叶酸片联合胰岛素强化治疗在糖尿病视网膜病变患者中的临床应用

Clinical application of folic acid tablets combined with insulin intensive treatment in patients with diabetes retinopathy

目的分析在糖尿病视网膜病变患者中应用叶酸片联合胰岛素强化治疗的效果。方法60例糖尿病视网膜病变患者作为研究对象,按照入院时间先后顺序分为对照组、试验组,每组30例。对照组用胰岛素强化治疗,试验组在对照组基础上增加叶酸片治疗。对比两组视野检测指标[丢失方差(LV)、平均缺陷(MD)、刺激丢失方差(sLV)],患眼动脉血流速度[收缩期峰值速度(PSV)、舒张末期速度(EDV)],血清指标[C反应蛋白、胰岛素样生长因子-1(IGF-1)、血管内皮生长因子(VEGF)],空腹血糖及血清超氧化物歧化酶(SOD)、丙二醛(MDA)水平,治疗效果,视网膜黄斑厚度、脉络膜厚度。结果治疗后,试验组MD(3.21±1.02)dB、LV(14.05±1.62)dB、sLV(3.09±0.99)dB低于对照组的(4.35±1.22)、(20.14±2.95)、(5.15±1.33)dB(P<0.05)。治疗后,试验组PSV(39.15±7.66)cm/s、EDV(10.24±2.51)cm/s高于对照组的(34.51±8.71)、(7.26±1.21)cm/s(P<0.05)。治疗后,试验组C反应蛋白(4.21±1.08)mg/L、IGF-1(90.24±23.51)ng/L、VEGF(82.15±13.51)pg/L低于对照组的(7.62±3.04)mg/L、(136.57±36.54)ng/L、(113.51±27.92)pg/L(P<0.05)。治疗后,试验组空腹血糖(6.22±0.85)mmol/L及血清MDA(3.62±0.51)nmol/ml低于对照组的(7.88±4.25)mmol/L、(5.85±0.27)nmol/ml,而血清SOD(118.61±4.30)U/ml高于对照组的(88.24±4.34)U/ml(P<0.05)。试验组治疗总有效率100.0%高于对照组的83.3%(P<0.05)。试验组视网膜黄斑厚度(331.22±13.51)μm、脉络膜厚度(244.75±25.66)μm均小于对照组的(348.51±15.01)、(370.88±36.50)μm(P<0.05)。结论在糖尿病视网膜病变患者的治疗中采用叶酸片联合胰岛素强化治疗,效果显著,可以在改善患眼动脉血流速度的同时改变血清指标,降低空腹血糖、视网膜黄斑厚度、脉络膜厚度,值得推荐。

Objective To analyze the effect of folic acid tablets combined with insulin intensive treatment in patients with diabetes retinopathy.Methods A total of 60 patients with diabetes retinopathy were selected as research subjects,and were divided into a control group and an experimental group according to the order of admission time,with 30 patients in each group.The control group received insulin intensive treatment,and the experimental group received folic acid tablets combined with insulin intensive treatment.Both groups were compared in terms of visual field detection index[loss variance(LV),mean defect(MD),square root of loss variance(sLV)],arterial blood flow velocity of the affected eye[peak systolic velocity(PSV),end-diastolic velocity(EDV)],serum index[C-reactive protein,insulin-like growth factor-1(IGF-1),vascular endothelial growth factor(VEGF)],fasting blood glucose,serum superoxide dismutase(SOD),malondialdehyde(MDA)levels,therapeutic effect,retinal macular thickness,and choroid thickness.Results After treatment,the experimental group had MD of(3.21±1.02)dB,LV of(14.05±1.62)dB and sLV of(3.09±0.99)dB,which were lower than(4.35±1.22),(20.14±2.95)and(5.15±1.33)dB in the control group(P<0.05).After treatment,the experimental group had PSV of(39.15±7.66)cm/s and EDV of(10.24±2.51)cm/s,which were higher than(34.51±8.71)and(7.26±1.21)cm/s in the control group(P<0.05).After treatment,the experimental group had C-reactive protein of(4.21±1.08)mg/L,IGF-1 of(90.24±23.51)ng/L,and VEGF of(82.15±13.51)pg/L,which were lower than(7.62±3.04)mg/L,(136.57±36.54)ng/L,and(113.51±27.92)pg/L in the control group(P<0.05).After treatment,the fasting blood glucose and serum MDA were(6.22±0.85)mmol/L and(3.62±0.51)nmol/ml in the experimental group,which were lower than(7.88±4.25)mmol/L and(5.85±0.27)nmol/ml in the control group;the serum SOD of(118.61±4.30)U/ml in the experimental group was higher than(88.24±4.34)U/ml in the control group(P<0.05).The total effective rate of 100.0%in the experimental group was higher than 83.3%in the control group(P<0.05).The retinal macular thickness and choroid thickness were(331.22±13.51)and(244.75±25.66)μm in the experimental groups,which were less than(348.51±15.01)and(370.88±36.50)μm in the control group(P<0.05).Conclusion In the treatment of patients with diabetes retinopathy,intensive therapy with folic acid tablets combined with insulin has significant effects,which can improve the arterial blood flow velocity of the affected eye while changing serum indexes,lower fasting blood glucose,retinal macular thickness and choroidal thickness.It is worthy of recommendation.