芪明颗粒对非增生期糖尿病视网膜病变患者视网膜微循环状态影响的临床研究

Effect of Qiming granule on retinal vessel oxygen saturation in patients with non-proliferative diabetic retinopathy

目的探讨芪明颗粒对非增生期糖尿病视网膜病变患者视网膜微循环状态的影响。方法纳入2016年10月至2017年5月于成都中医药大学附属医院眼科确诊为非增生期糖尿病视网膜病变(DR)的16例(31只眼)患者。其中,男性12例(23只眼),女性4例(8只眼);年龄49~75岁,平均年龄(62.5±8.3)岁。观察并记录芪明颗粒治疗前、治疗后4周、治疗后8周及治疗后12周患者的视力、眼底出血面积、糖化血红蛋白(HbA1c)、视网膜血氧饱和度、视网膜血管管径、眼平均灌注压的变化情况。治疗前后患者的视力、眼底出血面积、HbAlc、视网膜血氧饱和度、视网膜血管管径及眼平均灌注压等定量数据,以均数±标准差表示。采用单因素重复测量方差分析比较患者治疗前后视力的变化情况;采用配对样本t检验比较组内治疗前后HbAlc、视网膜血氧饱和度、视网膜血管管径及眼平均灌注压的变化。结果受试者糖尿病病程1~30年,平均(13.75±9.31)年。在治疗前、治疗后4周、治疗后8周及治疗后12周患者的视力分别为(73.81±7.90)、(73.97±8.53)、(74.74±7.29)及(76.26±6.80)。经单因素重复测量方差分析,治疗前后患者视力的比较,差异无统计学意义(F=2.162,P>0.05)。治疗前患者的收缩压、舒张压、眼压及眼平均灌注压分别为(129.13±8.36)mmHg(1 mmHg=0.133 kPa)、(74.44±6.92)mmHg、(15.58±2.90)mmHg及(46.06±4.90)mmHg。治疗后12周分别为(126.94±10.11)mmHg、(70.81±8.83)mmHg、(14.54±1.84)mmHg及(45.43±4.80)mmHg。经t检验,治疗前后患者收缩压、舒张压、眼压及眼平均灌注压的比较,差异无统计学意义(t=0.797,1.383,1.853,0.538;P>0.05)。治疗前患者的HbAlc、视网膜静脉血氧饱和度平均值及视网膜动静脉血氧饱和度差值的平均值分别为(7.68±1.17)%、(63.18±7.07)%及(37.93±6.50)%。治疗后12周分别为(6.73±1.49)%、(60.16±5.21)%及(39.93±4.04)%。经t检验,治疗前后患者HbAlc、视网膜静脉血氧饱和度平均值及视网膜动静脉血氧饱和度差值平均值的比较,差异有统计学意义(t=2.611,2.482,-2.259;P<0.05)。治疗前患者的眼底出血面积和视网膜动脉血氧饱和度平均值分别为(4713.70±8082.42)像素和(101.12±6.54)%。治疗后12周分别为(3776.66±6553.91)像素和(100.09±5.95)%。经t检验,治疗前后患者眼底出血面积和视网膜动脉血氧饱和度平均值的比较,差异无统计学意义(t=1.571,1.047;P>0.05)。结论芪明颗粒可以降低非增生期糖尿病视网膜病变患者视网膜静脉血氧饱和度,增大视网膜动静脉血氧饱和度差值。

Objective The aim of this study was to explore the effect of Qiming granule on retinal microcirculation in patients with non-proliferative diabetic retinopathy(DR).Methods From October 2016 to May 2017,16 eligible patients(31 eyes)with non-proliferative DR from the Department of Ophthalmology affiliated to Hospital of Chengdu University of Traditional Chinese Medicine were investigated.Among of them,including 12 male cases(23 eyes)and 4 female cases(8 eyes)with the average age(62.5±8.3)years-old.To observe and record the changes in visual acuity,fundus hemorrhage area,glycosylated hemoglobin(Hb A1 c),retinal blood oxygen saturation and vessel diameter,and the mean ocular perfusion pressure before and after treatment for 12 weeks with Qiming granule.The Hb A1 c,fundus hemorrhage area,retinal blood oxygen saturation and vessel diameter,and the mean ocular perfusion pressure before and after treatment were expressed by mean±standard deviation.The paired t testing was used to compare within groups.Visual acuity comparison adopts single factor repeated measures analysis of variance.Results The duration of diabetes in the subjects was 1 to30 years,with an average of(13.75±9.31)years.Before and after treatment for 4,8,12 weeks,visual acuity were(73.81±7.90),(73.97±8.53),(74.74±7.29),and(76.26±6.80),respectively.After treatment for 12 weeks,visual acuity had a tendency to improve.After analysis of variance,the difference in visual acuity was not statistically significant before and after treatment(F=2.162,P>0.05).Before treatment,systolic blood pressure,diastolic blood pressure,the intraocular pressure,the mean ocular perfusion pressure were(129.13±8.36)mm Hg(1 mm Hg=0.133 k Pa),(74.44±6.92)mm Hg,(15.58±2.90)mm Hg,(46.06±4.90)mm Hg,respectively.After treatment for 12 weeks,those were(126.94±10.11)mm Hg,(70.81±8.83)mm Hg,(14.54±1.84)mm Hg,(45.43±4.80)mm Hg,respectively.After analysis of paired t testing,there were nonsignificant difference in systolic blood pressure,diastolic blood pressure,the intraocular pressure before and after the treatment(t=0.797,1.383,1.853,0.538;P>0.05).Before treatment,Hb Alc,the mean values of retinal vein blood oxygen saturation,the mean values of the difference in arterial and venous oxygen saturation were(7.68±1.17)%,(63.18±7.07)%,(37.93±6.50)%,respectively.After treatment for 12 weeks,those were(6.73±1.49)%,(60.16±5.21)%,(39.93±4.04)%,respectively.After analysis of paired t testing,there were significant difference in Hb Alc,the mean values of retinal vein blood oxygen saturation,the mean values of the difference in arterial and venous oxygen saturation before and after the treatment(t=2.611,2.482,-2.259;P<0.05).Before treatment,the fundus hemorrhage area and the mean values of retinal artery blood oxygen saturation(4713.70±8082.42)pixels,(101.12±6.54)%,respectively.After treatment for 12 weeks,those were(3776.66±6553.91)pixels,(100.09±5.95)%,respectively.After analysis of paired t testing,there were non-significant difference in the fundus hemorrhage area and the mean values of retinal artery blood oxygen saturation before and after the treatment(t=1.571,1.047;P>0.05).Conclusions Qiming granule could reduce retinal venous oxygen saturation and increase the mean values of the difference in arterial and venous oxygen saturation in patients with non-proliferative DR.