23G PPV联合通脉糖眼明胶囊对PDR患者疗效及血清胰岛素相关因子的影响

Curative effect of 23G PPV combined with Tongmai Tangyanming Capsule on curative effect and serum insulin related factors in patients with PDR

目的:探究23G玻璃体切割术(PPV)后口服通脉糖眼明胶囊对增生性糖尿病视网膜病变(PDR)患者的临床疗效。方法:前瞻性随机对照研究。选取2018-02/2019-10我院收治的PDR患者98例109眼,随机分为对照组49例54眼仅行23G PPV术,观察组49例55眼23G PPV术后口服通脉糖眼明胶囊治疗,每次750mg,3次/天,疗程12wk。记录两组患者术前、术后12wk最佳矫正视力(BCVA)、眼压、视野敏感度、黄斑中心凹厚度(CMT),测定血清胰岛素样生长因子-1(IGF-1)、血管内皮生长因子(VEGF)的变化,计算胰岛素抵抗指数(HOMA-IR);随访12wk观察手术并发症及复发率。结果:术后12wk,两组患者BCVA(LogMAR)、视野敏感度较术前改善(P<0.001),CMT下降(P<0.001),眼压无变化(P>0.05);观察组术后12wk BCVA、视野敏感度优于对照组(P<0.05),CMT低于对照组(P<0.05);术后12wk,两组患者血清IGF-1、VEGF、HOMA-IR均较术前降低(P<0.001),且观察组均低于对照组(P<0.001);两组并发症及复发率无差异(P>0.05)。结论:23G PPV术后口服通脉糖眼明胶囊较单独手术治疗更能促进术后视力恢复,提升视野敏感度,减轻胰岛素抵抗,降低IGF-1及VEGF水平,抑制视网膜新生血管生成及增殖,降低复发。

AIM:To explore the clinical value of oral administration of Tongmai Tangyanming Capsule after 23-gauge(23G)pars plana vitrectomy(PPV)in patients with proliferative diabetic retinopathy(PDR).METHODS:This prospective study included 98 patients(109 eyes)with PDR admitted to the hospital between February 2018 and October 2019.The patients were randomly divided into control group(49 cases,54 eyes,23G PPV)and observation group(49 cases,55 eyes,oral administration of Tongmai Tangyanming Capsule,750 mg/time,3 times/d,for 12wk).The best corrected visual acuity(BCVA),intraocular pressure,visual field sensitivity and central macular thickness(CMT)were measured before and 12wk after surgery.Changes in insulin-like growth factor-1(IGF-1)and vascular endothelial growth factor(VEGF)were determined,and insulin resistance index(HOMA-IR)was calculated.The surgical complications and recurrence rate during 12wk of follow-up were observed.RESULTS:At 12wk after surgery,the BCVA(LogMAR)and visual field sensitivity of the two groups were improved(P<0.001),and CMT was decreased(P<0.001),but there was no significant change in intraocular pressure(P>0.05).Meanwhile,the BCVA and visual field sensitivity of the observation group were higher than those of the control group(P<0.05),and CMT was smaller than that of the control group(P<0.05).At 12wk after surgery,serum IGF-1,VEGF and HOMA-IR were decreased in the two groups(P<0.001),and these indicators in the observation group were lower than those in the control group(P<0.001).The incidence of complications and recurrence rate were similar in the two groups(P>0.05).CONCLUSION:Oral administration of Tongmai Tangyanming Capsule after 23G PPV can better promote postoperative visual recovery,improve visual sensitivity,reduce insulin resistance and lower the levels of IGF-1 and VEGF,inhibit retinal neovascularization and proliferation,and reduce the risk of recurrence.