| ObjectiveAnalyze the TCM syndrome differentiation of MGD of middle-aged and old people using Latent structure analysis.Guide clinical research combining the systemic and local syndrome differentiation,then observe the therapeutic effect from clinical examination,microbiological test,and composition of meibomain secretion etc.The meibomian gland dysfunction and dry eye associated with it will be further discussed.Content1.Reveal the TCM syndrome differentiation of MGD of middle-aged and old people using Latent structure analysis.To clarify the TCM syndrome elements and to screen the significant symptoms of the disease.Then it is possible to establish objective and quantitative diagnostic criteria for syndrome differentiation.2.Prescribing medication for external washing according to the result of the data analysis and referring to the local syndrome differentiation.Then observe the therapeutic effect and explore its mechanism.3.Contrast the symptoms,signs,grading of meibomian gland dysfunction,lose of meibomian gland,and tear film stability before and after treatment to evaluate the clinical effectiveness.4.Analyze the properties and composition of meibomain secretion using mass spectrometry to clarify the change of meibomain secretion and definite the improvement after treatment,also the susceptibility.5.Study the local micro environmental change and damage mechanism by microbiological examination of palpebral margin before and after treatment to find the more effective and practical treatment.6.To guide patients with long-term Chinese medicine regulation and slow the progression of the diseases according to the syndrome differentiation based on the Latent structure analysis.It especially has important significance for those who have no symptoms or mild symptoms.Method1.Perform questionnaire survey and collect data to analyze common clinical syndromes.According to the literature of TCM in recent five years and combined with clinical experience,the questionnaire survey was established.Select the clinical symptoms of high frequency into the database.It is a total of 561 eligible patients with MGD collected from outpatients of eye hospital of China Academy of Chinese medicine and online survey of ophthalmologists in hospital of Beijing from January 2015 to May 2017.2.Prescript the medicine of external washing based on local syndrome differentiation.It is found preliminary through part of data that yin deficiency of liver and kidney and yin deficiency and dampness-heat are common to middleaged and eldly people referring data analysis.Most of these patients are dampness-heat stagnating.So the subject uses kuh-seng,the tuber of stemona,dandelion,mint,mother chrysanthemum etc for external washing to clear heat,promote diuresis,dispel wind and insects combining pathological basis of western medicine,literature and modern pharmacology.Then observe therapeutic effect and explore mechanism.3.Observe the clinical effectivenessContrast the symptom score,eyelid abnomality score,and dry eye analysis of patients before and after treatment to evaluate the clinical effectiveness.We observes the loss of area to evaluate the function of meibomian gland by infrared transmission non-contact and the video analysis function observes the breakup time of tear film.4.Observe the bacteria in the patients' mebomian secretion.MGD is closely related to bacteria infection of meibomian gland.It is play important role of bacterial cholesterol esterase and fatty wax lipase to MGD.Detect the positive rate and species of bacteria and then observe the result of treatment by bacteria analysis of meibomian gland secretion before and after treatment.5.Observe the mites of eyelash root and meibomian gland secretionThe direct damage of mites and the immune response caused by mites are all the causes of MGD.It is not very clearly for the influence on the pathologic mechanism of MGD.However,It is found that the detection rate is positively directed with age,especially to the patients with MGD who are easier to detect.And also the treatment is useful.We observe some elderly patients and find many of them having a lager number of mites in the eyelash and meibomian gland secretion,even cortical mites to few patients.In this study we observe the number and species of mites of the eyelash and meibomian gland before and after treatment.6.Analyze the component of meibomian gland and the changes before and after treatmentVarious factors of endogenous and exogenous result in changes in components and high melting point of meibomian gland secretion.The subject is designed to detect the content change of octadecanoic acid,palmitic acid and squalene to measure the change of important components of fatty acids.And these are used to determine the treatment effect.But in the specific experimental process,the squalene was not detected for its low content in patients with MGD and its low response value.Result1.Syndrom observation:The study of TCM syndromes have collected 561 cases from January,2015 to May,2017 of eye hospital clinic.At last,select the optimal models of the questionnaire using Latent structure analysis with the BIC score-20656.24.2.Clinical trial:Collected 64 cases from February 1,2016 to January 1,2017 of eye hospital clinic.All patients were differentiated random for syndrome differentiation and detection of each index before and after treatment.3.Grading of meibomian gland dysfunction:there was no statistical difference in both treatment group and control group before and after treatment(P>0.05).Evaluation of the clinical effectiveness:there was significant statistical difference in treatment group before and after treatment(P<0.01)for symptom score of dry eye,and there was also statistical difference in control group before and after treatment(P<0.05).there was significant statistical difference in treatment group before and after treatment(P<0.01)for eyelid abnomality score,and there was also statistical difference in control group before and after treatment(P<0.05).there was no statistical difference in both treatment group and control group before and after treatment(P>0.05).for breakup time of tear film,there was statistical difference in treatment group(P<0.05),but the control group was no statistical difference.4.Analysis of meibomain secretion:the palmitic acid before and after treatment:there was statistical difference in treatment group(P<0.05),and the control group also slightlly improved after treatment but no statistical difference.the steartic acid before and after treatment:there was statistical difference in treatment group(P<0.05),and the control group also slightlly improved after treatment but no statistical difference.5.Detection of mites:there was significant statistical difference in treatment group before and after treatment(P<0.01),and there was also statistical difference in control group before and after treatment.6.Detection of bacteria:there was significant statistical difference in treatment group before and after treatment(P<0.01),and there was also statistical difference in control group before and after treatment.Conclusion1.Draw the conclusion that the common syndromes are yin deficiency of liver and kidney,yin deficiency and dampness-heat and heart-spleen deficiency by analysis of meibomian gland dysfunction using Latent structure analysis.2.The disease is based on Yin deficiency and the local syndrome is differentiation with both of damp heat and wind pathogen.The external washing of TCM with the effect of heat-clearing,damp-drying drug,chlordimeform and dispelling wind can relieve clinical symptoms,improve the meibomian gland functioncan and the composition of meibomian secretion,and it has significant effect in the aspect of anti mite and bacteria.It preliminary proves that the prescription according the combination of systemic and local syndrome differentiation,so it can be used in the therapy of meibomian gland dysfunction.3.It is combined the local syndrom differentiation and systemic syndrome differentiation to guide clinical treatment.The treatment plays advantage of treating external eye disease with symptomaic treatment in acute condition.It guides conditioning,slowes recurrence according to the results of the syndrome analysis with permanent treatment in chronic condition.So we made a preliminary exploration of the management model of chronic disease. |
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