糖尿病视网膜病变患者视觉功能与丹参的干预效应 定量化的视力和视敏度评估

Visual function of patients with diabetic retinopathy and the intervention of dan-shen root: Quantified evaluation of sight and visual acuity

目的:观察具有益气养阴活血、改善血黏度、改善机体免疫力功能效的丹参对糖尿病视网膜病变患者血黏度和血脂代谢及视觉功能的作用。方法:①选择2001-04/2005-02在大坪医院野战外科研究所眼科住院的增殖型糖尿病视网膜病变患者35例51只眼。男17例,女18例,年龄39～79岁。纳入病例原发病均为2型糖尿病,且自愿参加。35例患者在常规糖尿病治疗基础上给予丹参注射液6mL,加入生理盐水注射液250mL中静脉滴注,1次/d,6周为1个疗程。②治疗前和治疗6周后进行视功能改善情况评估。视力检查方法采用《标准对数视力表》,在良好的自然光线下进行,正常视力标准规定能分辨1'视角的视力为正常视力标准,记为1.0视力。视力记录视标每增加1行,记录相差0.1,呈算术等差级数排列。采用声控动态视野仪对受检者在暗室进行视敏度检测。视觉系统的空间分辨能力常用视敏度(眼能够分辨的最小细节所对应的视角的倒数)表示。从生理解剖角度,视敏度可以解释为是由视锥细胞在视网膜上的镶嵌排列的精细程度所决定;而从光学角度,则可以认为是受到眼光学系统的衍射极限的限制。③早上空腹抽取静脉血,血黏度检测采用自动血液黏度仪,静脉血胆固醇、纤维蛋白原、三酰甘油水平检测采用全自动生化分析仪分析。组间计量资料差异性比较采用自身对照t检验。结果:按意向处理分析,纳入和进入结果分析的增殖型糖尿病视网膜病变患者均为35例51只眼。①平均视力、30°视敏度、30°～60°视敏度:治疗后明显好于治疗前(0.66±0.32,14.89±1.57,6.87±0.94;0.43±0.29,12.17±1.37,5.36±0.88,t=3.389,3.157,4.458,P<0.05)。②全血比黏度、血浆比黏度、总胆固醇、纤维蛋白原、三酰甘油水平:治疗后明显低于治疗前[3.87±0.19,1.84±0.11,(5.57±0.41),(5.05±0.31),(1.48±0.16)mmol/L;4.57±0.28,2.38±0.24,(6.58±0.35),(5.91±0.33),(2.11±0.19)mmol/L;t=2.897～4.568,P<0.01]。结论:①对视功能的评定选取视力和视敏度,可避免靠传统视力检查来衡量患者的视功能状况的局限性。视敏度检查被用于评价视觉系统的形觉功能,能较早地反映出疾病所引起的形觉功能的障碍。因此使用丹参后患者的视力和视敏度得到了显著的提高,说明丹参对增殖性糖尿病视网膜病变有显著的改善作用。②血液的高黏滞状态对糖尿病患者视网膜具有损伤作用。丹参治疗后患者血黏度降低,局部血流量和微循环得到了改善,在一定程度上延缓了糖尿病性视网膜病变病程。

AIM: To observe the effects of dan-shen root, which has the functions of supplementing qi, nourishing yin and activating blood circulation, improving blood viscosity and organic immunity, on the blood viscosity, blood lipid metabolism and visual function in patients suffered from diabetic retinopathy. METHODS: ① Fifty-one eyes of 35 patients (17 males and 18 females) at 39 to 79 years of age with proliferative diabetic retinopathy, who were hospitalized in the Department of Ophthalmology, Research Institute of Field Surgery, Daping Hospital, Third Military Medical University of Chinese PLA from April 2001 to February 2005, were selected, they were all type 2 diabetic patients at the beginning and took part in this study voluntarily. On the basis of routine diabetic treatment, the 35 patients received venous drip of Danshen parenteral solution (6 mL), which was added into 250 mL saline parenteral solution, once a day for 6 weeks as a course. ②The improvement of visual function was assessed before treatment and 6 weeks after treatment. Their sight was examined with the standard logarithmic visual acuity chart under good natural light; The standard for normal sight was able to differentiate the 1′ visual angle and marked as 1.0 sight; The record difference was 0.1 with the increase of every line of the sight mark, it showed arithmetic progression arrangement. The visual acuity was detected with sound control dynamic sight apparatus in a dark room. The spatial differentiation ability of visual system was always expressed by the visual acuity (the reciprocal of the visual angle corresponding to the minimal detail that eyes could differentiated). Considering from the physiological anatomy, visual acuity could be explained to be decided by the refined degree of cone cell arrangement on retina; But considering optically, it could be considered that it was restricted the ultimate diffraction of optical system. ③Fasting venous samples were drawn in the morning, blood viscosity was detected with automatic blood viscosity meter; The levels of total cholesterol, fibrinogen and triglyceride in venous blood were detected with the automatic biochemistry analyzer; The self-control t test was used to compare the intergroup difference of the measured data. RESULTS: According to intention-to-treat analysis, all the 51 eyes of 35 patients with proliferative diabetic retinopathy were involved in the analysis of results. ①The average sight, 30° visual acuity and 30° to 60°visual acuity after treatment were all better than those before treatment (0.66±0.32, 14.89±1.57, 6.87±0.94; 0.43±0.29, 12.17±1.37, 5.36±0.88, t=3.389, 3.157, 4.458, P < 0.05). ②The total blood viscosity, plasma viscosity and levels of total cholesterol, fibrinogen and triglyceride after treatment were obviously lower than those before treatment [3.87±0.19, 1.84±0.11, (5.57±0.41), (5.05±0.31), (1.48±0.16) mmol/L; 4.57±0.28, 2.38±0.24, (6.58±0.35), (5.91±0.33), (2.11±0.19) mmol/L; t=2.897 to 4.568, P < 0.01]. CONCLUSION:① Evaluation of visual function by using sight and visual acuity can avoid the restriction of traditional sight examination in measuring the visual function of the patients. The examination of visual acuity in assessing the form sense function of visual system can earlier reflect the disorder of form sense function caused by the disease. The sight and visual acuity of the patients are significantly improved after dan-shen root treatment, it is indicated that dan-shen root plays a significant role in ameliorating diabetic retinopathy. ②The high viscosity and stasis of blood have damaging effect on the retina of diabetic patients. After dan-shen root treatment, the patients' blood viscosity is decreased, local blood flow and microcirculation are ameliorated, and it delays the progress of diabetic retinopathy to a certain extent.