577 nm激光联合双丹明目胶囊治疗Ⅲ期糖尿病视网膜病变的疗效及对血液流变学和血清学的影响

Efficacy of Joint Application of 577 nm Laser and Shuangdan Mingmu Capsule on stage Ⅲ Diabetic Retinopathy and Its Impact on Hemorheology,Serum VEGF, PDG

目的探讨577 nm激光联合双丹明目胶囊治疗Ⅲ期糖尿病视网膜病变(diabetic retinopathy,DR)的疗效及对血液流变学和血清抗血管内皮生长因子(vascular endothelial growth factor,VEGF)、血小板来源的生长因子(platelet derived growth factor,PDGF)的影响。方法选择2020年4月至2021年12月,Ⅲ期DR患者84例122只眼,随机分为研究组患者42例60只眼、对照组患者42例62只眼。对照组应用波长577 nm激光进行光凝治疗,治疗功率150~450 W,曝光时间0.15~0.20 s,光斑直径200~300μm,光凝点数1200~1500点,激光光凝治疗共3次,每次间隔1周。研究组应用激光光凝联合双丹明目胶囊治疗。治疗前、治疗后1个月和治疗后4个月记录患者视野缺损程度,最佳矫正视力(best corrected visual acuity,BCVA),视网膜中央动脉包括峰值血流速度(peak systolic velocity,PSV)、平均血流速度(mean velocity,MV)、舒张末期血流速度(end diastolic velocity,EDV)、搏动指数(pulsatility index,PI)及阻力指数(resistance index,RI),视网膜中央静脉包括最大血流速度(_(max)imum blood flow velocity,V_(max))、最低血流速度(Minimum blood flow velocity,V_(min))及MV水平,以及血清VEGF、PDGF及治疗期间不良反应发生情况。并采用中文版低视力者生活质量量表(Chinese version of the low vision quality of life questionnaire,CLVQOL)评估患者生活质量改变。结果治疗后4个月,研究组总有效率显著高于对照组(P<0.05)。两组患者治疗后1和4个月的视野缺损程度,眼中央动脉PI、RI,眼视网膜中央静脉V_(max)、V_(min)显著低于治疗前(P<0.05);眼中央动脉MV、PSV、EDV、CLVQOL评分均显著高于治疗前(P<0.05);治疗后4个月,研究组患者视野缺损程度、PI、RI、眼中央静脉V_(_(max))、V_(_(min))、MV显著低于对照组,眼中央动脉PSV、MV、EDV、CLVQOL评分、BCVA显著高于对照组(P<0.05)。治疗后4个月,两组患者血清VEGF、PDGF水平显著低于治疗前(P<0.05),且两组间比较差异具有显著意义(P<0.05)。治疗期间两组患者的患眼无可见激光斑及外层视网膜完整性的缺失等严重不良反应发生。结论577 nm激光联合双丹明目胶囊治疗Ⅲ期DR可以改善患者视网膜血液流变学,降低血清VEGF、PDGF水平,治疗效果显著。

Objective To investigate the efficacy to treat stage Ⅲ diabetic retinopathy(DR) jointly with 577 nm laser and Shuangdan Mingmu capsule and its effects on hemorheology,serum anti-vascular endothelial growth factors(VEGF) and platelet derived growth factors(PDGF).Methods Totally 84 patients(122 eyes) with stage Ⅲ DR treated during the period from Apr.2020 to Dec.2021 were randomly divided into a study group(42 cases,60 eyes) and control group(42 cases,62 eyes).The patients in the control group were treated with 577 nm laser(power 150~450 W,exposure time 0.15-0.20 s,spot diameter 200-300 μm,photocoagulation points 1 200~1 500).The laser photocoagulation was conducted 3 times at an interval of 1 week.The patients in the study group were treated with 577 nm laser photocoagulation plus Shuangdan Mingmu capsule.The clinical efficacy,visual field defect degree,best corrected visual acuity(BCVA),Chinese version of low vision quality of life scale(CLVQOL) score,central retinal artery includes peak systolic velocity(PSV),mean velocity(MV),end diastolic velocity(EDV),pulsatility index(PI) and resistance index(BI),central retinal vein includes _(max)imum blood flow velocity(V),_(min)imum blood flow velocity(F),MV,serum VEGF and PDGF level before the treatment and 1 and 4 months after treatment,and the incidence of adverse reactions occurred during the treatment were compared between the two groups respectively.Results Four months after the treatment,the total effective rate of the study group was significantly higher than that of the control group(P<0.05).In addition,for both groups,the degree of visual field defect,PI and RI of central ophthalmic artery,Vand Vof central retinal vein decreased significantly(P<0.05),the MV,PSV,EDV and CLVQOL score of central ophthalmic artery increased significantly(P<0.05).The degree of visual field defect,PI,RI,V,Vand MV of central ophthalmic vein were significantly lower in the study group than in the control group,and the PSV,MV,EDV,CLVQOL score and BCVA of central ophthalmic artery much higher in the study group than in the control group(P<0.05).While the levels of serum VEGF and PDGF decreasing remarkably in both groups,the levels of serum VEGF and PDGF were much lower in the study group than in the control group(P<0.05).During the treatment,neither visible laser spot nor loss of outer retinal integrity occurred in both groups,and the adverse reactions occurred were relieved by themselves or safely tolerated in both groups.Conclusions The combined usage of 577 nm laser and Shuangdan Mingmu capsule will improve retinal hemorheology and reduce the levels of serum VEGF and PDGF in patients with stage Ⅲ DR,and the therapeutic effect is remarkable.