摘要：
目的 探讨活血化瘀方联合吸入卡波金对糖尿病视网膜病变(diabetic retinopathy,DR)患者血清炎性细胞因子水平及视野缺损度的影响.方法 将符合入选标准的76例DR患者采用随机数字表法分为2组,每组38例.2组均给予常规降糖处理,对照组在此基础上加服羟苯磺酸钙片,研究组在对照组基础上加服活血化瘀方与吸入卡波金治疗.2组均治疗2个月.采用全自动生化分析仪检测FPG、2 hPG、HbAlc,采用免疫透射比浊法检测血清超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、血清胱抑素C(Serum cystatin C,Cys C)水平,采用放射免疫法检测血清同型半胱氨酸(homocysteine,Hcy),采用ELISA法测定血清TGF-β1、IL-6,采用比色法检测血清GSH-Px,采用眼底荧光血管造影检测黄斑水肿面积、微血管瘤数量及出血灶面积;在正常瞳孔下进行视野缺损状况检查,评价临床疗效.结果 研究组总有效率为84.2％(32/38)、对照组为60.5％(23/38),2组比较差异有统计学意义(χ2=5.331,P=0.021).治疗后,研究组血清FPG、HbA1c水平均低于对照组(t值分别为2.059、2.081,P值均<0.05);血清Hcy、Cys C、hs-CRP、TGF-β1、IL-6水平均低于对照组(t值分别为4.575、2.799、19.520、6.614、10.644,P<0.05或P<0.01),GSH-Px水平高于对照组(t=10.483,P<0.01).与对照组治疗后比较,研究组微血管瘤数量减少、出血灶面积缩小、视野灰度值降低、黄斑水肿面积缩小(t值分别为7.543、3.923、4.957、6.691,P值均<0.01).结论 活血化瘀方联合吸入卡波金可降低DR患者视野缺损度,减轻机体炎症反应,提高临床疗效.%Objective To investigate the effect of the promoting blood circulation to Huoxue-Huayu decoction combined with carbogen for diabetic retinopathy (DR). Methods A total of 76 DR patients who met the inclusion criteria were divided into 2 groups by random number table method, 38 cases in each group. Both groups were given the routine hypoglycemic treatment, and the control group added the treatment of calcium oxybenzosulfonate tablets, wihle the treatment group added the Huoxue-Huayu decoction. Both groups were treated for 2 months. The FPG, 2 hPG and HbAlc were detected by automatic biochemical analyzer. The serum levels of hypersensitive c-reactive protein (hs-CRP) and Serum cystatin C (Cys C) were detected by immuno-transmission turbidimetry. The serum homocysteine (Hcy) was determined by radioimmunoassay. The serum transforming growth factor β1 (TGF-β1) and il-6 were detected by the ELISA. The serum glutathione peroxidase (GSH-Px) was detected by colorimetry. The Fluorescence fundus angiography was used to detect the area of macular edema, the number of microangiomas and the area of bleeding focus. The Visual field defect was examined under normal pupils to evaluate the clinical efficacy. Results The total effective rate was 84.2％(32/38) in the treatment group and 60.5％ (23/38) in the control group, with statistically significant difference (χ2=5.331, P=0.021). After treatment, the serum levels of FPG and HbA1c in the treatment group were significantly lower than those in the control group (t values were 2.059 and 2.081, respectively, all Ps<0.05). The Serum Hcy, Cys C, hs-CRP, TGF-β1, IL-6 levels in the treatment group were significantly lower than those in the control group (t values were 4.575, 2.799, 19.520, 6.614, 10.644, P<0.05 or P<0.01), while the GSH-Px levels were significantly higher than the control group (t=10.483, P<0.01). Compared with the control group after treatment, the number of microangiomas in the treatment group decreased, the area of bleeding focus decreased, the gray scale value of the visual field decreased, and the area of macular edema decreased (t values were 7.543, 3.923, 4.957 and 6.691, all Ps<0.01). Conclusions The Huoxue-Huayu decoction combined with carbogen can reduce the degree of visual field defect , reduce the inflammatory reaction and improve the clinical effect for DR patients.
