补肾活血明目汤治疗肝肾亏虚,络脉瘀阻证非增殖型糖尿病视网膜病变50例
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摘要
目的:探讨补肾活血明目汤治疗肝肾亏虚,络脉瘀阻证非增殖型糖尿病视网膜病变(NPDR)的临床疗效及对血管内皮细胞生长因子(VEGF)和肿瘤坏死因子-α(TNF-α)影响。方法:将97例患者随机按数字表法分为对照组47例(91眼)和观察组50例(95眼)。对照组有效控制血糖,并给予缬沙坦胶囊,80 mg/次,1次/d;辛伐他汀片,40 mg/次,1次/d,晚上服用;阿司匹林肠溶片,100 mg/次,1次/d,羟苯磺酸钙胶囊,0.5 g/次,3次/d,口服。观察组在对照组治疗的基础上加用丹补肾活血明目汤,1剂/d。两组疗程均为12周。进行治疗前后视力和眼底检查及中医证候积分;检测治疗后甘油三酯(TG),总胆固醇(TC),高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C),TNF-α和VEGF水平。结果:观察组眼底病变疗效总有效率86.3%,对照组70.3%,观察组优于对照组(P<0.05);治疗后观察组视力好于对照组(P<0.01);治疗后观察组眼底检查和中医证候评分低于对照组(P<0.01);治疗后两组TG,TC和LDL-C水平较治疗前下降(P<0.01),治疗后观察组LDL-C水平低于对照组(P<0.01),观察组HDL-C升高并高于对照组(P<0.01);治疗后观察组TNF-α,VEGF水平低于对照组(P<0.01)。结论:在西医常规治疗的基础上,补肾活血明目汤能提高NPDR视力,改善症状、体征,临床疗效优于单纯西医治疗,其作用机制可能与调节脂代谢,降低TNF-α和VEGF水平有关。
Objective: To discuss the clinical efficacy of Bushen Huoxue Mingnu decoction in treating non-propagative diabetic retinopathy( NPDR) with the deficiency of liver and kidney combined collaterals stasis resistance of tradition Chinese medical( TCM) syndrome,and to investigate its influence on vascular endothelial cell growth factor( VEGF) and tumor necrosis factor-α( TNF-α). Method: Ninety-seven patients were randomly divided into the control group( 47 cases) and the observation group( 50 cases) by a random number table.Patients in the control group received 80 mg valsartan capsules once daily for controlling the blood glucose,40 mg simvastatin tablets once nightly,100 mg aspirin enteric-coated tablets once daily,and 0. 5 g calcium dobesilate capsules thrice daily. Based on the treatment of the control group,patients in the observation added 1 dose Bushen Huoxue Mingnu decoction. All patients in both two groups received 12 weeks of treatment. Before and after treatment,vision and fundus examination were made and scores of TCM syndrome were graded. Levels of triglyceride( TG),total cholestero l( TC),high density lipoprotein cholesterol( HDL-C),and low density lipoprotein cholesterol( LDL-C),TNF-α and VEGF were detected. Result: The total effective rate of fundus lesions in the observation group was 86. 3%,which was superior to that of 70. 3% in the control group( P <0. 05). After therapy,vision in the observation group was better than that in the control group( P < 0. 01). The inspection and TCM syndrome score in the observation group were lower than those in the control group( P <0. 01). Levels of TG,TC and LDL-C declined after treatment in both two groups compared before( P < 0. 01).The LDL-C level in the observation group was lower( P < 0. 01),while the HDL-C standard was higher than those in the control group( P < 0. 01). After treatment,TNF-α and VEGF levels in the observation group were lower than those in the control group( P < 0. 01). Conclusion: Based on the conventional Western treatment,Bushen Huoxue Mingmu decoction could improve vision,signs and symptoms of NPDR patients. Its clinical curative effect is superior to using Western medicine treatment alone. The mechanism may be related to regulating lipid metabolism,reducing TNF-α and VEGF levels.
