中药汤剂口服联合玻璃体内注射曲安奈德对非增生性糖尿病视网膜病变黄斑水肿患者血清及玻璃体液IL-6、VEGF表达的影响

Effects of Oral Traditional Chinense Medicine Decoction Combined with Intravitreal Injection of Triamcinolone Acetonide on the Expression of IL-6 and VEGF in Serum and Vitreous Humor in Patients with Non-proliferative Diabetic Retinopathy and Macular Edema

目的观察益气养阴活血利水中药汤剂对非增生性糖尿病视网膜病变黄斑水肿(diabetic macular edema, DME)患者血清和玻璃体液中白细胞介素-6(interleukin-6,IL-6)、血管内皮生长因子(vascular endothelial growth factor,VEGF)质量浓度和临床疗效的影响,从而探索其治疗的分子机制。方法将60例(71眼)非增生性糖尿病视网膜病变黄斑水肿患者随机分为治疗组(30例,36眼)和对照组(30例,35眼)。两组均予以玻璃体内注射曲安奈德(triamcinolone acetonide,TA),每月注射1次,共注射3次,治疗组同时予以益气养阴活血利水中药口服,服用2个月。观察比较两组患者治疗前和治疗后1、2个月血清和玻璃体液中IL-6、VEGF质量浓度差异,观察比较两组患者治疗前和治疗后1、2、5个月视力、视网膜厚度、黄斑区渗漏及治疗随访期间并发症发生情况。结果治疗组在治疗1、2个月后血清、玻璃体液中IL-6、VEGF质量浓度均低于对照组(P<0.05或P<0.01)。治疗组患者患眼在治疗后第1、2、5个月视力、视网膜厚度情况均优于对照组(P<0.05或P<0.01)。在治疗后第2、5个月治疗组黄斑荧光素渗漏情况少于对照组(P<0.05或P<0.01)。治疗及随访期间,并发症发生情况治疗组眼压升高眼数少于对照组(P<0.05)。结论益气养阴活血利水中药口服联合玻璃体内注射TA通过降低非增生性糖尿病视网膜病变DME患者血清及玻璃体中IL-6、VEGF质量浓度,抑制视网膜毛细血管炎症反应,减少血管活性介质的释放,从而减轻黄斑区水肿和渗漏,提高患者的视功能,而且并发症少,值得在临床中推广应用。

Objective To observe the effects of traditional Chinense medicine(TCM)decoction for benefiting Qi,nourishing Yin,activating blood,and promoting diuresis on the mass concentrations of interleukin-6(IL-6)and vascular endothelial growth factor(VEGF)in serum and vitreous humor and clinical outcome in patients with non-proliferative diabetic retinopathy(NPDR and diabetic macular edema(DME),and to explore the molecular mechanism of the treatment.Methods A total of 60 patients(71 eyes)with NPDR and DME were randomly divided into treatment group(30 cases,36 eyes)and control group(30 cases,35 eyes).Both groups were given intravitreal injection of triamcinolone acetonide(TA)once per month,3 times in total.In addition,the treatment group received oral TCM decoction for benefiting Qi,nourishing Yin,activating blood,and promoting diuresis for 2 months.The mass concentrations of IL-6 and VEGF in serum and vitreous humor before and at 1 and 2 months after treatment were compared between the two groups;the visual acuity,retinal thickness,and macular leakage before and at 1,2,and 5 months after treatment,as well as the incidence of complications during the treatment and follow-up,were also compared between the two groups.Results At 1 and 2 months after treatment,the treatment group had significantly lower mass concentrations of IL-6 and VEGF in serum and vitreous humor than the control group(P<0.05 or P<0.01).At 1,2,and 5 months after treatment,the treatment group had significantly superior visual acuity and retinal thickness to the control group(P<0.05 or P<0.01);at 2 and 5 months after treatment,the treatment group had significantly less macular fluorescein leakage than the control group(P<0.05 or P<0.01).During the treatment and follow-up,the treatment group had a significantly lower number of eyes with ocular hypertension than the control group(P<0.05).Conclusion For patients with NPDR and DME,oral TCM decoction for benefiting Qi,nourishing Yin,activating blood,and promoting diuresis combined with intravitreal injection of TA can reduce the mass concentrations of IL-6 and VEGF in serum and vitreous humor,inhibit retinal capillary inflammation,and decrease the release of vascular active medium,thereby reducing macular edema and leakage and improving the visual acuity of patients.Moreover,it has few complications and holds promise for clinical application.