芪明颗粒联合眼内抗血管内皮生长因子注射治疗糖尿病黄斑水肿临床疗效观察

Clinical Observation on Intravitreal Injection of Anti-VEGF Combined With Qiming Granule in Treatment of Diabetic Macular Edema

目的回顾比较经芪明颗粒联合抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗糖尿病黄斑水肿患者的黄斑区厚度、最佳矫正视力以及糖化血红蛋白等指标,评估芪明颗粒联合抗VEGF治疗糖尿病黄斑水肿(diabetic macular edema,DME)的持续性效果,并明确糖化血红蛋白与黄斑水肿发生、发展的关系。方法回顾性分析2018年1月-2019年4月就诊于我院眼科诊断为糖尿病黄斑水肿的患者25例(28只眼),16眼单纯抗VEGF球内注药同时联合芪明颗粒口服治疗为联合治疗组,12眼行单纯抗VEGF球内注射为单纯治疗组。两组患者均采用"1+PRN"方案进行眼内注射治疗。以治疗后黄斑厚度<300μm作为治疗有效起始记录点,观察两组患者再次发生黄斑水肿的时间,黄斑厚度变化情况,视力改变及血红蛋白情况等。结果联合治疗组发生黄斑水肿复发的平均时间明显长于单纯治疗组,两组复发时间的差异具有统计学意义,P<0.05。联合治疗组在复发时黄斑厚度与单纯治疗组黄斑水肿复发时黄斑厚度比较差异有统计学意义,P<0.05。在比较复发时两组的最佳矫正视力,两组的差异有统计学意义,P<0.05。黄斑水肿复发时联合治疗组糖化血红蛋白(hemoglobin A1c,HbA1c)为(6.26±0.34)%,单纯治疗组糖化血红蛋白为(7.41±0.43)%,两组比较差异有统计学意义,P<0.05。复发患者糖化血红蛋白平均值为(6.988±0.297)%,未复发患者糖化血红蛋白平均值为(5.350±0.499)%,两组差异有统计学意义,P<0.05。结论眼内注射抗VEGF药物确实对DME有明确的治疗作用,在抗VEGF治疗的同时口服芪明颗粒对延缓DME复发及降低黄斑水肿病变程度有一定的作用。糖化血红蛋白的水平与糖尿病黄斑水肿的产生和复发有密切关系,可能对评估DME的预后及预防复发起指导作用。

Objective To observe clinical efficacy of intravitreal injection of anti-VEGF combined with Qiming Granule in the treatment of diabetic macular edema.Methods 25 DME patients(28 eyes)in our hospital from January 2018 to April 2019 were reviewed as the retrospective analysis study subjects,they were divided into the combined group(16 eyes)and the simple group(12 eyes).The combined group received anti-VEGF intravitreal injection combined with Qiming Granule oral intervention.The simple group received simple anti-VEGF intravitreal injection intervention.All patients followed the plan of"1+PRN".Afer the treatment,the CMT<300μm was signed as the base line,then to record the time of the recurrence of DME,and also the CMT,BCVA and HbA1c.Results The interval of the recurrent diabetic macular edema is significant longer in the combined group than in the simple group(P<0.05).Significant difference was found between the combine group and the simple group in BCVA,CMT and HbA1c(P<0.05)at the point of the recurrent diabetic macular edema.The mean value of HbA1c in recurrent patients was(6.988±0.297)%,and the mean value of HbA1c in no-recurrent patients was(5.350±0.499)%,the difference was significantly.Conclusion Intravitreal injection of anti-VEGF remarkably ameliorate the macular edema.If combined with Qiming Granule in treatment,it can effectively relieve macular edema and the interval of the recurrent diabetic macular edema was certain put off.The HbA1c level was closely related to the occurrence and recurrence of diabetic macular edema.