专家带路 | 四大专家告诉你关于视网膜静脉阻塞治疗的新方法

时间:2019-07-13 来源: 专栏
ag真人平台

Fundus diseases have always been a problem that plagues the ophthalmology. Retinal vein occlusion (RVO) is still completely controlled without specific treatment. On June 15th, during the 13th Annual Meeting of the Chinese Medical Doctors Association of Ophthalmologists and the Annual Meeting of the Eye Branch of Henan Medical Doctors Association in Zhengzhou, Zhangzhou Pharmaceutical held the topic of thrombus injection for the treatment of retinal vein occlusion. During the session, the forum was chaired by Professor Zhao Mingwei of Peking University People's Hospital and Professor Chen Youxin of Peking Union Medical College Hospital.

aec747c843b844dc9d59ba7fdfc4426c

Professor Zhao Mingwei

Professor Zhao Mingwei pointed out that Chinese medicine has a certain auxiliary effect in the treatment of ischemic eye disease, and Sanqi saponin has a long history in the prevention and treatment of ischemic eye disease. The application of Xueshuantong for injection (main ingredient Panax notoginseng saponins) has been used for nearly 25 years. As the original research enterprise of Xueshuantong, Zhangzhou Pharmaceutical has paid attention to academics in recent years, paying attention to standardized Chinese and Western medicine treatment, and helping traditional medicine to make ophthalmology development. Should contribute.

0b8fe2aac8b744f3b1e6fa164fed84db

Professor Lu Fang

Professor Lu Fang, deputy director of the Eye Branch of Sichuan Medical Association and Professor Lu Fang of Huaxi Hospital, said that RVO is a common fundus disease in the elderly. Many patients have good effects after anti-VEGF drug therapy or hormone therapy, but the recurrence problem is a difficult problem in the clinic. Is the combination of short-term, flat, and fast characteristics of Western medicine and Chinese medicine treatment more beneficial to patients? Some patients in the clinic have achieved good results after receiving Western medicine and traditional Chinese medicine injection with Xueshuantong (freeze-dried). Professor Lu Fang said that Chinese medicine can effectively prevent macular edema, and its role in the treatment of RVO can not be ignored, and the potential is huge.

cdcb1e56c0e54e4cb88e05ea765ce928

Professor Yue Lijing

xxProfessor Yue Lijing, president of the Guangdong Eye Health Association and director of the Department of Ophthalmology of the Second Hospital of Guangdong Province, pointed out that the incidence of RVO is second only to diabetic retinopathy, and RVO and its associated diseases bring a heavy disease burden to patients. At present, RVO has no specific drugs, and it is commonly used in medicines such as glucocorticoids, anti-VEGF drugs and thrombolytic drugs. These drugs are effective in clinical treatment, but the disadvantages are that they are prone to complications such as high intraocular pressure, glaucoma, cataract, and adverse reactions such as endophthalmitis, vitreous hemorrhage, and retinal detachment. Studies have shown that Panax notoginseng saponins have a three-fold mechanism of improving ocular blood circulation, inhibiting angiogenesis and protecting the optic nerve, and can be used as a new perspective for clinical treatment of RVO.

RVO, also known as retinal stroke, is the second most common type of blinding retinal vasculopathy. Clinical manifestations of retinal blood flow stagnation, venous tortuosity, retinal hemorrhage and edema. RVO can cause a variety of complications, such as macular edema, retinal/anterior neovascularization, vitreous hemorrhage. "RVO and its complications have greatly damaged vision. We must try our best to save more vision within the most reasonable time," Professor Lu Fang said.

Risk factors for RVO include cardiovascular factors, metabolic disorders, eye factors and others, but ocular circulatory disorders are an important cause.

Professor Lu pointed out that the purpose of RVO treatment is to prevent visual damage caused by macular edema as much as possible. In addition to targeted treatment, it is also necessary to actively treat systemic diseases. At present, there is no uniform treatment standard for RVO in China.

xxThe 2015 UK RVO Clinical Guidelines recommend that non-ischemic CRVO be selected for anti-VEGF drugs or intraocular hormones depending on vision. Ischemic CRVO, iris/atrial angiogenesis, anterior chamber angle open, emergency PRP; anterior chamber angle closure for emergency PRP + laser treatment/lead (the latter is preferred); no iris/angle Neovascularization, FFA>DA without perfusion, prophylactic PRP. The treatment of ischemic CRVO macular edema is the same as non-ischemic CRVO. The treatment of BRVO is similar to that of CRVO, and if the ischemic BRVO develops neovascularization, local laser photocoagulation in the ischemic quadrant is also considered.

