激光光凝联合羟苯磺酸钙及血栓通对糖尿病视网膜病变微循环及炎性因子的影响
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摘要
目的:探讨激光光凝联合羟苯磺酸钙及血栓通对糖尿病视网膜病变微循环及炎性因子的影响。方法:选取DR患者86例,按照数字列表法随机分为对照组和联合组,每组43例。对照组给予激光光凝治疗,联合组在激光光凝治疗基础上加用羟苯磺酸钙及血栓通治疗。观察两组治疗前后血管瘤、黄斑、出血斑、视力、视野灰度值、视网膜中央动脉及睫状后短动脉的峰值血流速度(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)及空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、血钙、血浆黏度、红细胞聚集指数、红细胞变形指数、血小板聚集率、低氧诱导因子-1(HIF-1)、血管内皮生长因子(VEGF)、白细胞介素1β(IL-1β)、基质金属蛋白酶9(MMP-9)等指标。比较两组临床疗效。结果:①联合组治疗总有效率(95.35%)明显高于对照组(72.09%)(P<0. 05)。②两组治疗后FBG、P2hBG、HbA1c较治疗前均有下降(P<0.05),但两组差异无统计学意义(P>0.05)。③与治疗前比较,两组治疗后血管瘤、黄斑、出血斑、视力、视野灰度值、血浆黏度、红细胞聚集指数、红细胞变形指数、血小板聚集率、视网膜中央动脉及睫状后短动脉PSV、EDV、RI及HIF-1α、VEGF、IL-1β、MMP-9水平均有改善(P<0.05),但联合组改善情况显著优于对照组(P<0.05)。结论:与激光单用相比,激光联合羟苯磺酸钙及血栓通治疗DR的疗效显著,可显著改善患者的微循环和炎性反应状态,临床应用价值较高。
Objective: To study the effects of laser photocoagulation combined with calcium dobesilate and Xueshuantong on microcirculation and inflammatory factors in patients with diabetic retinopathy(DR). Methods: 86 patients with DR in our hospital were selected as research objects.According to the number table, the patients were divided randomly into control group and combination group, 43 cases in each group. On the basis of conventional treatment for diabetes mellitus,the control group was treated with laser photocoagulation,the combination group was treated with laser photocoagulation combined with calcium dobesilate and Xueshuantong. Hemangioma, macular, blood spots, visual acuity,visual field gray value, peak flow velocity(PSV), end-diastolic velocity(EDV), resistance index(RI) of central retinal artery and posterior ciliary artery, and fasting plasma glucose(FPG), 2 h postprandial blood glucose(2 h PG), glycosylated hemoglobin(HbA1 c), blood calcium, blood plasma viscosity, erythrocyte aggregation index, erythrocyte deformation index, platelet aggregation rate, hypoxic induction factor-1(HIF-1) and vascular endothelial growth factor(VEGF), interleukin 1β(IL-1β), matrix metalloproteinase 9(MMP-9) before and after treatment were supervised in the two groups. Clinical efficacy was compared between the two groups. Results: ①The total effective rate 95.35%) of the combination group was significantly higher than that of the control group72.09%)(P<0.05). ②Compared with those before teeatment, FBG, P2 hBG and HbA1 c decreased after treatment in the two groups,(P<0.05), but the difference between the two groups was not statistically significant(P>0.05). ③Compared with those before teeatment, Hemangioma, macular, blood spots, visual acuity,visual field gray value, PSV, EDV, RI of central retinal artery and posterior ciliary artery, blood plasma viscosity, erythrocyte aggregation index, erythrocyte deformation index, platelet aggregation rate, HIF-1, VEGF, IL-1β, MMP-9 improved after treatment in the two groups(P<0.05), and the improvements of combination group were significantly better than those of control group(P<0.05).Conclusion: Compared with laser photocoagulation alone, laser photocoagulation combined with calcium dobesilate and Xueshuantong has better clinical curative effect on DR, It can significantly improve the microcirculation and inflammatory reaction of patients, and has high clinical value.
