中醫藥治療眼睛前葡萄膜炎的臨床證據：病歷回溯性研究

Evidence for Traditional Chinese Medicine in Treating Anterior Uveitis: A Pilot Cohort Study

目的：探討中醫藥作為治療眼睛前葡萄膜炎非類固醇療法之可行性。設計：病歷回溯性研究。方法：共55例門診確診為前葡萄膜炎的患者，分為：單純類固醇治療組22例（第1組）和中藥（當歸龍薈丸）併用或不併用類固醇組合治療組33例（第2組），第2組再進一步分為僅單獨使用中藥（n=8）和中藥併用類固醇（n=24）兩個亞組，並觀察追踪至2週。我們評估了眼睛前房發炎細胞數分級和視力的變化，並比較了兩個治療組之間的恢復率。結果：與第1組相比，第2組的前房細胞分級降低幅度更大（p=0.005）；同樣地第2組比第1組的視力改善顯著（p=0.002）；第2組和第1組的中位恢復時間分別為6天和11天。與第1組相比，第2組的治療使恢復率提高了3.90倍（p＜0.001），然而中藥併用和不併用類固醇兩個亞組之間的恢復趨勢幾乎相同。結論：此中藥古方（當歸龍薈丸）併用或不併用類固醇治療眼睛前葡萄膜炎之療效在評估的各項結果均優於單獨使用類固醇者，這也暗示其作為前葡萄膜炎非類固醇消炎藥的潛在應用。

Purpose: To explore a viable non-steroid anti-inflammatory therapy in treating anterior uveitis (AU) using Chinese herbal medicine. Design: A retrospective cohort study. Methods: A total of 55 patients with AU diagnosed who were followed up to two weeks with two treatment groups: 22 patients in steroid alone (group 1) and 33 patients in Chinese Angelica, Gentian & Aloe Formula (Dang Gui Long Hui Wan) with or without (w/o) steroid combined (group 2). Group 2 was further divided into two subgroups: TCM only (n = 8), and TCM with steroid (n = 24). We assessed the changes of anterior chamber cells grading and visual acuity, and compared the recovery rates between two treatment groups. Results: A larger reduction in anterior chamber (AC) grading in group 2 was observed than group 1 (p = 0.005). Similarly a significant improvement was observed in visual acuity in group 2 vs. group 1 (p = 0.002). The median time for recovery is 6 and 11 days respectively for group 2 and group 1. The treatment of group 2 increased the recovery rate by 3.90-fold as compared to group 1 (95% CI, 2.07 - 7.36; p ＜ 0.001), whereas the trends of recovery between the subgroups of TCM with and w/o steroid were similar. Conclusions: The results are highly consistent to favor the Chinese herbal medicine (Dang Gui Long Hui Wan) with or w/o steroid in terms of various outcomes assessed than steroids alone, also implying its potential application as an anti-inflammation drug for anterior uveitis.