]
[Abstract]
Retinal vein occlusion(RVO)is often accompanied by macular edema(ME), which is the main cause of visual impairment in patients. From the perspective of traditional Chinese medicine theory, the key pathogenesis lies in Qi stagnation and blood stasis, as well as internal retention of water and dampness, which is closely related to the dysfunction of internal organs such as liver depression and qi stagnation, spleen failure to function properly, and kidney deficiency with water retention. Although anti-vascular endothelial growth factor(VEGF)therapy has become the first-line treatment option for RVO-ME, some patients show a low response or no response to this therapy, resulting in recurrent ME. According to traditional Chinese medicine, such difficult-to-treat cases are often caused by long-term illness entering the meridians and the interplay of phlegm and blood stasis, or by deficiency of the body's vital energy and the lingering of pathogenic factors. Intervention should be carried out through therapeutic methods such as promoting blood circulation and diuresis, resolving phlegm and unblocking meridians, and strengthening the body's vital energy and eliminating pathogenic factors. At present, the pathogenesis of RVO-ME is not yet fully understood. Modern medicine believes that it may involve multiple factors such as retinal microstructure damage, abnormal blood flow and systemic diseases throughout the body, while traditional Chinese medicine emphasizes the overall connection between local lesions and the imbalance of Qi, blood, Yin and Yang throughout the body. This article systematically reviews the existing research achievements of traditional Chinese and Western medicine on RVO-ME, analyzes its possible high-risk factors, and provides a theoretical basis for formulating individualized treatment plans integrating the advantages of traditional Chinese and Western medicine for such patients.
[中图分类号]
[基金项目]
山东省医药卫生科技发展计划项目(No.20220420115)