芪参益气明目方治疗m.3460G>A型Leber遗传性视神经病变的疗效分析OA

OBJECTIVE To evaluate the clinical efficacy of Qishen Yiqi Mingmu Formula in treating m.3460G>A Leber hereditary optic neuropathy(LHON)with Qi deficiency and blood stasis syndrome.METHODS Medical records of 16 patients(32 eyes)diagnosed with m.3460 G>A LHON and Qi deficiency and blood stasis syndrome via mitochondrial DNA testing,who attended the Ophthalmology Department of Dongfang Hospital,Beijing University of Chinese Medicine between December 2016 and December 2024,were included.For observing best corrected visual acuity(BCVA),cases with disease duration≤12 months were assigned to Group A(nine cases,18 eyes),and those with duration>12 months to Group B(seven cases,14 eyes).For visual field[mean defect(MD),mean sensitivity(MS)]index analysis,patients were divided into Group Gtop and Group LVC(eight cases each,16 eyes each)based on the testing program used.A clinical database was established,and BCVA,visual field indices,and retinal nerve fiber layer(RNFL)thickness before and after treatment were compared and analyzed for correlations.RESULTS(1)BCVA:Post-treatment BCVA significantly decreased compared to pre-treatment in all 16 patients(t=3.111,P=0.002).Both Group A and Group B showed significant improvement in BCVA after treatment(tA=2.324,P=0.020;tB=2.251,P=0.024).Pre-treatment BCVA was significantly lower in Group A than in Group B(t=2.749,P=0.005);However,comparison of BCVA and BCVA changes between the two groups after treatment showed no statistically significant difference.(P>0.05).(2)MD:Post-treatment MD was significantly lower than pre-treatment in all 16 patients(t=4.651,P=0.000).Both Group Gtop and Group LVC showed significantly lower MD after treatment(tGtop=3.036,P=0.008;tLVC=3.559,P=0.003).Compared between the two groups,MD in the Gtop group was lower than that in the LVC group both before and after treatment,and the differences were statistically significant(tbefore treatment=2.326,P=0.027;tafter treatment=2.586,P=0.015).(3)MS:Post-treatment MS was significantly higher than pre-treatment in all 16 patients(t=4.218,P=0.000).Both Group Gtop and Group LVC showed significantly higher MS after treatment(tGtop=2.528,P=0.023;tLVC=3.546,P=0.003).There was no statistically significant difference in MS and MS changes between the two groups before and after treatment(all P>0.05).(4)RNFL thickness:No statistically significant differences were found in the average peri-papillary RNFL thickness or the thickness in the inferior,superior,nasal,and temporal quadrants before and after treatment(all P>0.05).(5)BCVA correlation analysis:BCVA (LogMAR) was positively correlated with age and negatively correlated with disease duration,both with statistical significance(rage=0.383,P=0.030;rduration=-0.450,P=0.010).BCVA showed no significant correlation with MD,MS,or average RNFL thickness(P>0.05).(6)BCVA multivariate regression analysis:Disease duration had a statistically significant impact on BCVA(t=4.402,P=0.000),while age,MD,and MS did not show significant effects(P>0.05).CONCLUSIONS Qishen Yiqi Mingmu Formula can,to some extent,improve BCVA and MS values,reduce MD values,and effectively enhance visual function in patients with m.3460G>A LHON.