黄斑格栅激光光凝联合芪明颗粒治疗糖尿病性黄斑水肿的疗效

Clinical efficacy of macular grid photocoagulation combined with Qiming granule in the treatment of diabetic macular edema

目的:观察黄斑格栅激光光凝联合口服芪明颗粒治疗糖尿病性黄斑水肿的临床疗效和安全性。方法:本研究为前瞻性非盲随机对照研究。筛选糖尿病性黄斑水肿患者共56例56眼,随机分为联合治疗组(28例28眼)和激光治疗组(28例28眼)。两组均行黄斑格栅激光光凝治疗,联合治疗组在激光治疗的同时口服芪明颗粒6个月。观察两组治疗前后的最佳矫正视力、黄斑中央视网膜厚度(macular center thickness,CMT)、眼底微血管瘤数量、渗出程度等情况,同时记录治疗过程中患者出现的不良反应。结果:治疗后6个月,联合治疗组患者全血黏度、血浆黏度、红细胞聚集指数和纤维蛋白原较治疗前和激光治疗组显著降低,差异具有统计学意义(均P<0.05);联合治疗组在治疗后第1,3个月时的视力较基线均有所提高,差异具有统计学意义(均P<0.05);联合治疗组在治疗后第1,3和6个月时的视力均优于激光治疗组,差异均有统计学意义(均P<0.05)。联合治疗组在治疗后第1,3,6个月时的CMT较基线均显著下降,差异具有统计学意义(均P<0.05);激光治疗组在治疗后第1和3个月时CMT较基线显著降低,差异具有统计学意义(均P<0.05);在治疗后第3和6个月,联合治疗组的CMT低于激光治疗组,两组差异有统计学意义(均P<0.05)。联合治疗组显效及有效的患者共23例(82.1%),显著高于激光治疗组的14例(50%),差异具有统计学意义(P<0.05)。治疗期间联合治疗组有1例(3.57%)出现了胃肠道反应,症状轻微可耐受,1周后自行缓解。结论:应用黄斑格栅样激光光凝联合口服芪明颗粒治疗糖尿病性黄斑水肿,可以更有效地减轻黄斑水肿,改善患者视力,值得在临床中推广应用。

Objective:To observe the clinical efficacy and safety of macular grid photocoagulation combined with Qiming granule in the treatment of diabetic macular edema.Methods:In this prospective,non-blind,randomized controlled study,56 cases of diabetic macular edema were screened and randomly divided into two groups:28 cases in the combined treatment group and 28 cases in the laser treatment group.All patients were treated with macular grid photocoagulation,and patients in the combined treatment group orally took Qiming granule for 6 months while the laser treatment was carried out.The best corrected visual acuity,macular center thickness(CMT),the number of fundus microaneurysm and the degree of exudation before and after treatment were observed,adverse reactions during the treatment were recorded.Results:Six months after the treatment,the blood viscosity,plasma viscosity,erythrocyte index and fibrinogen in the combined treatment group were significantly lower than those in the pre-treatment group and the laser treatment group(all P<0.05),the visual acuity in the combined treatment group at the first and third months after treatment was significantly higher than that at the baseline level(all P<0.05).The visual acuity in the combined treatment group at the first,third and sixth months after treatment was better than those in the laser treatment group(all P<0.05).The CMT in the combined treatment group at the first,third and sixth months after treatment decreased significantly than the baseline level(all P<0.05),the CMT of the laser treatment group decreased significantly from the baseline at the first and third months after treatment(all P<0.05).The CMT in the combined treatment group was lower than that in the laser treatment group at the third and sixth months after treatment(P<0.05).A total of 23 patients with obtained significant clinical efficacy in the combined treatment group(82.1%),significantly higher than 14 cases(50%)in the laser treatment group(P<0.05).During the treatment period,one case(3.57%)in the combined treatment group had gastrointestinal reaction,and the symptoms were relieved spontaneously after 1 week.Conclusion:The application of macular grid laser photocoagulation combined with Qiming granule in the treatment of diabetic macular edema can mitigate macular edema more effectively and improve the visual acuity,which is worthy of application in clinical practice.