The 2015 Canadian RVO Expert Consensus is similar to the UK Guide, but the evaluation system adds OCT to assess the extent of macular edema.

American AAO guidelines, BRVO patients with macular edema, the initial treatment of anti-VEGF drugs. CRVO with macular edema, anti-VEGF drug is effective, strongly recommended. Intravitreal injection of triamcinolone acetonide, dexamethasone and other glucocorticoids is effective, but there is a risk of cataracts and glaucoma.

CRVO iris or retinal neovascularization, the best treatment is panretinal photocoagulation (PRP), such as PRP is not enough to control neovascularization, consider combined anti-VEGF drugs.

Professor Lu Fang said that many RVO patients have good effects after anti-VEGF drug therapy or hormone therapy, but the recurrence problem is very common after three or four months, and edema and hemorrhage are more serious after recurrence, which is a difficult problem in the clinic. She found in the clinic that some patients did receive good results after receiving Western medicine and traditional Chinese medicine injection of Xueshuantong (main ingredient Panax notoginseng saponins).

xx文献表明,三七总皂苷在四个方面起主要治疗作用:(1)抗凝:抑制纤维蛋白原向纤维蛋白的转化。 (2)血管扩张:阻断去甲肾上腺素引起的细胞外钙离子流动,从而放松血管平滑肌。 (3)降低血液粘稠度。 (4)视神经保护:具有直接和间接的抗炎作用,对视神经损伤起保护作用。

陆方教授指出,有大量的动物实验和体外细胞实验,我希望将来进行大规模的RCT临床研究,以更好地评估其疗效和安全性。

专家评审

赵明伟教授:“RVO引起的视力丧失的三个主要原因是黄斑水肿,眼底缺血和100天青光眼。黄斑水肿用抗VEGF药物作为一线治疗,缺血期需要激光治疗,新生血管性青光眼需要综合治疗。在上述三个治疗阶段,可以使用中药。川州药业原有的研究药物注射血栓(冻干),其临床效果得到了基础研究的支持,并有望继续血栓通的临床试验。对疗效的深入研究。“

岳丽静教授表示,RVO的总患病率为1.3%,BRVO的患病率为1.2%,CRVO的患病率为0.1%。 RVO 37%与黄斑水肿(ME)相关,BRVO 30%与ME结合,CRVO 71%与ME结合。岳丽静教授介绍,无论是什么并发症,RVO都有低视力和失明的高发病率,眼循环障碍是一个重要原因。眼底血液循环障碍主要表现为血管外压迫,静脉淤滞和静脉血管壁损伤三个方面,RVO与新生血管形成,黄斑水肿形成和视神经损伤有关。

三七总皂苷对改善血液循环,抑制血管生成和保护视神经有三重作用

三七总皂苷的主要成分是清楚的,抑制由多种激动剂引起的血小板聚集。人参皂苷Rg1抑制血小板活化并防止血栓形成;人参皂甙Rg1/Rb1/resaerythritol R1在炎症过程中显着降低白细胞与血管内皮的粘附;人参皂苷Rb1能有效抑制视网膜色素上皮细胞分泌VEGF,抑制缺氧和氧化应激状态下视网膜神经节细胞凋亡,保护视神经。

96项临床研究表明,三七总皂苷可显着改善RVO患者的血液流变学和凝血指标,并显着提高RVO患者的视力。总皂苷与激光治疗相结合改善视力的总有效率高达80%。

通常,三七总皂苷具有改善眼部血液循环,抑制血管生成和保护视神经的三重作用机制。

下图显示了三七总皂苷的三重作用机制

0c759088862a4f908e6d04338c9d92a8

三七总皂苷制剂的优良代表

岳教授介绍说,作为三七总皂苷(注射用血栓)的原始研究员,漳州药业在三七百色地区建立了三七标准化种植基地,这是一个严格控制质量的房地产网站。原药材。指纹质量严格受指纹控制。实际产品图和参考图之间的相似度超过95%。产品质量控制更科学,稳定性和安全性更好。

