鳖甲软脉汤治疗中期糖尿病视网膜病变疗效观察

Observation on the curative effect of Biejia Ruanmai decoction on middle-stage diabetic retinopathy

目的观察鳖甲软脉汤治疗中期糖尿病性视网膜病变(DR)的疗效及对视觉功能、黄斑形态、炎症细胞因子的影响。方法选择2020年10月—2021年12月在上海中医药大学附属龙华医院医院眼科门诊及病房治疗的95例中期DR患者,排除脱落病例15例,共纳入80例。随机将患者分为2组各40例,对照组采用羟苯磺酸钙胶囊治疗,观察组在对照组治疗基础上加用自拟鳖甲软脉汤治疗,2组均治疗3个月。比较2组患者治疗前后最佳矫正视力(BCVA)、黄斑中央厚度、黄斑中心旁水肿程度及血白细胞介素-1β(IL-1β)、白细胞介素-23(IL-23)、肿瘤坏死因子-α(TNF-α)水平,统计2组治疗效果。结果治疗后2组BCVA均较治疗前明显提高,黄斑中心凹厚度较治疗前明显缩小,黄斑中心旁水肿程度较治疗前明显减轻,差异均有统计学意义(P均<0.05),且观察组各指标改善程度均明显优于对照组(P均<0.05);治疗后2组血清IL-1β、IL-23、TNF-α水平均明显降低(P均<0.05),且观察组均明显低于对照组(P均<0.05)。观察组和对照组总有效率分别为92.5%(37/40)和75.0%(30/40),观察组显著高于对照组(P<0.05)。结论鳖甲软脉汤治疗中期DR可明显改善视力及黄斑形态,并可降低炎症细胞因子水平,减轻炎症反应,提高临床疗效。

Objective It is to observe the curative effect of Biejia Ruanmai decoction in the treatment of middle-stage diabetic retinopathy(DR)and its effects on visual function,macular morphology and inflammatory cytokines.Methods A total of 95 middle-stage DR patients treated in the ophthalmology clinic and ward of Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from October 2020 to December 2021 were selected,in which 15 cases were excluded,and finally 80 cases were included.The patients were randomly divided into 2 groups with 40 cases in each group.The control group was treated with calcium dobesilate capsules,and the observation group was treated with self-made Biejia Ruanmai decoction on the basis of the treatment of the control group.Both groups were treated for 3 months.The best corrected visual acuity(BCVA),central macular thickness,the degree of paracentre macular edema,and the levels of serum interleukin-1β(IL-1β),interleukin-23(IL-23)and tumor necrosis factor-α(TNF-α)before and after treatment were compared between the two groups,and the treatment effect of the two groups were evaluated.Results After treatment,the BCVA of the two groups was significantly improved,central macular thickness was significantly reduced,and the the degree of paracentre macular edema was significantly reduced compared with those before treatment,and the differences were statistically significant(all P<0.05),and the improvement of each index in the observation group was significantly better than that in the control group(P<0.05).After treatment,the levels of serum IL-1β,IL-23 and TNF-αin the two groups were significantly decreased(all P<0.05),and the observation group was significantly lower than the control group(P<0.05).The total effective rates of the observation group and the control group were 92.5%(37/40)and 75.0%(30/40),respectively,and the observation group was significantly higher than the control group(P<0.05).Conclusion Biejia Ruanmai decoction can significantly improve the visual acuity and macular shape,reduce the level of inflammatory cytokines,relieve the inflammatory response,and improve the clinical efficacy in the treatment of middle-stage DR.