凉血化瘀方佐治糖尿病视网膜病变血热瘀阻证临床疗效及相关机制探讨

Clinical efficacy and related mechanism of Liangxue Huayu Formula in the treatment of diabetic retinopathy

关键词:  凉血化瘀方  糖尿病视网膜病变  临床疗效  相关机制

Key words:  Liangxue Huayu Formula  diabetic retinopathy  clinical efficacy  related mechanism

摘要:

[目的] 探讨分析凉血化瘀方佐治糖尿病视网膜病变（DR）血热瘀阻证临床疗效及相关机制。[方法] 选择2019年3月—2020年3月西安市第一医院收治的DR患者89例，随机分为观察组45例、对照组44例。对照组在常规治疗基础上给予羟苯磺酸钙胶囊口服，观察组在对照组基础上给予凉血化瘀汤治疗，两组均连续治疗3个月。比较两组患者治疗临床疗效、治疗前后视网膜血流动力学指标变化、眼部相关指标变化及氧化应激、血清炎症因子水平变化。[结果] 观察组患者治疗总有效率显著高于对照组（P<0.05）。治疗后两组患者视网膜中央动脉舒张末期流速（EDV）、收缩期峰值流速（PSV）及平均血流速度（Vm）较治疗前升高（P<0.05），治疗后两组患者视网膜中央静脉回流速度（CRV）、血流阻力指数（RI）及搏动指数（PI）较治疗前降低（P<0.05），且治疗后观察组患者EDV、PSV及Vm高于对照组（P<0.05），CRV、RI及PI低于对照组（P<0.05）。治疗后两组患者视野灰度值、黄斑厚度、出血斑面积以及血管瘤体积均较治疗前降低（P<0.05），且治疗后观察组患者视野灰度值、黄斑厚度、出血斑面积以及血管瘤体积低于对照组（P<0.05）。治疗后两组患者血清趋化素（Chemerin）、单核细胞趋化因子蛋白-1（MCP-1）以及丙二醛（MDA）均较治疗前降低（P<0.05），超氧化物歧化酶（SOD）较治疗前升高（P<0.05），且治疗后观察组患者血清Chemerin、MCP-1以及MDA低于对照组（P<0.05），血清SOD高于对照组（P<0.05）。[结论] 凉血化瘀方佐治糖尿病视网膜病变可有效提高患者临床疗效，促进患者眼部症状的改善，其机制可能与改善局部微循环，以及减轻视网膜氧化应激、炎性损伤有关，值得临床推广。

Abstract:

[Objective] To explore and analyze the clinical effect and related mechanism of Liangxue Huayu Formula in treating diabetic retinopathy(DR) with blood-heat stasis. [Methods] The 89 patients with DR in our hospital from March 2019 to March 2020 were selected and randomly divided into observation group(45 cases) and control group(44 cases) according to the random number table method. The control group was given calcium dobesilate capsules on the basis of conventional treatment, and the observation group was given Liangxue Huayu Formula on the basis of the control group. Both groups were treated for 3 months. The clinical efficacy, changes of retinal hemodynamics, eye related indexes, oxidative stress and serum inflammatory factors were compared between the two groups. [Results] The total effective rate of treatment in the observation group was significantly higher than that in the control group(P<0.05). After treatment, the EDV, PSV and Vm of the two groups were significantly higher than before treatment(P<0.05). After treatment, the CRV, RI and PI of the two groups were significantly lower than before treatment(P<0.05), and the observation group was EDV, PSV and Vm were significantly higher than the control group(P<0.05), and CRV, RI and PI were significantly lower than the control group(P<0.05). After treatment, the visual field gray value, macular thickness, bleeding spot area, and hemangioma volume of the two groups of patients were significantly lower than before treatment(P<0.05). After treatment, the visual field gray value, macular thickness, bleeding spot area, and hemangiomas of the observation group were significantly reduced. The volume of hemangioma was significantly lower than that of the control group(P<0.05). After treatment, the serum Chemerin, MCP-1 and MDA of the two groups were significantly lower than those before treatment(P<0.05), and the serum SOD was significantly higher than that before treatment(P<0.05). After treatment, the serum Chemerin, MCP-1 and MDA of the observation group were significantly lower than those of the control group(P<0.05), and the serum SOD was significantly higher than that of the control group(P<0.05). [Conclusion] The treatment of diabetic retinopathy with cooling blood and removing stasis can effectively improve the clinical curative effect and promote the improvement of ocular symptoms. The mechanism may be related to the improvement of local microcirculation and the reduction of retinal oxidative stress and inflammatory injury, which is worthy of clinical promotion.