八珍汤合五苓散加减联合雷珠单抗对增殖期糖尿病性视网膜病变玻璃体切割术后患者自觉症状及视网膜功能恢复的影响

Influence of Addition and Subtraction of Bazhen Decoction and Five Drugs with Poria Combined with Leizhumab on Conscious Symptoms and Retinal Function Recovery in Patients with Proliferative Diabetic Retinopathy after Vitrectomy

目的观察八珍汤合五苓散加减联合雷珠单抗对增殖期糖尿病性视网膜病变玻璃体切割术后患者自觉症状及视网膜功能恢复的影响。方法将符合入选标准的84例增殖期糖尿病性视网膜病变玻璃体切割术后患者按随机数字表法分为两组,每组42例。对照组于术前给予雷珠单抗治疗,观察组在对照组基础上给予八珍汤合五苓散加减治疗。两组治疗12周后,比较记录两组治疗前后自觉症状(眼睛干涩感、眼睛异物感、眼睛烧灼感、眼睑肿胀)、眼最佳矫正视力(best corrected visual acuity, BCVA)、黄斑中心凹视网膜厚度(central macular thickness, CMT)及治疗期间并发症发生状况,比较两组患者的临床疗效。结果观察组总有效率为90.8%(69/76),明显高于对照组总有效率70.3%(52/74)(χ^(2)=10.122,P=0.001);治疗后,观察组眼睛干涩感、眼睛异物感、眼睛烧灼感及眼睑肿胀积分均低于对照组(t值分别为4.273、3.895、4.388、4.153,P值均<0.05);与同组治疗前比较,两组治疗不同时间点的logMAR BCVA均呈降低趋势(P<0.05),观察组治疗不同时间点的logMAR BCVA均低于同期对照组(P<0.05);两组治疗不同时间点的CMT均呈降低趋势(P<0.05),观察组治疗不同时间点的CMT均低于同期对照组(P<0.05);两组均未出现眼压升高、继发性青光眼、感染性眼内炎等严重的眼局部并发症。结论八珍汤合五苓散加减联合雷珠单抗能够有效降低增殖期糖尿病性视网膜病变玻璃体切割术后患者黄斑中心凹视网膜厚度,有助于缓解患者自觉症状,提高患者视力,促进视网膜功能的恢复。

Objective To observe the influence of addition and subtraction of Bazhen decoction and five drugs with Poria on the recovery of conscious symptoms and retinal function in patients with proliferative diabetic retinopathy after vitrectomy. Methods 84 patients with proliferative diabetic retinopathy after vitrectomy were randomly divided into two groups, with 42 in each group. The control group was treated with Leizhumab before operation, while the observation group was treated with addition and subtraction of Bazhen decoction and five drugs with Poria on the basis of the control group. After treatment for 12 weeks, the conscious symptoms(dry and astringent eyes, foreign body sensation, burning eyes, eyelid swelling), best corrected visual acuity(BCVA), central macular foveal retinal thickness(CMT) and adverse reactions were recorded before and after treatment, and complications during treatment of the two groups were compared. Results The total effective rate of the observation group was 90.8%(69/76), which was significantly higher than that of the control group 70.3%(52/74)(χ^(2)=10.122,P=0.001);After treatment, the scores of dry and astringent sensation, foreign body sensation, burning sensation and eyelid swelling in the observation group were lower than those in the control group(t values were 4.273, 3.895, 4.388, 4.153, P<0.05, respectively). Compared with the same group before treatment, the index of logMAR BCVA in the two groups at different time points decreased(P<0.05), and the index of logMAR BCVA in the observation group at different time points was lower than that of control group at the same time(P<0.05);The index of CMT in the two groups at different time points decreased(P<0.05), and index of CMT in the observation group at different time points was lower than that of control group at the same time(P<0.05). No severe ocular complications such as elevated intraocular pressure, secondary glaucoma and infective endophthalmitis were found in both groups. Conclusions Addition and subtraction of Bazhen decoction and five drugs can effectively reduce the macular fovea retinal thickness in patients with proliferative diabetic retinopathy after vitrectomy, which is helpful to alleviate the conscious symptoms, improve the visual acuity of patients, and promote the recovery of retinal function.