普罗布考治疗高血脂非增生型糖尿病视网膜病变疗效观察

Probucol for non-proliferative diabetic retinopathy with hyperlipidemia

目的观察普罗布考治疗高血脂非增生型糖尿病视网膜病变（DR）的临床效果。方法临床确诊为高血脂非增生型DR的52例患者104只眼纳入研究。将患者随机分为普罗布考治疗组（治疗组）和对照组，分别为26例52只眼。给予两组患者饮食、运动指导的同时进行口服降糖药和（或）胰岛素强化治疗。治疗组在控制血糖、血压基础上给予普罗布考O．5g，2次／d；对照组在控制血糖、血压基础上口服阿托伐他汀10mg，1次／d。总疗程12个月。治疗前及治疗后1、3、6、12个月，所有患者均行视力、检眼镜、荧光素眼底血管造影、相关血液及尿液检查。对比观察治疗前后两组患者视力、眼底、黄斑水肿、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDLC）、高密度脂蛋白胆固醇（HDLC）及8-羟基脱氧鸟苷（8-OHdG）的变化情况。结果治疗后治疗组、对照组视力预后总有效率分别为44．23％、40．38％，二者比较，差异无统计学意义（Z=-0．335，P〉0．05）。治疗组、对照组视网膜出血及微动脉瘤均较治疗前减轻，其眼底预后总有效率分别为65．38％、36．54％，二者比较，差异有统计学意义（Z=-2．973。P％0．05）。治疗组、对照组合并黄斑水肿分别为6、5只眼，均较治疗前显著减少，差异有统计学意义（X2=4．833、4．300，P％0．05）；两组合并黄斑水肿眼数比较，差异无统计学意义（x2=0．102，P〉0．05）。治疗后12个月，治疗组（t=15．653、7．634、14．871）、对照组（t=13．275、7．415、13．632）TG、TC和LDLC均较治疗前有所降低，差异有统计学意义（P〈0．05）；HDLC较治疗前无明显变化，差异无统计学意义（t=0．584、0．275，P〉0．05）。治疗组、对照组之间TG、TC、LDLC、HDLC比较，差异均无统计学意义（t=1．857、0．133、1．671、0．875，P〉0．05）。治疗后1、3、6、12个月，治疗组（t=7．352、15．581、27．324、28．143）及对照组（t=6．877、8．672、14．671、14．855）8-0HdG较治疗前呈逐渐降低趋势，差异有统计学意义（P％0．05）。治疗后1个月，治疗组及对照组8-0HdG比较，差异无统计学意义（t=0．513，P〉0．05）；治疗后3、6、12个月，治疗组8-OHdG较对照组降低，差异有统计学意义（t=3．434、5．917、5．226，P〈O．05）。结论普罗布考治疗高血脂非增生型DR可降低血脂、稳定视功能、减轻黄斑水肿。

[Abstract] Objective To observe the effectiveness of probucol for non-proliferative diabetic retinopathy （NPDR） with hyperlipidemia. Methods Fifty-two patients （104 eyes） of NPDR with hyperlipidemia were enrolled in this study. The patients were randomly divided into treatment group and control group, 26 patients （52 eyes） in each group. Both groups received diet and exercise guidance, oral hypoglycemic agents and （or） intensive insulin therapy. After blood sugar and blood pressure were controlled, the treatment group received probucol 0.5 g, two times per day; and the control group received atorvastatin of 10 mg, one time per day. The total course was 12 months. Before and after one, three, six and 12 months, all patients underwent vision, ophthalmoscope, fundus fluorescein angiography, blood and urine tested. Variations of visual acuity, fundus condition, macular edema, triglyceride （TG）, total cholesterol （ TC）, low-density lipoprotein cholesterol （ LDLC）, high-density lipoprotein cholesterol （HDLC） and 8-0HdG were observed before and after treatment. Results The total effective rate of visual prognosis were 44.23% and 40.38% in the treatment group and the control group, the difference had no statistical significacy （Z= 0. 335, P〈0.05）. Retinal hemorrhages and microaneurysms alleviated after treatment in both groups. The total efficiency of fundus prognosis was 65.38% in the treatment group and 36.54% in the control group, and the difference was statistically significant （Z= -2. 973, P〉0.05）. Maeular edema was in six and five eyes in the treatment group and the control group respectively, which were lower than before treatment, the difference was statistically significant （x2= 4.833, 4. 300; P〈 0. 05）. Between the two groups, the difference was not statistically significant （x2 =0. 102, P〉 0. 05）. Twelve months after treatment, TG, TC and LDLC were decreased in the treatment group （t= 15. 653, 7. 634, 14. 871） and control group （t = 13. 275, 7. 415, 13. 632）, and the difference was statistically significant （P〈0.05）. HDLC showed no significant difference than before in the two groups （t= 0. 584, 0. 275; P2〉0.05）. TG, TC, LDLC and HDLC showed no difference between the two groups （t= 1. 857, 0. 133, 1. 671, 0. 875; P〉0.05）. 8-0HdG decreased gradually during the one, three, six and 12 months in the treatment group （t=7. 352, 15. 581, 27. 324, 28. 143） and control group （t=6. 877, 8. 672, 14. 671, 14. 855） after treatment, and the difference was statistically significant （P%0.05）. In the first month after treatment, 8-0HdG showed no difference between the two groups （t=0. 513, P〉0.05）. In the 3, 6, and 12 months after treatment, the 8-0HdG was lower in the treatment group than that in the control group, and the difference was statistically significant （t=3.434, 5.917, 5.226; P〈0.05）. Conclusion In the treatment of NPDR with hyperlipidemia, probucol can reduce blood lipid, stable visual function and relieve macular edema.