非增殖期糖尿病视网膜病变的药物临床观察

发布时间：2018-05-25 03:28

本文选题：复方血栓通 + 临床研究　；参考：《北京中医药大学》2012年硕士论文

【摘要】：1研究目的： (1)评价复方血栓通对非增殖期糖尿病视网膜病变患者的视力、眼底、网膜黄斑中心凹厚度以及中医症状的影响,探讨复方血栓通改善视力、眼底情况,减小网膜黄斑厚度的药物疗效以及缓解中医症状的功效。(2)观察复方血栓通对NPDR,患者房水中血管内皮生长因子(VEGF)的影响差异,探讨复方血栓通抑制糖尿病视网膜病变网膜新生血管的可能性。 2研究方法本研究可分为两部分,实验一是在治疗前后对所有受试者进行视力、眼底检查、眼底荧光造影以及OCT网膜黄斑厚度相关数据记录以及中医症状进行统计分析,得出结论。实验二是：将受试者分为A、B、C三组。对三组患者进行房水取样检测,评价房水中VEGF(血管内皮生长因子)含量与复方血栓通治疗作用的相关性,来探讨复方血栓通改善眼底的作用以及抑制糖尿病视网膜病变网膜新生血管的可能性。 3研究结果 (1)第一部分：结果显示：1)复方血栓通对提高早期糖尿病视网膜病变患者的视力、眼底微血管瘤的数目减少、眼底出血的吸收增多、黄斑区荧光渗漏的逐渐减轻、网膜黄斑水肿的改善等临床症状及缓解中医症状体征有一定作用。2)同时,对于中医症状如视物模糊、目睛干涩、体虚自汗和便秘等,复方血栓通能较有效地改善减轻症状。 (2)第二部分：糖尿病视网膜病变患者房水中VEGF含量检测的相关数据分析。实验二中,(对照组)B组房水中VEGF含量大于治疗组(A组)和NDR组(C组)(P0.05)。治疗组(A组)平均VEGF含量大于NDR组(C组)(P0.05)。在糖网二期患者中,治疗组(α1)房水中VEGF含量小于对照组(α2)(P0.05)；在糖网三期患者中,治疗组(β1)房水中VEGF含量小于对照组(β2)(P0.05)；α、β两组房水中平均VEGF含量均大于NDR组(P0.05)。在所有参与实验者中,VEGF与年龄、性别无关。 4结论 4.1在第二部分试验中,AB两组,A组患者房水中VEGF降低,B组患者房水VEGF升高,VEGF升高与视网膜新生血管的形成有关,它在非增殖性糖尿病视网膜病变中起着重要作用,并且最终会发展成增殖性糖尿病视网膜病变。因此,复方血栓通在抑制VEGF等方面可能具有一定的作用,通过减少VEGF的表达,降低发生新生血管的可能性,大大减少了发生玻血、网脱的危险,有效阻止了糖尿病视网膜病变从非增殖期向增殖期发展的步伐。 4.2在α组中,α1组(DR二期治疗组)的视力、眼底、黄斑中心凹厚度以及中医症状评分与α2组(对照组)比较,均有所提高和好转；在β组中,β1组(治疗组)的视力、眼底、黄斑中心凹厚度以及中医症状评分与β2组(对照组)比较,均有所提高和好转。 4.3在所有患者中,房水中VEGF的含量与年龄、性别无关。研究提示： (1)复方血栓通对提高非增殖期糖尿病视网膜病变患者的视力,眼底(改善眼底微血管瘤、出血、黄斑区荧光渗漏)、网膜黄斑水肿及中医症状体征有一定作用。临床中,可以考虑作为治疗非增殖期糖尿病视网膜病变的一种用药选择。 (2)通过进行糖尿病视网膜病变患者房水中VEGF含量检测的相关数据分析,得出结论：复方血栓通能有效减少房水中VEGF含量,的确可以有效抑制糖尿病视网膜病变网膜新生血管,降低了糖网发展到增殖期网膜机化条索牵拉、发生网脱的风险。但是,本研究中非增殖期糖尿病视网膜病变与体质、病程、合并内科其他疾病等因素的关系并不确定,而且还存在问题如因患者个人意愿,无法重复按阶段取房水检测VEGF含量,所有这些不确定因素还有待于进一步研究。
[Abstract]:1 Study Purpose :

( 1 ) To evaluate the effects of compound thrombus on the visual acuity , fundus , macular hole thickness and the symptoms of TCM in non - proliferative diabetic retinopathy .

2 Study Methods

This study can be divided into two parts . One is to study the visual acuity , fundus examination , fundus fluorescein angiography and the correlation data record of OCT and macular thickness in all subjects before and after treatment . The results are as follows : The subjects are divided into three groups A , B and C .

3 Study Results

( 1 ) The first part : ( 1 ) The results showed that : 1 ) Compound Xuetong can improve the visual acuity of patients with early diabetic retinopathy , decrease the number of fundus microhemangioma , increase the absorption of fundus hemorrhage , decrease the fluorescence leak in macular region , improve the macular edema , and alleviate symptoms and signs of Chinese medicine .

( 2 ) In the second part , the data of VEGF in the patients with diabetic retinopathy were analyzed . The VEGF in the control group ( group A ) was higher than that in the control group ( group A ) and the group C ( P0.05 ) .
In the third phase of sugar net , the content of VEGF in the water of the treatment group ( 尾1 ) was smaller than that in the control group ( P0.05 ) .
The levels of VEGF in both groups were higher than those in the group ( P0.05 ) . VEGF was not related to age and sex in all subjects involved in the experiment .

4 Conclusion

4.1 In the second part of the experiment , the VEGF of the patients in group A and group A is decreased , the VEGF in B group is related to the formation of retinal neovascularization , it plays an important role in the development of non - proliferative diabetic retinopathy . Therefore , compound thrombus can play an important role in inhibiting VEGF and so on .

4.2 In group 伪 , the visual acuity , fundus , macular hole thickness and the score of TCM symptoms were improved and improved compared with group 伪 2 ( control group ) .
In the 尾 - group , the visual acuity , fundus , macular hole thickness and symptom scores of 尾 - 1 group ( treatment group ) were improved and improved compared with that of 尾2 - group ( control group ) .

4.3 In all patients , the level of VEGF in the aqueous humor was not related to age , sex . Study tips :

( 1 ) Fufang Xuetong has a certain effect on improving vision , fundus ( improving fundus microangioma , hemorrhage , macular region fluorescence leak ) , retinal macular edema and symptoms and signs in non - proliferative diabetic retinopathy , and can be considered as a drug choice for treating diabetic retinopathy in non - proliferative phase .

( 2 ) By analyzing the correlation data of VEGF in the patients with diabetic retinopathy , it is concluded that the compound thrombus can effectively reduce the VEGF content in the patients with diabetic retinopathy , reduce the risk of net loss in the development of diabetic retinopathy .
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R774.1

【参考文献】