羟苯磺酸钙对糖尿病视网膜病变合并白内障患者眼底微循环的影响

Effect of calcium dobesilate on fundus microcirculation in patients with diabetic retinopathy and cataract

目的:研究羟苯磺酸钙与降糖药联用对伴有视网膜病变的糖尿病性白内障患者眼底微循环及血清低氧诱导因子-1α(hypoxia inducible factor-1α,HIF-1α)、血管内皮生长因子(vascular endothelial growth factor,VEGF)的影响。方法:选取我院2013-01/2015-12眼科住院的伴有视网膜病变的2型糖尿病性白内障患者98例126眼为研究对象,随机分为治疗组(49例64眼)和对照组(49例62眼);对照组患者给予口服阿卡波糖片和二甲双胍治疗,治疗组患者在对照组基础上再口服羟苯磺酸钙胶囊;比较两组患者12mo后的临床疗效,血糖控制效果、血清HIF-1α、VEGF检测,以及眼部功能。结果:治疗12mo后,治疗组和对照组的总有效率分别为87.5%、61.3%,差异有统计学意义(P<0.05),治疗组患者的视力显著高于对照组,差异有统计学意义(P<0.05)。治疗后1、12mo两组患者的血糖均较治疗前显著降低,但组间差异均无统计学意义(P>0.05)。治疗1mo后,治疗组患者的血浆黏度、红细胞聚集指数、红细胞变形指数、血沉、红细胞压积显著低于对照组,差异有统计学意义(P<0.05);治疗组患者的视网膜睫状后短动脉和中央动脉的PSV、EDV均显著高于对照组,差异有统计学意义(P<0.05),RI显著低于对照组,差异有统计学意义(P<0.05)。治疗12mo后,两组患者的HIF-1α和VEGF显著降低,差异有统计学意义(P<0.05),治疗组和对照组的HIF-1α水平分别为35.90±11.36、46.75±12.08mmol/L,VEGF水平分别为89.72±13.61、110.30±16.74mmol/L,治疗组的HIF-1α和VEGF均显著低于对照组,差异有统计学意义(P<0.05)。结论:羟苯磺酸钙与降糖药联用治疗伴有视网膜病变的糖尿病性白内障患者,能够有效控制血糖,提高临床疗效,改善眼底微循环,缓解病情进展,下调HIF-1α和VEGF水平,抑制血管增生。

AIM:To analyze the effect of calcium dobesilate combined with hypoglycemics for patients with diabetic retinopathy(DR)and cataract,and the influence on microcirculation of eye fundus,hypoxia inducible factor-1α(HIF-1α),vascular endothelial growth factor(VEGF)level.METHODS:Totally 98 DR patients with cataract(126 eyes)from January 2013 to December 2015 in our hospital were selected as the research objects,and were divided into two groups randomly(treatment group:64 eyes in 49 patients,control group:62 eyes in 49 patients).The control group was treated with acarbose tablet and metformin,while treatment group was treated with calcium dobesilate additionally.The clinical effect,the glycemic control effect,serum HIF-1αand VEGF level,eye function and fundus microcirculation of two groups after 12mo were compared.RESULTS:After 12mo,the total effective rates of two groups were 87.5%,61.3%respectively,which indicated significantly difference(P<0.05);the vision of treatment group was significantly higher than that of control group(P<0.05).Two groups'blood glucose level decreased significantly,and no significant difference between two groups(P>0.05).After 1-month treatment,the plasma viscosity,erythrocyte aggregation index,erythrocyte deformability index,erythrocyte sedimentation rate and hematocrit in the treatment group were significantly lower than those in the control group(P<0.05).The PSV and EDV of the posterior ciliary artery and central artery in the treatment group were significantly higher than those in the control group(P<0.05),and RI was significantly lower than that in the control group(P<0.05).After 12-month treatment,the HIF-1αlevel of two groups were 35.90±11.36mmol/L,46.75±12.08mmol/L respectively;the VEGF of two groups level were 89.72±13.61mmol/L,110.30±16.74mmol/L,respectively,the treatment group's HIF-1αlevel and VEGF were significantly lower than control group(P<0.05),and both decreased significantly after treatment(P<0.05).CONCLUSION:Calcium dobesilate combined with hypoglycemics can effectively increase the clinical effect in the treatment of retinopathy diabetic cataract,effectively control blood glucose,improve microcirculation of eye fundus,decrease HIF-1α,VEGF level,inhibit angiogenesis.