羟苯磺酸钙联合高压氧对老年非增生性糖尿病视网膜病变患者疗效及微循环状态的影响

Efficacy of Calcium Dobesilate Combined with Hyperbaric Oxygen and Its Influence on Microcirculation State in Senile Patients with Non-proliferative Diabetic Retinopathy

目的:探讨羟苯磺酸钙联合高压氧治疗对老年非增生性糖尿病视网膜病变(NPDR)的疗效及对患者血糖、血管内皮功能、血液流变学、血流动力学的影响。方法:96例NPDR患者随机分为A组和B组,每组48例。A组在糖尿病综合治疗基础上给予羟苯磺酸钙胶囊口服,B组在A组基础上加用高压氧治疗。治疗3个月后评价两组临床疗效。比较治疗前后两组患者的视野灰度值、微血管瘤体积、出血斑面积、黄斑厚度、空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(Hb A1c)、内皮素-1(ET-1)、血管内皮生长因子(VEGF)、胰岛素样生长因子(IGF-1)、全血高切黏度、全血低切黏度、血浆黏度、血小板聚集率、纤维蛋白原水平及视网膜中央动脉的峰值血流速度(PSV)、舒张末期血流速度(EDV)及阻力指数(RI)等指标变化情况。记录两组药品不良反应发生情况。结果:B组治疗后总有效率为89. 2%,明显高于A组的65. 9%(P <0. 05)。治疗后两组患者的各项指标均较治疗前明显改善(P <0. 05),且B组患者各项指标均优于A组(P <0. 05)。两组药品不良反应发生率比较,差异无统计学意义(P> 0. 05)。结论:羟苯磺酸钙联合高压氧治疗可有效纠正老年NPDR患者的高血糖、血管内皮功能、血液流变学、血流动力学,同时可有效改善其视网膜病变情况,其疗效优于羟苯磺酸钙单用。

Objective：To investigate the efficacy of calcium dobesilate combined with hyperbaric oxygen and its influence on blood glucose,vascular endothelial function,hemorheology,hemodynamics in senile patients with non-proliferative diabetic retinopathy（ NPDR）. Methods：96 cases of senile patients with NPDR were divided randomly into control group（ with calcium dobesilate,n = 48） and combination group（ with calcium dobesilate ＋ hyperbaric oxygen,n = 48）.The clinical efficacy was determined by retinal hemorrhage,retinal exudation,microangioma reduction,visual field and vision improvement. Vision grayscale value,the volume of micro hemangioma,hemorrhagic spot area,macular thickness,fasting plasma glucose（ FPG）,2 h postprandial blood glucose（2 hPG）,glycosylated hemoglobin（ Hb A1 c）,endothelin-1（ET-1）,vascular endothelial growth factor（VEGF）,insulin-like growth factor-1（IGF-1）,whole blood high shear viscosity,whole blood low shear viscosity,plasma viscosity,platelet aggregation rate,fibrinogen and peak systolic velocity（PSV）,end diastolic velocity（EDV） and resistance index（RI） of the central retinal artery were observed in the two groups. Adverse reactions of both groups were recorded during treatment. Results：The total effective rate（89. 2%） of the combined group was significantly higher than that of the control group（65. 9%）. Compared with those before treatment,all indexes of patients were siginificantly improved after treatment（ P 〈 0. 05）,and all indexes of patients in group B were superior to those in goup A（ P 〈 0. 05）. There was no statistically significant difference in the incidence of adverse reactions between the two groups（ P 〉 0. 05）. Conclusion：Calcium dobesilate combined with hyperbaric oxygen could effectively correct hyperglycemia,vascular endothelial function,hemorheology,hemodynamics,and improve retinopathy in senile patients with NPDR,its curative effect was superior to calcium dobesilate monotherapies.