培土消水方加减协同玻璃体内注射康柏西普及眼内光凝治疗糖尿病性黄斑水肿的疗效观察

Observation of Peitu Xiaoshui Decoction Combined with Intravitreal Conbercept Injection and Retinal Laser Surgery in Treating Patients with Diabetic Retinopathy Macular Edema

目的:观察白拟培土消水方治疗糖尿病黄斑水肿的临床疗效。方法:对非增殖性糖尿病视网膜病变(NPDR)合并弥漫性黄斑水肿(DME)患者共40例43只眼纳入前瞻性临床对照研究,以随机数字表法分组,中药组给培土消水方口服协同康柏西普玻璃体内注射及黄斑区"C"型、视网膜无灌注区光凝治疗,共计20例22只眼;对照组仅给康柏西普玻璃体内注射及黄斑区"C"型、视网膜无灌注区光凝治疗,共20例21只眼。观察2组患眼组内和组间在治疗后1周、1、3、6个月最佳矫正视力(BCVA)、平均黄斑中心凹厚度(CMT)与治疗前的变化;治疗后6个月时黄斑水肿的复发率,及统计分析。结果:2组患眼组内在治疗后较治疗前BCVA,CMT均有所改善(F=15.383、786.382,P〈0.05);中药组与对照组组间比较,在治疗后1周BCVA,CMT无明显差异(t=0.603、-1.007,P>0.05),在1,3,6个月有明显改善(BCVA:t=2.838、2.581、3.619,CMT:t=-18.404、-5.039、-11.299,P<0.05),在治疗后6个月黄斑水肿复发率低(x^2=43.00,P<0.05);中药组在治疗后均病情改善趋势平稳,而对照组在治疗后1个月BCVA,CMT有反复。结论:采用培土消水方协同康柏西普玻璃体注射及激光光凝能有效地增强局部治疗的效果;可以改善视力、减轻黄斑水肿、延迟水肿复发时间且能减少局部治疗的副作用,可望为患者带来更好的预后。

Objective:To observe the clinical efficacy of Peitu Xiaoshui Decoction in the treatment of diabetic macular edema.Methods:Non proliferative diabetic retinopathy(NPDR) diffuse macular edema(DME) in patients with a total of 40 eyes of 43 patients included in the prospective clinical study,which were randomly divided into two groups,Chinese medicine group to Peitu Xiaoshui Decoction oral Xipu intravitreal injection and collaborative Compaq macular type 'C' and no retinal perfusion photocoagulation,a total of 20 eyes in 22 cases:the control group only give Compaq intravitreal injection and Xipu macular type 'C' and the retinal non perfusion photocoagulation,20 eyes of 21 cases.Observation of 2 eyes within and between groups in 1 weeks after treatment,1,3 and 6 months,the best corrected visual acuity(BCVA),average foveal thickness(CMT) and the changes before treatment:6 months after treatment of macular edema and the recurrence rate,statistical analysis.Results:2 eyes within group after treatment than before treatment,BCVA,CMT were improved(F =15.383,786.382,P < 0.05):the Chinese medicine group and the control groups at 1 weeks after treatment,BCVA,CMT showed no significant difference(t=0.603,-1.007,P<0.05),significantly improved at 1,3,6 months(BCVA:t =2.838,2.581,3.619,CMT:t =-18.404,-5.039,-11.299,P <0.05),in the low recurrence rate at 6 months after treatment of macular edema(x^2 =43.00,P <0.05):TCM group after treatment were improved trend of steady,while at 1 months after treatment the control group BCVA,CMT has repeatedly.Conclusion:Peitu Xiaoshui Decoction with intravitreal conbercept injection and laser photocoagulation treatment can effectively enhance the local therapeutic effect:can improve visual acuity,reduce macular edema,edema and delay the recurrence time can reduce the side effects of topical treatment,is expected to bring a better prognosis for patients.