阿托伐他汀钙对糖尿病患者白内障手术后黄斑水肿发生率的影响

The effects of Atorvastatin calcium on the incidence of macular edema after phacoemulsification in diabetic patients

目的观察阿托伐他汀钙对糖尿病患者白内障手术后黄斑水肿发生率的影响。方法接受晶状体超声乳化联合人工晶状体植入手术的糖尿病高脂血症白内障患者42例42只眼纳入研究。采用随机数字表法将患者分为使用降血脂药物干预组（干预组）和不使用降血脂药物干预组（非干预组），分别为23、19例。均在控制血糖、血压基础上常规行晶状体超声乳化联合人工晶状体植入手术。其中，干预组患者在手术后1d给予羟甲基戊二酰辅酶A还原酶抑制剂阿托伐他汀钙10mg口服，1次／d，连续使用24周；非干预组患者不服用阿托伐他汀钙及其他降脂药物。两组患者均行最佳矫正视力（BCVA）、眼底彩色照相、光相干断层扫描（OCT）等眼部检查及血糖、血压、血脂及血肌酐等全身检查；手术前平均最小分辨角对数（10gMAR）BCVA、中心凹视网膜厚度（CRT）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）、高密度脂蛋白胆固醇（HDL—C）比较，差异均无统计学意义（t=1．251、1．257、1．031、1．042、1．461，P〉0．05）。以手术后24周为疗效评价时间点，对比分析两组患者手术眼BCVA、黄斑水肿发生率、CRT以及患者TC、LDL-C和HDL—C的变化。结果手术后1d，两组患者手术眼平均logMARBCVA比较，差异无统计学意义（t=1．523，P〉0．05）。手术后4、12、24周，干预组患者手术眼平均logMARBCVA较非干预组明显提高，差异有统计学意义（t=3．920、3．012、7．025，P〈0．05）。手术后24周内干预组患者手术眼发生黄斑水肿2只眼，发生率为8．69％；非干预组患者手术眼发生黄斑水肿4只眼，发生率为21．05％。两组患者手术眼黄斑水肿发生率比较，差异有统计学意义（x2=4．896，P〈0．05）。手术后1d，两组患者手术眼平均CRT比较，差异无统计学意义（t=1．501，P〉0．05）。手术后4、12、24周，干预组患者手术眼平均CRT较非干预组明显降低，差异均有统计学意义（t=4．673、7．583、9．035，P〈0．05）。手术后4、12、24周，干预组患者平均TC（t=7．043、7．930、8．611）、LDL-C（t=9．374、9．554、10．856）较非干预组明显降低，差异均有统计学意义（P〈0．05）；两组患者平均HDL—C比较，差异无统计学意义（t=1．057、1．127、1．295，P〉0．05）。结论在控制血糖、血压基础上，糖尿病高脂血症白内障患者在超声乳化手术后应用阿托伐他汀钙控制血脂，可以有效降低黄斑水肿的发生率。

Objective To investigate the effects of Atorvastatin calcium on the incidence of macular edema after phacoemulsification in diabetic patients. Methods Forty two eyes of 42 cataract patients with diabetes and kypercholesterolemia who underwent phacoemulsifieation surgery were divided into interventional group （23 patients） and non-interventional group （19 patients） by random number table methods. The blood glucose and pressure of patients in two groups was controlled strictly before and after surgery. 10 mg Atorvastatin calcium per day was delivered one day after cataract surgery for the patients of interventional group and used for 24 weeks. No lipid-lowing agent was provided to the patients of non-interventional group. The main outcome measures included the best corrected visual acuity （BCVA）,central retina thickness （CRT）, total cholesterol （TC）, low density lipoprotein cholesterol （LDL-C） and high density lipoprotein cholesterol （HDL-C）. No significant difference was shown in the BCVA, CRT, TC, LDL-C and HDL-C in two groups before phaeoemulsification surgery （t= 1. 251, 1.257, 1.031, 1. 042, 1. 461; P〈0.05）. At the end of the 24 weeks after surgery, the efficacy evaluation and comparative analysis were performed. The analysis included the BCVA, the incidence of maeular edema, CRT, TC, LDL-C and HDL-C. Results The BCVA was no significantly different between two groups one day after surgery （t = 1. 523, P〈0.05）. But 4, 12, 24 weeks after phacoemulsification surgery, the BCVA in interventional group was better than that in non-interventional group（t= 3. 920, 3. 012, 7. 025 ; P〈0. 05）. 24 weeks after the operation, macular edema was occurred in 2 eyes （8.69%） in interventional group and 4 eyes （21.05 %） in non-interventional group. Significance difference was found between two groups （Z2= 4. 896,P〈0.05）. There was no significance different of the CRT between two groups one day after operation （t= 1. 501, P〈0.05）. Whereas, the significance difference of the CRT was occurred in two groups 4, 12, 24 weeks after surgery（t = 4. 673, 7. 583, 9. 035; P〈0. 05）. Comparing with that in non-interventional group, the level of TC （t = 7. 043, 7. 930, 8. 611） and LDL-C （t = 9. 374, 9. 554, 10. 856） in interventional group was significantly decreased 4 to 24 weeks after operation （P〈0.05）. But no significance different of HDL-C was shown in two groups 4, 12 and 24 weeks after surgery （t= 1. 057, 1. 127, 1. 295; P〈 0.05）. Conclusion The treatment of Atorvastatin calcium effectively reduced the incidence rate of macular edema in hypercholesterolemia patients with good glycemic and hypertension control after phacoemulsification surgery.