Objective: To study the effects of laser photocoagulation combined with calcium dobesilate and Xueshuantong on microcirculation and inflammatory factors in patients with diabetic retinopathy(DR). Methods: 86 patients with DR in our hospital were selected as research objects.According to the number table, the patients were divided randomly into control group and combination group, 43 cases in each group. On the basis of conventional treatment for diabetes mellitus,the control group was treated with laser photocoagulation,the combination group was treated with laser photocoagulation combined with calcium dobesilate and Xueshuantong. Hemangioma, macular, blood spots, visual acuity,visual field gray value, peak flow velocity(PSV), end-diastolic velocity(EDV), resistance index(RI) of central retinal artery and posterior ciliary artery, and fasting plasma glucose(FPG), 2 h postprandial blood glucose(2 h PG), glycosylated hemoglobin(HbA1 c), blood calcium, blood plasma viscosity, erythrocyte aggregation index, erythrocyte deformation index, platelet aggregation rate, hypoxic induction factor-1(HIF-1) and vascular endothelial growth factor(VEGF), interleukin 1β(IL-1β), matrix metalloproteinase 9(MMP-9) before and after treatment were supervised in the two groups. Clinical efficacy was compared between the two groups. Results: ①The total effective rate 95.35%) of the combination group was significantly higher than that of the control group72.09%)(P<0.05). ②Compared with those before teeatment, FBG, P2 hBG and HbA1 c decreased after treatment in the two groups,(P<0.05), but the difference between the two groups was not statistically significant(P>0.05). ③Compared with those before teeatment, Hemangioma, macular, blood spots, visual acuity,visual field gray value, PSV, EDV, RI of central retinal artery and posterior ciliary artery, blood plasma viscosity, erythrocyte aggregation index, erythrocyte deformation index, platelet aggregation rate, HIF-1, VEGF, IL-1β, MMP-9 improved after treatment in the two groups(P<0.05), and the improvements of combination group were significantly better than those of control group(P<0.05).Conclusion: Compared with laser photocoagulation alone, laser photocoagulation combined with calcium dobesilate and Xueshuantong has better clinical curative effect on DR, It can significantly improve the microcirculation and inflammatory reaction of patients, and has high clinical value.
引文
[1] 刘双林.重度非增殖期糖尿病视网膜病变的不同光凝方案的临床分析[J].医学临床研究,2013,30(10):2049-2050.
[2] 陈晓乐,韩金涛,陈晓鹏,等.复方血栓通胶囊联合卡波金对糖尿病视网膜病变患者血清炎症因子及视野缺损的影响[J].现代中西医结合杂志,2017,26(3):241-244.
[3] 李凤鸣.中华眼科学[M].北京:人民卫生出版社,2005:2169.
[4] GASPERINI G,de SIQUEIRA IC,COSTA LR.Lower-level laser therapy improves neurosensory disorders resulting from bilateral mandibular sagittal split osteotomy:a randomized crossover clinical trial[J].J Craniomaxillofac Surg,2014,42(5):e130-133.
[5] BURSELL SE,CLERMONT AC,KINSLEY BT,et al.Retinal blood flow changes in patients with insulin-dependent5 diabetes mellitus and no diabetic retinopathy[J].Invest Ophthalmol Vis Sci,1996,37(5):886-897.
[6] PERRONE L,DEVI TS,HOSOYA K,et al.Thioredoxin interacting protei TXNIP) induces inflammation through chromatin modification in retinal capillary endothelial cells under diabetic conditions[J].J Cell Physiol,2009,221(1):262-272.
[7] 李红,曹虹,王雨生.激光治疗糖尿病视网膜病变的研究进展[J].眼科新进展,2010,30(5):489-492.
[8] 赵颖.羟苯磺酸钙联合激光治疗对糖尿病视网膜病变患者血管内皮生长因子和胰岛素样生长因子-1 的影响[J].中国基层医药,2014,21(20):3131-3133.
[9] SZABO ME,HAINES D,GARAY E,et al.Antioxidant properties of calcium dobesilate in ischemic/ reperfused diabetic rat retina[J].Eur J Pharmacol,2001,428(2):277-286.