从2015年到2016年,由天津中医药大学张伯利院士领导的大型RCT研究显示,在30,884例患者中,不良反应的发生率为4.14‰(128例),这是偶然的水平。经对症治疗后,患者病情好转,无后遗症和死亡病例,安全性良好。

专家评审

Professor Chen Youxin: "Chinese medicine can cure diseases, but often do not know how to treat diseases. We hope to know why through scientific research. These studies introduced by Professor Yue show that the use of thrombus injection for the treatment of RVO is clinically effective, theoretically explained Western medicine should not contravene traditional Chinese medicine. Artemisinin, which was awarded the Nobel Prize by Professor Tu Yu, was extracted from the Chinese medicine Daqingye. Researching traditional Chinese medicine through scientific and modern methods is waiting for everyone to work together."

xx
新闻排行
  1. 本文来自公众号-新丰台莲花池公园,位于西三环六里桥北部它是北京最早的历史公园之一“首先是莲花池,然后?

    本文来自公众号-新丰台莲花池公园,位于西三环六里桥北部它是北京最早的历史公园之一“首先是莲花池,然后?...

  2. 择校指导:这六大热门研专业,能跨专业考还好就业!  考研择校不能盲目选择,要综合判断读此专业的价值,

    择校指导:这六大热门研专业,能跨专业考还好就业!  考研择校不能盲目选择,要综合判断读此专业的价值,...

  3. 择校指导:这六大热门研专业,能跨专业考还好就业!  考研择校不能盲目选择,要综合判断读此专业的价值,

    择校指导:这六大热门研专业,能跨专业考还好就业!  考研择校不能盲目选择,要综合判断读此专业的价值,...

  4. 本文来自公众号-新丰台莲花池公园,位于西三环六里桥北部它是北京最早的历史公园之一“首先是莲花池,然后?

    本文来自公众号-新丰台莲花池公园,位于西三环六里桥北部它是北京最早的历史公园之一“首先是莲花池,然后?...

  5. 择校指导:这六大热门研专业,能跨专业考还好就业!  考研择校不能盲目选择,要综合判断读此专业的价值,

    择校指导:这六大热门研专业,能跨专业考还好就业!  考研择校不能盲目选择,要综合判断读此专业的价值,...

  6. 7月不要穿匡威,快点开始这个“藤鞋”让你凉爽一个夏天匡威的鞋子在人们中很受欢迎。无论是经典款式还是20?

    7月不要穿匡威,快点开始这个“藤鞋”让你凉爽一个夏天匡威的鞋子在人们中很受欢迎。无论是经典款式还是20?...

  7. 凌晨,英德大雨,广东发生地震!在凌晨,英德雷取电,雨倾盆而下。我相信我睡觉的许多小朋友也能感受到大自

    凌晨,英德大雨,广东发生地震!在凌晨,英德雷取电,雨倾盆而下。我相信我睡觉的许多小朋友也能感受到大自...

  8. Fundusdiseaseshavealwaysbeenaproblemthatplaguestheophthalmology.Retinalveinocclusion(RVO)isstillcomp

    Fundusdiseaseshavealwaysbeenaproblemthatplaguestheophthalmology.Retinalveinocclusion(RVO)isstillcomp...

  9. 《镇魂》朱一龙被问到哪个场景令人印象深刻?看到他的回答,镇灵魂女孩哭了!去年夏天,最大的黑马应该是《

    《镇魂》朱一龙被问到哪个场景令人印象深刻?看到他的回答,镇灵魂女孩哭了!去年夏天,最大的黑马应该是《...

  10. 凌晨,英德大雨,广东发生地震!在凌晨,英德雷取电,雨倾盆而下。我相信我睡觉的许多小朋友也能感受到大自

    凌晨,英德大雨,广东发生地震!在凌晨,英德雷取电,雨倾盆而下。我相信我睡觉的许多小朋友也能感受到大自...

日期归档
友情链接