Objective: To discuss the clinical efficacy of Bushen Huoxue Mingnu decoction in treating non-propagative diabetic retinopathy( NPDR) with the deficiency of liver and kidney combined collaterals stasis resistance of tradition Chinese medical( TCM) syndrome,and to investigate its influence on vascular endothelial cell growth factor( VEGF) and tumor necrosis factor-α( TNF-α). Method: Ninety-seven patients were randomly divided into the control group( 47 cases) and the observation group( 50 cases) by a random number table.Patients in the control group received 80 mg valsartan capsules once daily for controlling the blood glucose,40 mg simvastatin tablets once nightly,100 mg aspirin enteric-coated tablets once daily,and 0. 5 g calcium dobesilate capsules thrice daily. Based on the treatment of the control group,patients in the observation added 1 dose Bushen Huoxue Mingnu decoction. All patients in both two groups received 12 weeks of treatment. Before and after treatment,vision and fundus examination were made and scores of TCM syndrome were graded. Levels of triglyceride( TG),total cholestero l( TC),high density lipoprotein cholesterol( HDL-C),and low density lipoprotein cholesterol( LDL-C),TNF-α and VEGF were detected. Result: The total effective rate of fundus lesions in the observation group was 86. 3%,which was superior to that of 70. 3% in the control group( P <0. 05). After therapy,vision in the observation group was better than that in the control group( P < 0. 01). The inspection and TCM syndrome score in the observation group were lower than those in the control group( P <0. 01). Levels of TG,TC and LDL-C declined after treatment in both two groups compared before( P < 0. 01).The LDL-C level in the observation group was lower( P < 0. 01),while the HDL-C standard was higher than those in the control group( P < 0. 01). After treatment,TNF-α and VEGF levels in the observation group were lower than those in the control group( P < 0. 01). Conclusion: Based on the conventional Western treatment,Bushen Huoxue Mingmu decoction could improve vision,signs and symptoms of NPDR patients. Its clinical curative effect is superior to using Western medicine treatment alone. The mechanism may be related to regulating lipid metabolism,reducing TNF-α and VEGF levels.
引文
[1]贺光玉,甄东户.复方丹参滴丸治疗非增殖期糖尿病视网膜病变的临床观察[J].兰州大学学报:医学版,2013,39(4):76-78.
[2]孟艳娇,于秀辰.中医药治疗糖尿病视网膜病变进展[J].北京中医药大学学报:中医临床版,2011,18(2):38-40.
[3]中华中医药学会.糖尿病视网膜病变中医防治指南[J].中国中医药现代远程教育,2011,9(4):154-155.
[4]中华中医药学会糖尿病分会.糖尿病视网膜病变中医诊疗标准[J].世界中西医结合杂志,2011,6(7):632-637.
[5]卢百阳,武志峰.糖尿病视网膜病变发病机制研究进展[J].国际眼科杂志,2008,8(11):2308-2311.
[6]相萍萍,王旭.中医药治疗糖尿病视网膜病变研究进展[J].中华中医药杂志,2014,29(3):813-815.
[7]徐琳,赵魁彦,龚惠红,等.血脂异常与2型糖尿病视网膜病变的关系探讨[J].陕西医学杂志,2012,41(6):691-692.
[8]刘秀翠.血清中VEGF,TNF-α和CRP水平与2型糖尿病视网膜病变关系的临床研究[J].基层医学论坛,2010,14(19):588-590.
[9]耿晓仲.糖尿病肾病患者血清VEGF和TNF-α水平表达的临床意义[J].重庆医学,2010,39(21):2942-2943.
[2]孟艳娇,于秀辰.中医药治疗糖尿病视网膜病变进展[J].北京中医药大学学报:中医临床版,2011,18(2):38-40.
[3]中华中医药学会.糖尿病视网膜病变中医防治指南[J].中国中医药现代远程教育,2011,9(4):154-155.
[4]中华中医药学会糖尿病分会.糖尿病视网膜病变中医诊疗标准[J].世界中西医结合杂志,2011,6(7):632-637.
[5]卢百阳,武志峰.糖尿病视网膜病变发病机制研究进展[J].国际眼科杂志,2008,8(11):2308-2311.
[6]相萍萍,王旭.中医药治疗糖尿病视网膜病变研究进展[J].中华中医药杂志,2014,29(3):813-815.
[7]徐琳,赵魁彦,龚惠红,等.血脂异常与2型糖尿病视网膜病变的关系探讨[J].陕西医学杂志,2012,41(6):691-692.
[8]刘秀翠.血清中VEGF,TNF-α和CRP水平与2型糖尿病视网膜病变关系的临床研究[J].基层医学论坛,2010,14(19):588-590.
[9]耿晓仲.糖尿病肾病患者血清VEGF和TNF-α水平表达的临床意义[J].重庆医学,2010,39(21):2942-2943.