摘要 目的 探讨中药川芎嗪对原发性开角型青光眼的血液流变学、眼底荧光血管造影以及视功能的影响。方法 采用自身对照的方法对眼压已控制的原发性开角型青光眼患者11例(19)眼进行川芎嗪治疗前后血液流变学测定、眼底荧光血管造影、Humphrey视野检查以及图形视诱发电位(PVEP)检测。结果 用磷酸川芎嗪治疗后患者血液流变学各指标明显下降(P＜0.05～0.001)；眼底荧光血管造影臂-脉络膜循环时间从治疗前的14.67±2.74s下降至13.00±2.14s(P＜0.005)，臂-视网膜动脉循环时间从14.2±2.43s下降至12.93±2.02s(P＜0.02)，视网膜动-静脉时间从17.67±5.94s下降至12.93±2.81s，(P＜0.02)；Humphrey静态视野的总缺失从-933.39±641.76减少至-773.56±663.55(P＜0.001)，平均缺损从-12.99±9.43减少至-11.10±9.10(P＜0.01)；动态视野之I4e等视线面积从5 568.09±1 974.34mm2 扩大至6 093.51±1 798.16mm2( P＜0.02)；100’、25’和6’三种方格PVEP的P1潜伏期分别从117.77±13.98ms、120.12±15.81ms和139.75±19.81ms缩短至114.46±12.90ms、112.24±10.59ms和124.08±15.44ms(P＜0.05)。结论 川芎嗪可以降低原发性开角型青光眼患者的血液粘度，缩短眼底荧光血管造影各循环时间，改善血流动力学和青光眼的视功能损害。
Effect of ligustrazine on patients with primary open-angle glaucoma
LIU Xing,ZHOU Wen-Bing,GE Jian,LING Yun-Lan,CAI Xiao-Yu
Key words glaucoma;hemorrheology;visual function;ligustrazine;fundus fluorescein angiography;visual evoked potential
Abstract Objective To investigate the effect of ligustrazine on hemorrheology,fundus fluorescein angiography(FFA)and visual function in patients with primary open-angle glaucoma(POAG).Methods Before and after treatment eleven patients(19 eyes) with POAG,whose intraocular pressure were controlled,were performed the following examinations by self control:hemorrheology,FFA,visual field and pattern visual evoked potential(PVEP).Results After treatment with ligustrazine,the patients' parameters of blood viscosity diminished(P＜0.05～0.001)；the arm-choroid filling time(A-CT),arm-retinal artery filling time(A-AT),retinal artery-venous filling time(A-VT)of FFA were shorter(A-CT:from 14.67±2.74s to 13.00±2.14s,A-AT:from 14.20±2.43s to 12.93±2.02s,A-VT:from 17.67±5.94s to 12.93±2.81s，P＜0.02～0.005);the average values of total defect(TD) and mean defect(MD) of Humphrey field analysis were lower(TD:from-933.39±641.76 to -773.56±663.55，MD：from -12.99±9.43 to -11.10±9.10,P＜0.001);the sizes of ispoters of visual field (I4e)were enlarged(from 5 568.09±1 974.34mm2 to 6 093.51±1 798.16mm2 P＜0.02)；the average values of P1 latency to 100',25' and 6' check of PVEP were shortened(P1 100':from 117.77±13.98ms to 114.46±12.90ms,P1 25':from 120.12±15.81ms to 112.24±10.59ms,P1 6':from 139.75±19.81ms to 124.08±15.44ms(P＜0.05).Conclusion Ligustrazine can decrease the blood viscosity,shorten the blood vessels' filling time of FFA and improve the visual function in patients with POAG.
国内外学者已发现眼压不是原发性开角型青光眼(primary open-angle glaucoma,POAG)患者视功能损害的唯一因素，血液粘度异常增高也可使视盘、视网膜血液供应障碍，导致视功能损害。但迄今为止，未见有关用川芎嗪通过改善血液粘度达到治疗POAG视功能损害的报道。为了观察川芎嗪是否能改善POAG视功能损害，我们对一组眼压已控制的患者进行了治疗前后的观察，现将结果报告如下。
1 对象和方法
1.1 对象 随机选择POAG患者11例(共19眼)，平均年龄49.09±8.09a，平均眼压1.94±0.46kPa。POAG的诊断标准参照1987年全国青光眼协作组关于原发性青光眼早期诊断标准。所有患者的眼压均用药物或手术控制在2.99kPa以下。停用影响血液粘度药物及有助于视神经功能恢复的药物(如血栓通、复方丹参、肌苷、维生素类药物)至少1mo，手术治疗后起码3mo方能入选。
1.2 方法
1.2.1 药品和给药方法 磷酸川芎嗪缓释胶囊(每粒200mg，批号931101-1)由广东利民制药厂提供。用法为每次3粒，每日2次，1个疗程30d，连续3个疗程，治疗期间停用其它药物。
1.2.2 观察内容 本研究采用自身对照的方法，患者服用川芎嗪前后进行下述检查：(1)视力、眼压；(2)血液流变学指标测定；(3)眼底荧光血管造影；(4)Humphrey视野检查；(5)图形视诱发电位(PVEP)检查。
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