明目地黄丸联合甲钴胺治疗糖尿病视网膜病变的临床研究

Clinical study on Mingmu Dihuang Pills combined with mecobalamin in treatment of diabetic retinopathy

目的研究明目地黄丸联合甲钴胺片治疗糖尿病视网膜病变的临床疗效。方法选取2018年2月-2019年3月绵阳市第三人民医院收治的80例糖尿病视网膜病变患者作为研究对象,所有患者随机分为对照组和治疗组,每组各40例。对照组患者口服甲钴胺片,1片/次,3次/d。治疗组患者在对照组治疗基础上口服明目地黄丸,3丸/次,2次/d。两组患者连续治疗6个月。观察两组的临床疗效,比较两组的视网膜指标、血清炎性因子水平、氧化应激指标、血管新生因子水平。结果治疗后,对照组和治疗组的总有效率分别为67.50%、87.50%,两组比较差异有统计学意义(P<0.05)。治疗后,两组患者视野灰度值、黄斑厚度、出血斑面积和血管瘤体积均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组患者视野灰度值、黄斑厚度、出血斑面积和血管瘤体积显著低于对照组,两组比较差异有统计学意义(P<0.05)。治疗后,两组患者的肿瘤坏死因子-α(TNF-α)、细胞间黏附分子-1(ICAM-1)、白细胞介素-1β(IL-1β)水平均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组患者的TNF-α、ICAM-1和IL-1β水平显著低于对照组,两组比较差异有统计学意义(P<0.05)。治疗后,两组患者丙二醛(MDA)水平显著降低,而超氧化物歧化酶(SOD)、一氧化氮(NO)水平均显著升高,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组患者MDA、SOD和NO水平优于对照组,两组比较差异有统计学意义(P<0.05)。治疗后,两组患者血管内皮生长因子(VEGF)、胰岛素样生长因子(IGF-1)、骨膜蛋白(periostin)水平显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组患者VEGF、IGF-1和periostin水平显著低于对照组,两组比较差异有统计学意义(P<0.05)。结论明目地黄丸联合甲钴胺片治疗糖尿病视网膜病变具有较好的临床疗效,可改善的炎症和氧化应激状态,抑制血管新生,改善视网膜病变,具有一定的临床推广应用价值。

Objective To study the clinical efficacy of Mingmu Dihuang Pills combined with Mecobalamin Tablets in treatment of diabetic retinopathy. Methods Patients(80 cases) with diabetic retinopathy in the Third Hospital of Mianyang from February 2018 to March 2019 were randomly divided into control and treatment groups, and each group had 40 cases. Patients in the control group were po administered with Mecobalamin Tablets, 1 tablet/time, three times daily. Patients in the treatment group were po administered with Mingmu Dihuang Pills on the basis of the control group, 3 pills/time, twice daily. Patients in two groups were treated for 6 months. After treatment, the clinical efficacies were evaluated, and retinal indexes, serum levels of inflammatory factors, oxidative stress, and the levels of angiogenesis factors in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 67.50% and 87.50%, respectively, and there was difference between two groups(P < 0.05). After treatment, visual field gray value, macular thickness, bleeding spot area, and volume of hemangioma in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the retinal indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). After treatment, the levels of TNF-α, ICAM-1 and IL-1β in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the serum levels of inflammatory factors in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). After treatment, the levels of MDA in two groups were significantly decreased, but the levels of SOD and NO in two groups were significantly increased, and the difference was statistically significant in the same group(P < 0.05). And the oxidative stress indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups(P < 0.05). After treatment, the levels of VEGF, IGF-1, and periostin in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the levels of angiogenesis factors in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). Conclusion Mingmu Dihuang Pills combined with Mecobalamin Tablets has clinical curative effect in treatment of diabetic retinopathy, can improve inflammation and oxidative stress, inhibit angiogenesis, and improve retinopathy, which has a certain clinical application value.