沙格列汀联合羟苯磺酸钙对非增生性糖尿病视网膜病变的疗效及对患者视网膜血流动力学和血清AGE-P、NADPH水平的影响

Effects of saxagliptin combined with calcium hydroxybenzenesulfate on non-proliferative diabetic retinopathy and on retinal hemodynamics and serum AGE-P and NADPH levels in patients

目的观察沙格列汀联合羟苯磺酸钙对非增生性糖尿病视网膜病变(NPDR)的疗效及对患者视网膜血流动力学和血清糖基化终产物-肽(AGE-P)、还原型烟酰胺腺嘌呤二核苷酸磷酸(NADPH)水平的影响。方法前瞻性选取2020年7月至2022年10月亳州市人民医院收治的92例NPDR患者为研究对象,根据随机数字表法将其分为两组,每组46例。两组均给予常规治疗,对照组加用羟苯磺酸钙治疗,观察组在对照组基础上联合沙格列汀治疗。比较两组临床眼底指标,检测两组视力相关指标、AGE-P、NADPH、晚期蛋白氧化产物(AOPP)及视网膜血流动力学的差异,评估两组安全性。结果观察组出血、渗出吸收时间及水肿消失时间分别为(2.65±0.77)、(9.87±1.87)、(4.61±1.23)d,均短于对照组[(3.37±0.69)、(12.05±2.26)、(6.55±1.87)d],差异均有统计学意义(P<0.05)。观察组和对照组的视野灰度值、黄斑厚度、出血瘤体积、出血斑面、AGE-P、NADPH、AOPP均较治疗前下降,且观察组分别为(1.37±0.25)%、(312.02±14.78)μm、(12.04±2.26)mm^(2)、(1.41±0.39)μm^(3)、(14.36±3.16)mg/L、(5.87±1.03)pg/mL、(14.02±3.56)μmol/L,低于对照组[(2.23±0.41)%、(357.25±16.56)μm、(14.74±3.12)mm^(2)、(2.08±0.44)μm^(3)、(17.47±3.65)mg/L、(6.93±1.41)pg/mL、(19.36±4.71)μmol/L],差异均有统计学意义(P<0.05)。两组的视网膜中央动脉、睫状后动脉收缩期最大血流速度(PSV)、舒张末期血流速度(EDV)均治疗前升高,两组的视网膜中央动脉、睫状后动脉的血管阻力指数(RI)均较治疗前下降,差异均有统计学意义(P<0.05),但两组治疗后视网膜血流动力学比较,差异均无统计学意义(P>0.05)。观察组总不良反应率[10.87%(5/46)]与对照组[6.52%(3/46)]比较,差异无统计学意义(P>0.05)。结论沙格列汀联合羟苯磺酸钙治疗NPDR患者可促进眼底出血、渗出的吸收,明显改善视力水平,可能与减轻氧化应激损伤有关。

Objective To observe the efficacy of saxagliptin combined with calcium hydroxybenzenesulfate in the treatment of non-proliferative diabetic retinopathy(NPDR)and the effects on retinal hemodynamics,serum advanced glycosylation end products peptide(AGE-P)and nicotinamide adenine dinucleotide phosphate(NADPH)levels in patients.Methods Ninety-two patients with NPDR admitted to Bozhou People's Hospital from July 2020 to October 2022 were prospectively selected and divided into two groups according to random number table method,each group 46 cases.Both groups were given routine treatment,the control group was treated with calcium hydroxybenzoate,and the observation group was treated with saxagliptin on the basis of the control group.The clinical fundus indexes were compared between the two groups,and the differences of vision-related indexes,AGE-P,NADPH,advanced protein oxidation products(AOPP)and retinal hemodynamics were detected between the two groups,so as to evaluate the safety of the two groups.Results The time of bleeding,exudation,absorption and disappearance of edema in the observation group were(2.65±0.77),(9.87±1.87)and(4.61±1.23)d,which were shorter than those in the control group[(3.37±0.69),(12.05±2.26)and(6.55±1.87)d],respectively,the differences were statistically significant(P<0.05).The grayscale values of the visual field,macular thickness,hematoma volume,macular surface,AGE-P,NADPH,and AOPP of the observation and control groups were lower than those before treatment,and the observation groups were(1.37±0.25)%and(312.02±14.78)μm,(12.04±2.26)mm^(2),(1.41±0.39)μm^(3),(14.36±3.16)mg/L,(5.87±1.03)pg/mL,(14.02±3.56)μmol/L,respectively,which were lower than those in the control group[(2.23±0.41)%,(357.25±16.56)μm,(14.74±3.12)mm^(2),(2.08±0.44)μm^(3),(17.47±3.65)mg/L,(6.93±1.41)pg/mL,(19.36±4.71)μmol/L],the differences were statistically significant(P<0.05).The peak systolic blood flow velocity(PSV)and end diastolic blood flow velocity(EDV)of the central retinal artery and posterior ciliary artery in both groups increased before treatment.The resistance index(RI)of the central retinal artery and posterior ciliary artery in both groups decreased compared to before treatment,and the differences were statistically significant(P<0.05).However,there was no statistically significant difference in retinal hemodynamics between the two groups after treatment(P>0.05).The total adverse reaction rate in the observation group was 10.87%(5/46),compared with the control group[6.52%(3/46)],there was no statistically significant difference(P>0.05).Conclusion The treatment of NPDR with saxagliptin combined with calcium oxybenzenesulfonate can promote the absorption of fundus hemorrhage and exudation,significantly improve the visual acuity,which may be related to the alleviation of oxidative stress injury.