知柏地黄汤联合人工泪液治疗阴虚燥热型糖尿病相关干眼症临床研究

Clinical Study on Zhibai Dihuang Tang Combined with Artificial Tears for Dry Eyes Induced by Diabetes Mellitus of Yin Deficiency and Dryness-Heat Type

目的:观察知柏地黄汤联合人工泪液治疗阴虚燥热型糖尿病相关干眼症的临床疗效及可能作用机制。方法:选取阴虚燥热型糖尿病相关干眼症患者60例,按随机数字表法分为对照组和观察组各30例。对照组局部予以玻璃酸钠滴眼液治疗,观察组在对照组基础上给予知柏地黄汤治疗。比较2组治疗前后干眼问卷调查表主观评分及泪河高度、泪膜破裂时间、泪液分泌量,检测治疗前后泪液肿瘤坏死因子-α(TNF-α)、白细胞介素-1α(IL-1α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)的水平。结果:治疗前,2组主观症状评分比较,差异无统计学意义(P>0.05)。治疗后,2组干燥感、烧灼感、疲劳感主观症状评分较治疗前降低,观察组干燥感、烧灼感主观症状评分低于对照组,差异有统计学意义(P<0.05)。治疗前,2组泪河高度、泪膜破裂时间和泪液分泌量比较,差异无统计学意义(P>0.05)。治疗后,观察组泪膜破裂时间较治疗前升高,且高于对照组,差异有统计学意义(P<0.05)。治疗前,2组泪液炎症因子水平比较,差异无统计学意义(P>0.05)。治疗后,观察组泪液中TNF-α、IL-1α、IL-6、IL-8水平较治疗前降低,且观察组TNF-α、IL-1α、IL-6水平低于对照组,差异有统计学意义(P<0.05)。结论:知柏地黄汤联合人工泪液治疗阴虚燥热型糖尿病相关干眼症较单纯局部人工泪液能更有效改善患者干眼症状,其机制可能与减少泪液炎症因子表达有关。

Objective:To observe the clinical effect of Zhibai Dihuang tang combined with artificial tears for dry eyes induced by diabetes mellitus of yin deficiency and dryness-heat type and its possible mechanism.Methods:A total of60 cases of patients with dry eyes induced by diabetes mellitus of yin deficiency and dryness-heat type were selected and divided into the control group and the observation group according to the random number table method,30 cases in each group.The control group was given sodium hyaluronate eye drops,and the observation group was additionally given Zhibai Dihuang tang based on the treatment of the control group.Before and after treatment,the score of subjective symptoms in dry eye questionnaire,the height of lacrimal river,tear break-up time,and tear secretion volume were compared between thetwogroups.Thelevelsoftumornecrosisfactor-α(TNF-α),interleukin-1α(IL-1α),interleukin-6(IL-6),and interleukin-8(IL-8)in tear were detected before and after treatment.Results:Before treatment,there was no significant difference being found in the comparison of the score of subjective symptoms between the two groups(P>0.05).After treatment,the scores of subjective symptoms including dry sensation,burning sensation,and fatigue in the two groups were decreased when compared with those before treatment,and the scores of dry sensation and burning sensation in the observation group were lower than those in the control group,the difference being significant(P<0.05).Before treatment,when compared the height of lacrimal river,tear break-up time,and tear secretion volume between the two groups,there was no significance in the difference(P>0.05).After treatment,tear break-up time in the observation group was prolonged when compared with that before treatment,and higher than that in the control group,the difference being significant(P<0.05).Before treatment,there was no significant difference being found in the comparison of the levels of inflammatory factors in tear between the two groups(P>0.05).After treatment,the levels of TNF-α,IL-1α,IL-6,and IL-8 in tear in the observation group were decreased when compared with those before treatment,and the levels of TNF-α,IL-1α,and IL-6 in the observation group were lower than those in the control group,the difference being significant(P<0.05).Conclusion:In the treatment of dry eyes induced by diabetes mellitus of yin deficiency and dryness-heat type,the therapy of Zhibai Dihuang tang combined with artificial tears can more effectively improve symptoms of dry eyes than simple artificial tears,which is possibly related to the decrease of the expression of inflammatory factors in tear.