糖尿病视网膜病变与血瘀关系的探讨

A Study on the Relationship Between Diabetic Retinopathy and Blood Stasis Syndrome

通过对中医血瘀证与糖尿病视网膜病变（ＤＲ） 关系的研究， 阐明血瘀在ＤＲ发生、发展上的作用及其证候特征， 为ＤＲ临床防治寻求有效治则及方药提供理论依据。将１８５ 例（２８３ 眼） 糖尿病（ＤＭ） 患者分为无ＤＲ组、ＤＲ组， 中医证型分气阴两虚、阴阳两虚、血瘀气滞３ 型； 西医分单纯期、增殖前期、增殖期３期。结合眼底荧光血管造影、血液流变学检查结果进行分析。结果： ①单纯期、增殖前期气阴两虚证所占比例大， 占８１ ．２５ ％ ， 增殖期以血瘀气滞证的比例较大， 占５０ ．６３ ％ ； ②无ＤＲ 之ＤＭ 组、ＤＲ 组的臂—视网膜循环时间（ｔＡ－ ＲＣ） 均较正常人延长（ Ｐ＜０ ．００１） ； ③无ＤＲ之ＤＭ、ＤＲ患者血液流变学中的全血粘度、血浆粘度、红细胞压积均较正常人组升高（Ｐ＜ ０ ．０５）， 血瘀气滞组升高更明显。结论：ＤＲ 眼底荧光血管造影的ｔＡ－ ＲＣ延长及各种血管病变表现、血液流变学的异常是血瘀贯穿ＤＲ始终的重要参考指标， 祛瘀法须贯穿ＤＲ治疗的全过程。在辨证时除应用传统辨证方法外，

Objective:To investigate the characteristics of blood stasis syndrome and its role on the pathogenesis of diabetic retinopathy (DR) by studying the relationship between DR and blood stasis syndrome. Methods:185 patients (283 eyes) with diabetes mellitus (DM) were subjected to DR group and non-DR group.Three types of TCM syndrome were observed, i.e.,Qi and Yin deficiency (QYD), Yin and Yang deficiency (YYD) and blood stasis and Qi stagnation (BSQS). The fundi of DR were divided into simple pre-proliferative and proliferative stages. The fundus fluorescein angiography(FFA) and blood rheology were also analyzed. Results:(1) The arm-to-retina circulation time(t A-RC ) of DM Patients was significantly different from that of normal control group (P< 0.001 ).(2)Blood viscosity, hematocrit and plasma viscosity of DR patients were significantly different from that of normal control group (P< 0.05 ). These differences were more prominent in the cases of BSQS syndrome which was seen in most cases of DR in proliferative stage. Conclusions: The changes of FFA and blood rheology are the most important characteristics in the whole course of DR. Elimination of blood stasis is the key of treatment, and the TCM syndrome differentiation should be combined with the fundus examination.