[10] 邵红,马彦,韩艳,等.sCD163 与2型糖尿病背景性视网膜病变的关系[J].中国老年学杂志,2013,33(8):1800-1801.
[11] 杜军辉,孙宏志,成静.复方血栓通治疗糖尿病视网膜病变研究进展[J].中华临床医师杂志电子版),2012,62(2):7373-7375.
[12] ADAMIS AP.Is diabetic retinopathy an inflammatory disease?[J].Br J Ophthalmol,2002,86(4):363-365.
[13] MATSUDA S,TAM T,SINGH R,et al.The impact of metabolic parameters on clinical response to VEGF inhibitors for diabetic macular edema[J].J Diabetes Complicat,2015,28(2):166-170.
[14] FOGLI S,MOGAVERO S,EGAN GE,et al.Pathophysiology and pharmacological targets of VEGF in diabetic macular edema[J].Pharmacol Res,2016,103(5):149-157.
[15] 吴鹏程,张文芳,张书.VEGF 和 MMP-9 在大鼠视网膜缺血再灌注损伤中表达及相关性研究[J].国际眼科杂志,2014,14(5):815-818.
[2] 陈晓乐,韩金涛,陈晓鹏,等.复方血栓通胶囊联合卡波金对糖尿病视网膜病变患者血清炎症因子及视野缺损的影响[J].现代中西医结合杂志,2017,26(3):241-244.
[3] 李凤鸣.中华眼科学[M].北京:人民卫生出版社,2005:2169.
[4] GASPERINI G,de SIQUEIRA IC,COSTA LR.Lower-level laser therapy improves neurosensory disorders resulting from bilateral mandibular sagittal split osteotomy:a randomized crossover clinical trial[J].J Craniomaxillofac Surg,2014,42(5):e130-133.
[5] BURSELL SE,CLERMONT AC,KINSLEY BT,et al.Retinal blood flow changes in patients with insulin-dependent5 diabetes mellitus and no diabetic retinopathy[J].Invest Ophthalmol Vis Sci,1996,37(5):886-897.
[6] PERRONE L,DEVI TS,HOSOYA K,et al.Thioredoxin interacting protei TXNIP) induces inflammation through chromatin modification in retinal capillary endothelial cells under diabetic conditions[J].J Cell Physiol,2009,221(1):262-272.
[7] 李红,曹虹,王雨生.激光治疗糖尿病视网膜病变的研究进展[J].眼科新进展,2010,30(5):489-492.
[8] 赵颖.羟苯磺酸钙联合激光治疗对糖尿病视网膜病变患者血管内皮生长因子和胰岛素样生长因子-1 的影响[J].中国基层医药,2014,21(20):3131-3133.
[9] SZABO ME,HAINES D,GARAY E,et al.Antioxidant properties of calcium dobesilate in ischemic/ reperfused diabetic rat retina[J].Eur J Pharmacol,2001,428(2):277-286.
[10] 邵红,马彦,韩艳,等.sCD163 与2型糖尿病背景性视网膜病变的关系[J].中国老年学杂志,2013,33(8):1800-1801.
[11] 杜军辉,孙宏志,成静.复方血栓通治疗糖尿病视网膜病变研究进展[J].中华临床医师杂志电子版),2012,62(2):7373-7375.
[12] ADAMIS AP.Is diabetic retinopathy an inflammatory disease?[J].Br J Ophthalmol,2002,86(4):363-365.
[13] MATSUDA S,TAM T,SINGH R,et al.The impact of metabolic parameters on clinical response to VEGF inhibitors for diabetic macular edema[J].J Diabetes Complicat,2015,28(2):166-170.
[14] FOGLI S,MOGAVERO S,EGAN GE,et al.Pathophysiology and pharmacological targets of VEGF in diabetic macular edema[J].Pharmacol Res,2016,103(5):149-157.
[15] 吴鹏程,张文芳,张书.VEGF 和 MMP-9 在大鼠视网膜缺血再灌注损伤中表达及相关性研究[J].国际眼科杂志,2014,14(5):815-818.